Second cancers after adjuvant tamoxifen therapy for breast cancer in Japan

Matsuyama, Yutaka; Tominaga, Takeshi; Nomura, Yasuo; Koyama, Hiroki; Kimura, Morihiko; Sano, Muneaki; Miura, Shigeto; Takashima, Shigemitsu; Mitsuyama, Shoshu; Ueo, Hiroaki; Ohashi, Yasuo

doi:10.1093/oxfordjournals.annonc.a010406

Cited by 59 publications

(34 citation statements)

References 19 publications

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“…An increased risk of endometrial cancer has been found in prevention and adjuvant trials of tamoxifen 29 as well as in observational studies. [30][31][32] Our data suggest that the excess of endometrial cancer is not entirely caused by tamoxifen, since the risk was already increased within 1 year of the breast cancer diagnosis, the risk was increased before 1975 when tamoxifen was rarely used, and an increased risk of breast cancer was also seen after endometrial cancer. Thus, common risk factors such as reproductive and genetic factors, obesity 33,34 and/or some unknown factors are likely to lie behind some of the excess.…”

Section: Discussionmentioning

confidence: 65%

Risk of second cancer among women with breast cancer

Mellemkjær

Friis

Olsen

et al. 2005

Intl Journal of Cancer

212

250

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A large number of women survive a diagnosis of breast cancer. Knowledge of their risk of developing a new primary cancer is important not only in relation to potential side effects of their cancer treatment, but also in relation to the possibility of shared etiology with other types of cancer. A cohort of 525,527 women with primary breast cancer was identified from 13 population-based cancer registries in Europe, Canada, Australia and Singapore, and followed for second primary cancers within the period 1943-2000. We used cancer incidence rates of first primary cancer for the calculation of standardized incidence ratios (SIRs) of second primary cancer. Risk of second primary breast cancer after various types of nonbreast cancer was also computed. For all second cancer sites combined, except contralateral breast cancer, we found a SIR of 1.25 (95% CI 5 1.24-1.26) on the basis of 31,399 observed cases after first primary breast cancer. The overall risk increased with increasing time since breast cancer diagnosis and decreased by increasing age at breast cancer diagnosis. There were significant excesses of many different cancer sites; among these the excess was larger than 150 cases for stomach (SIR 5

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Section: Discussionmentioning

confidence: 65%

Risk of second cancer among women with breast cancer

Mellemkjær

Friis

Olsen

et al. 2005

Intl Journal of Cancer

212

250

View full text Add to dashboard Cite

show abstract

“…There are some previous results that suggest an increased risk of gastric adenocarcinoma among tamoxifen-treated patients. A pooled analysis of three studies in Scandinavia found a nonsignificantly, but nearly three-fold increased risk of gastric cancer (Rutqvist et al, 1995), and correspondingly elevated risks have been found also in other studies (Andersson et al, 1991;Curtis et al, 1996;Matsuyama et al, 2000). Finally, a trend of decreased survival among patients with gastric cancer who had been treated with tamoxifen and in whom the gastric cancer was positive for oestrogen receptors was observed in a randomised trial (Harrison et al, 1989).…”

Section: Discussionmentioning

confidence: 80%

“…Breastfeeding has been associated with a reduced risk of oesophageal adenocarcinoma (Cheng et al, 2000), a finding that does suggest sex hormonal influence, but childbearing has not been found to be linked with a risk of this cancer (Lagergren and Jansson, 2005). Moreover, no association between tamoxifen and risk of oesophageal cancer has been previously observed (Andersson et al, 1991;Rutqvist et al, 1995;Curtis et al, 1996;Matsuyama et al, 2000).…”

Section: Discussionmentioning

confidence: 97%

Tamoxifen exposure and risk of oesophageal and gastric adenocarcinoma: a population-based cohort study of breast cancer patients in Sweden

et al. 2006

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In a population-based cohort study of all women aged over 50 years with breast cancer in the Swedish Cancer Register in 1961 -2003, those diagnosed before 31 December 1987 were regarded as unexposed to tamoxifen, whereas those diagnosed after that date were considered potentially exposed. Crosslinkages within the Cancer Register and the Registers of Death and Emigration enabled follow-up. Standardised incidence ratios (SIRs) of oesophageal and gastric cancer represented relative risks. Among 138 885 cohort members contributing with 1 075 724 person-years of follow-up, we found a nonsignificantly increased risk of oesophageal adenocarcinoma during the potential tamoxifen exposure period (SIR 1.60, 95% confidence interval (CI) 0.83 -3.08), but the risk estimates decreased with increasing latency interval. No association was observed during the unexposed period. No increased risk of cardia adenocarcinoma was identified in either period. The risk of non-cardia gastric adenocarcinoma was increased in the potential tamoxifen period (SIR 1.27, 1.03 -1.57), and almost doubled (SIR 1.86, 95% CI 1.10 -3.14) in the period of longest latency (10 -14 years). The corresponding overall SIR was increased in the unexposed group also, but here SIR did not increase with longer latency intervals. An increased risk of tobacco-related tumours, that is, oesophageal squamous-cell carcinoma and lung cancer, was limited to the unexposed cohort, indicating that confounding by smoking might explain the increased SIR during the unexposed period. We concluded that there might be a link between tamoxifen and risk of non-cardia gastric adenocarcinoma.

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“…In two studies (Lavey et al, 1990;Rubagotti et al, 1996), which included a total of 59 SMN cases that occurred during an average follow-up of 5 years, the relative risk associated with chemotherapy was between 2 and 3. In the other six studies (Herring et al, 1986;Murakami et al, 1987;Valagussa et al, 1987Valagussa et al, , 1994Matsuyama et al, 2000;Tanaka et al, 2001), this risk ranged from 0.5 to 1.05. Overall, there is currently no evidence that the overall SMN risk is increased by the antineoplasic drugs administered for breast cancer treatment.…”

Section: Discussionmentioning

confidence: 92%

Radiation dose, chemotherapy, hormonal treatment and risk of second cancer after breast cancer treatment

et al. 2003

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In total, 281 of the 7711 women who were initially treated for breast cancer between 1954 and 1983 at the Gustave Roussy Institute developed a second malignant neoplasm (SMN) other than second primary breast cancer and nonmelanoma skin cancer at least 1 year after breast cancer treatment. We carried out a nested case -control study to determine the overall relationship between the dose of radiotherapy received at a given anatomical site and the risk of SMN at the same site. In total, 75% of the cases of SMN were previously treated by radiotherapy, as compared to 73% of the controls. In the irradiated patients, the median local dose was higher among cases (3.1 Gy) than among controls (1.3 Gy). More than 40% of the irradiated patients received a local dose of less than 1 Gy. A purely quadratic relationship was observed between the dose of radiation received at an anatomical site and the risk of SMN at this site. According to the quadratic model, the excess risk of SMN was 0.2% (95% CI 0.05 -0.5%) when the target organ received 1 Gy. This risk did not differ significantly according to age at the time of radiotherapy (o40 vs X40 years). The risk of SMN was 6.7-fold higher for doses of 25 Gy or more than in the absence of radiotherapy. No carcinogenic effect of chemotherapy was observed and a dose -effect relationship between the length of tamoxifen treatment and SMN occurrence was found. This relationship was limited to endometrial cancers and did not modify the relationship with radiation dose. Our results suggest that high radiation doses slightly increase the risk of second malignancies after breast cancer.

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Second cancers after adjuvant tamoxifen therapy for breast cancer in Japan

Abstract: The incidence and risk of second primary cancers associated with tamoxifen therapy is low. The potential benefit of adjuvant tamoxifen therapy in breast cancer patients outweighs the risk of second primary cancers for Japanese breast cancer patients.

Cited by 59 publications

References 19 publications

Risk of second cancer among women with breast cancer

Risk of second cancer among women with breast cancer

Tamoxifen exposure and risk of oesophageal and gastric adenocarcinoma: a population-based cohort study of breast cancer patients in Sweden

Radiation dose, chemotherapy, hormonal treatment and risk of second cancer after breast cancer treatment

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