Five Versus More Than Five Years of Tamoxifen Therapy for Breast Cancer Patients With Negative Lymph Nodes and Estrogen Receptor-Positive Tumors

Fisher, Bernard; Dignam, James J.; Bryant, John; DeCillis, Arthur P.; Wickerham, D. Lawrence; Wolmark, Norman; Costantino, Joseph P.; Redmond, Carol; Fisher, Edwin R.; Bowman, D. M. J. S.; Deschênes, L; Dimitrov, Nikolay V.; Margolese, Richard G.; Robidoux, André; Shibata, Henry R.; Terz, José J.; Paterson, Alexander; Feldman, Merrill I.; Farrar, William B.; Evans, James F.; Lickley, H. Lavina A.

doi:10.1093/jnci/88.21.1529

Cited by 797 publications

(390 citation statements)

References 27 publications

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“…Among the 1,062 patients treated with conservative surgery and radiation therapy, the ten-year rate of recurrence in the ipsilateral breast was 14.7 percent without tamoxifen and only 4.3 percent with tamoxifen. 51 A similar result was seen in the Stockholm Breast Cancer Study Group among node-negative patients randomized to tamoxifen or to a placebo. 52 Among the 432 patients treated with conservative surgery and radiation therapy, the ten-year rate of recurrence in the ipsilateral breast was 12 percent without tamoxifen and only 3 percent with tamoxifen.…”

Section: Elements Of the Breast Physical Examsupporting

confidence: 59%

Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

Morrow

Strom

Bassett

et al. 2002

CA: A Cancer Journal for Clinicians

301

165

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Multidisciplinary guidelines for management of invasive breast carcinoma from the American College of Radiology, the American College of Surgeons, the College of American Pathology, and the Society of Surgical Oncology have been updated to reflect the continuing advances in the diagnosis and treatment of invasive breast cancer. The guidelines provide a framework for clinical decision‐making for patients with invasive breast carcinoma based on review of relevant literature and include information on patient selection and evaluation, technical aspects of surgical treatment, techniques of irradiation, and follow‐up care.

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Section: Elements Of the Breast Physical Examsupporting

confidence: 59%

Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

Morrow

Strom

Bassett

et al. 2002

CA: A Cancer Journal for Clinicians

301

165

View full text Add to dashboard Cite

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“…The observed nonpersistence rate of 35.2% at 3.5 years is higher than the 5-year nonpersistence rates seen in selfreported studies of persistence (31%) 13 and in clinical trials of adjuvant tamoxifen (16%-32%). [7][8][9][10][11] In addition, it is likely that persistence with tamoxifen will have declined further by the time the cohort of patients in this study has completed 5 years of treatment. It is of particular concern that 14.5% of women obtained no more than 90 days supply of tamoxifen and in total 22.1% of women discontinued tamoxifen within 1 year of commencing treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Rates of discontinuation or nonpersistence reported in clinical trials of adjuvant tamoxifen range from 16% to 32% at 5 years. [7][8][9][10][11] These are low rates for a chronic therapy but not unusual in clinical studies where patients are carefully selected, highly motivated, and closely monitored. Persistence rates for patients not participating in clinical trials are typically lower, even with treatments that are documented to reduce the risk of life-threatening events and mortality-for example, statins.…”

Section: Methodsmentioning

confidence: 99%

Early discontinuation of tamoxifen

Barron

Connolly

Bennett

et al. 2007

Cancer

261

248

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BACKGROUND.Five years of treatment provides the optimum duration of tamoxifen therapy for the prevention of breast cancer recurrence and mortality. Durations of adjuvant tamoxifen therapy less than 5 years are associated with poorer outcomes for breast cancer patients. The purpose of the study was to assess rates of tamoxifen nonpersistence (early discontinuation) in women aged 35 years or older using prescription refill data from a national prescribing database.METHODS.A cohort of 2816 women commencing tamoxifen as initial hormonal therapy was identified between January 2001 and January 2004. The cumulative tamoxifen persistence rate was calculated for these women and the relation between nonpersistence and clinical and demographic variables assessed.RESULTS.Within 1 year of commencing treatment the cumulative tamoxifen nonpersistence rate was 22.1%. This is twice the rate of treatment discontinuation observed in other studies by this time. By the end of follow‐up at 3.5 years, the cumulative nonpersistence rate had increased to 35.2%. Determinants of nonpersistence identified included age and a history of antidepressant use.CONCLUSIONS.The rate of nonpersistence with tamoxifen therapy is higher than previously reported. This study demonstrates that persistence with tamoxifen cannot be assumed and raises concerns about persistence with other oral hormonal therapies for breast cancer and oral antineoplastics in general. Oncologists need to identify those at risk of nonpersistence and develop strategies to combat this barrier to treatment success. Cancer 2007. © 2007 American Cancer Society.

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“…Systemic therapy has been shown in several studies to also decrease local tumor recurrence following breastconserving surgery [26,59,25,28]. Factors that may or may not influence local recurrence (with conflicting data) include tumor size, nodal status, hormone receptor status, BRCA1-2 status, and lobular histology.…”

Section: Presence Of An Extensive Intraductal Component Inmentioning

confidence: 99%

Radiation Therapy in Early-Stage Invasive Breast Cancer

Lin

Tripuraneni

2011

Indian J Surg Oncol

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The treatment of breast cancer involves a multi-disciplinary approach with radiation therapy playing a key role. Breast-conserving surgery has been an option for women with early-stage breast cancer for over two decades now. Multiple randomized trials now have demonstrated the efficacy of breast-conserving surgery followed by radiation therapy. With the advancements in breast imaging and the successful campaign for early detection of breast cancer, more women today are found to have early-stage small breast cancers. Patient factors (breast size, tumor location, history of prior radiation therapy, preexisting conditions such as collagen vascular disease, age, having prosthetically augmented breasts), pathological factors (margin status, tumor size, presence of extensive intraductal component requiring multiple surgical excisions), as well as patient preference are all taken into consideration prior to surgical management of breast cancer. Whole-breast fractionated radiation therapy between 5 and 7 weeks is considered as the standard of care treatment following breast-conserving surgery. However, new radiation treatment strategies have been developed in recent years to provide alternatives to the conventional 5-7 week whole-breast radiation therapy for some patients. Accelerated partial breast radiation therapy (APBI) was introduced because the frequency of breast recurrences outside of the surgical cavity has been shown to be low. This technique allows treatments to be delivered quicker (usually 1 week, twice daily) to a limited volume. Often times, this treatment involves the use of a brachytherapy applicator to be placed into the surgical cavity following breast-conserving surgery. Accelerated hypofractionated whole-breast irradiation may be another faster way to deliver radiation therapy following breast-conserving surgery. This journal article reviews the role of radiation therapy in women with early-stage breast cancer addressing patient selection in breast-conserving therapy, a review of pertinent trials in breast-conserving therapy, as well as the different treatment techniques available to women following breast-conserving surgery.Keywords Accelerated partial breast irradiation . Breast brachytherapy . Breast-conserving surgery and radiation . Hypofractionated whole-breast radiation . Breast irradiation in early-stage breast cancer

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Five Versus More Than Five Years of Tamoxifen Therapy for Breast Cancer Patients With Negative Lymph Nodes and Estrogen Receptor-Positive Tumors

Abstract: The benefit from 5 years of tamoxifen therapy persists through 10 years of follow-up. No additional advantage is obtained from continuing tamoxifen therapy for more than 5 years.

Cited by 797 publications

References 27 publications

Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

Early discontinuation of tamoxifen

Radiation Therapy in Early-Stage Invasive Breast Cancer

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