Myocardial infarction risk and tamoxifen therapy for breast cancer

Geiger, Ann M.; Chen, W; Bernstein, Leslie

doi:10.1038/sj.bjc.6602562

Cited by 27 publications

(22 citation statements)

References 21 publications

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“…However, this study compared breast cancer patients versus women with other cancers; our large cohort allowed comparison of breast cancer patients on tamoxifen with breast cancer patients not on tamoxifen. Our findings of no association have been reported previously in epidemiologic studies as well, specifically between tamoxifen and myocardial infarction or stroke (14,15), although no large population-based cohort study has yet been presented.…”

Section: Discussioncontrasting

confidence: 69%

Tamoxifen Treatment in Danish Breast Cancer Patients and 5-Year Risk of Arterial Atherosclerotic Events: A Null Association

Hernandez

Sørensen²,

Jacobsen³

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Although the effectiveness of tamoxifen in preventing the recurrence of breast cancer is well established, associations between tamoxifen and the occurrence of atherosclerotic events are not as clear. Breast cancer patients taking tamoxifen have lower serum cholesterol and other lipid levels than those not taking tamoxifen, suggesting that tamoxifen might prevent atherosclerotic events, but the existing studies are conflicting. We examined the relation between tamoxifen and incident hospitalization of angina pectoris, acute myocardial infarction, heart failure, and stroke. The study population of 16,289 women was identified from the Danish Breast Cancer Cooperative Group nationwide clinical database and includes women diagnosed with stage I or II estrogen receptor -positive breast cancer between 1990 and 2004 at ages 45 to 69. Use of a large populationbased sample with complete outcome ascertainment allowed us to calculate precise measures of risks, risk ratios, and adjusted hazard ratios comparing tamoxifen-treated patients with untreated patients. We found strong evidence for null associations for each of the four outcomes of interest during the first year and first 5 years after the start of therapy. These findings are important in risk/benefit analyses as tamoxifen therapy in postmenopausal women is being replaced with aromatase inhibitors. (Cancer Epidemiol Biomarkers Prev 2008;17(9):2509 -11)

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Section: Discussioncontrasting

confidence: 69%

Tamoxifen Treatment in Danish Breast Cancer Patients and 5-Year Risk of Arterial Atherosclerotic Events: A Null Association

Hernandez

Sørensen²,

Jacobsen³

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…A total of 1 191 371 individuals were enrolled in 39 eligible studies, including 11 randomized controlled trials, 13 cancer registry database studies, and 15 single‐ and multi‐institutional trials . Twenty‐two studies were based in Europe, 13 in North America, 1 in Australia and 3 were multinational; 16 studies recruited participants from population registers, and 23 were hospital based (Table ).…”

Section: Resultsmentioning

confidence: 99%

Long‐Term Cardiovascular Risk After Radiotherapy in Women With Breast Cancer

Cheng

Nie²,

et al. 2017

JAHA

180

136

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BackgroundRadiotherapy for breast cancer often involves some incidental exposure of the heart to ionizing radiation. The effect of this exposure on the subsequent risk of heart disease is uncertain. We performed a meta‐analysis to investigate the link between radiotherapy and long‐term cardiovascular morbidity and mortality in patients with breast cancer.Methods and ResultsWe performed a literature search using MEDLINE (January 1966 to January 2015) and EMBASE (January 1980 to January 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95%CIs for the associations of interest were included. Pooled effect estimates were obtained by using random‐effects meta‐analysis. Thirty‐nine studies involving 1 191 371 participants were identified. Patients who received left‐sided radiotherapy, as compared with those receiving right‐sided radiotherapy, experienced increased risks of developing coronary heart disease (RR 1.29, 95%CI 1.13‐1.48), cardiac death (RR 1.22, 95%CI 1.08‐1.37) and death from any cause (RR 1.05, 95%CI 1.01‐1.10). In a comparison of patients with radiotherapy and without radiotherapy, the RRs were 1.30 (95%CI 1.13‐1.49) for coronary heart disease and 1.38 (95%CI 1.18‐1.62) for cardiac mortality. Radiotherapy for breast cancer was associated with an absolute risk increase of 76.4 (95%CI 36.8‐130.5) cases of coronary heart disease and 125.5 (95%CI 98.8‐157.9) cases of cardiac death per 100 000 person‐years. The risk started to increase within the first decade for coronary heart disease and from the second decade for cardiac mortality.ConclusionsExposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent risk of coronary heart disease and cardiac mortality.

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“…Studies have shown that changing levels of low-density lipoprotein and high-density lipoprotein cholesterol are important risk factors for cardiovascular disease (26). Lipid cholesterol levels are lowered by tamoxifen (27) and although initial indications of an effect on myocardial infarction (28 -31) have not been borne out in most subsequent studies (32), indications are that lipid cholesterol levels are not affected in the same way by the different aromatase inhibitors. The effects of anastrozole, exemestane, and tamoxifen on serum lipids in postmenopausal women with breast cancer (30 patients per treatment group randomized to 3 months of adjuvant therapy) have been evaluated (33).…”

Section: Differences In Selectivity and Potency Between The Aromatasementioning

confidence: 99%

Anastrozole as an Adjuvant Endocrine Treatment for Postmenopausal Patients with Breast Cancer: Emerging Data

Buzdar

Cuzick

2006

Clinical Cancer Research

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The Arimidex,Tamoxifen, Alone or in Combination (ATAC) trial compared the efficacy and safety of anastrozole versus tamoxifen versus the combination as initial adjuvant treatment for early breast cancer in over 9,000 postmenopausal women. Analyses at 33 and 47 months median follow-up showed that anastrozole significantly prolonged disease-free survival and time to recurrence and reduced the incidence of contralateral breast cancer compared with tamoxifen. Results of the completed treatment analysis at 68 months median follow-up confirmed the earlier findings, showing that the absolute difference in disease-free survival continued to increase beyond completion of treatment. Mature safety data from the ATAC trial show that, overall, anastrozole has a favorable safety profile compared with tamoxifen. In the absence of current data on further follow-up or the outcome of trials investigating proactive sequencing of endocrine therapies, we present a model based on several trials, including ATAC.This model suggests that using an aromatase inhibitor as initial adjuvant therapy is a better option than switching to an aromatase inhibitor after z2 years of tamoxifen. The relative toxicities of the three approved third-generation aromatase inhibitors, anastrozole, letrozole, and exemestane, are discussed. These data suggest that long-term safety profiles may differ between aromatase inhibitors, although comprehensive comparative data for letrozole and exemestane versus tamoxifen are lacking.

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Myocardial infarction risk and tamoxifen therapy for breast cancer

Cited by 27 publications

References 21 publications

Tamoxifen Treatment in Danish Breast Cancer Patients and 5-Year Risk of Arterial Atherosclerotic Events: A Null Association

Tamoxifen Treatment in Danish Breast Cancer Patients and 5-Year Risk of Arterial Atherosclerotic Events: A Null Association

Long‐Term Cardiovascular Risk After Radiotherapy in Women With Breast Cancer

Anastrozole as an Adjuvant Endocrine Treatment for Postmenopausal Patients with Breast Cancer: Emerging Data

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