Scottish Adjuvant Tamoxifen Trial: a Randomized Study Updated to 15 Years

Stewart, Helen; Prescott, R. J.; Forrest, A. P. M.

doi:10.1093/jnci/93.6.456

Cited by 171 publications

(100 citation statements)

References 4 publications

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“…A drawback of this study was the relatively short period of tamoxifen treatment of the patients during 1 or 3 years, according to the original setting up of the trial. Recent studies suggest that tamoxifen should be given for longer periods (probably 5 years or more) (Early Breast Cancer Trialist's Collaborative Group, 1998;Fischer et al, 2001;Steward et al, 2001). In our marker study about 50% of the patients received tamoxifen for only 1 year and 74 patients did not receive tamoxifen treatment at all.…”

Section: Discussionmentioning

confidence: 99%

Cyclin A is a prognostic indicator in early stage breast cancer with and without tamoxifen treatment

et al. 2002

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Overexpression of G1-S regulators cyclin D1 or cyclin A is frequently observed in breast cancer and is also to result in ligandindependent activation of oestrogen receptor in vitro. This might therefore, provide a mechanism for failure of tamoxifen treatment. We examined by immunohistochemical staining the effect of deregulation of these, and other cell cycle regulators on tamoxifen treatment in a group of 394 patients with early stage breast cancer. In univariate analysis, expression of cyclin A, Neu, Ki-67 index, and lack of OR expression were significantly associated with worse prognosis. When adjusted by the clinical model (for lymph node status, age, performance status, T-classification, grade, prior surgery, oestrogen receptor status and tamoxifen use), only overexpression of cyclin A and Neu were significantly associated with worse prognosis with hazard ratios of, respectively, 1.709 (P=0.0195) and 1.884 (P=0.0151). Overexpression of cyclin A was found in 86 out of the 201 ORpositive cases treated with tamoxifen, and was the only independent marker associated with worse prognosis (hazard ratio 2.024, P=0.0462). In conclusion, cyclin A is an independent predictor of recurrence of early stage breast cancer and is as such a marker for response in patients treated with tamoxifen.

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Section: Discussionmentioning

confidence: 99%

Cyclin A is a prognostic indicator in early stage breast cancer with and without tamoxifen treatment

et al. 2002

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“…In the present study, the patients received an adjuvant therapy with oral 5-FU and TAM. TAM is the gold standard for adjuvant endocrine therapy after breast cancer surgery (Early Breast Cancer Trialists' Collaborative Group, 1998;Stewart et al, 2001). However, oral 5-FU as adjuvant therapy is not popular in the USA and Europe.…”

Section: Discussionmentioning

confidence: 99%

Ten-year follow-up results of a randomised controlled study comparing level-I vs level-III axillary lymph node dissection for primary breast cancer

et al. 2006

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The most appropriate level of axillary dissection for breast cancer remains unclear. The present randomised study compared the treatment results of level-I vs level-III dissection in T1/2/3 and N0/1a/1b (1987 UICC classification) breast cancer without distant metastasis. Between 1995 and 1997, 522 patients were enrolled, and 514 were eligible. They were stratified into breast-conserving surgery or mastectomy, and then further stratified into level-III dissection (group-A, n ¼ 258) or level-I dissection (group-B, n ¼ 256). All patients were given oral 5-fluorouracil at 200 mg day À1 and tamoxifen at 20 mg day À1 , daily for 2years. Group-A resulted in a significantly longer operation time (77.0 vs 60.5 min, Po0.0001) and significantly larger blood loss (62.1 vs 48.1 ml, Po0.0001) than group-B, but in no significant differences in the frequencies of arm oedema and shoulder disturbance. Group-A resulted in a significantly larger number of dissected nodes than group-B (18.7 vs 14.8, Po0.0001), but in no differences in the number of involved nodes (1.54 vs 1.44). There were no significant differences in the 10-year overall and disease-free survival rates: 89.6 and 76.6% for group-A vs 87.8 and 74.1% for group-B, respectively. In conclusion, level-III dissection resulted in a longer operation time and greater blood loss than level-I, but did not improve the survival rate. Level-III dissection is not a recommended surgery for T1 -3/N0 -1b breast cancer.

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“…5 Furthermore, a recent clinical trial found that the beneficial effect of 5 years of adjuvant tamoxifen persisted after 15 years of follow-up in postmenopausal women. 23 This is important because the oldest old are living longer than ever before. 24 The average life expectancy of healthy American women is 9.6 years for 85 year olds, 6.8 years for 90 year olds, and 4.8 years for 95 year olds.…”

Section: Discussionmentioning

confidence: 99%

Advanced age and adjuvant tamoxifen prescription in early‐stage breast carcinoma patients

Blackman

Lash

Fink

et al. 2002

Cancer

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BACKGROUNDAdjuvant tamoxifen is recommended for all women with estrogen receptor‐positive breast carcinoma without regard for age. We investigated age‐dependent variations in adjuvant tamoxifen prescription patterns in a cohort of women 80 years of age and older.METHODSWe studied 92 women diagnosed at four U.S. sites with primary, early‐stage breast carcinoma. Each woman consented to a medical record review and participated in two telephone interviews. We compared the proportion of tamoxifen prescriptions received by women 85–92 years of age with those received by women 80–84 years of age. Relative risks (RR) and 95% confidence intervals (95% CI) were generated using generalized estimating equations. Confounding by demographic, disease, and treatment characteristics was assessed.RESULTSBefore adjustment, patients 85–92 years of age were 28% less likely to receive a tamoxifen prescription compared with patients 80–84 years of age (RR = 0.72, 95% CI 0.57–0.91). In this sample, patients not prescribed tamoxifen had substantially more comorbidity. After adjusting the crude finding for comorbidity, the RR was 0.74 (95% CI 0.58–0.93). In addition, the oldest patients and those not prescribed tamoxifen were significantly less likely to be married or have living children. After adjusting the crude finding for these two factors, the RR was 0.75 (95% CI 0.59–0.95). There was no confounding by the other demographic, disease, or treatment covariates assessed.CONCLUSIONGiven the increasing longevity of the oldest old, undertreatment with adjuvant tamoxifen may put older breast carcinoma patients at an increased risk of disease recurrence and breast carcinoma mortality. Cancer 2002;95:2465–72. © 2002 American Cancer Society.DOI 10.1002/cncr.10985

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Scottish Adjuvant Tamoxifen Trial: a Randomized Study Updated to 15 Years

Abstract: Information from this study suggests that, if adjuvant tamoxifen is given to women with operable breast cancer, it need not be for more than 5 years.

Cited by 171 publications

References 4 publications

Cyclin A is a prognostic indicator in early stage breast cancer with and without tamoxifen treatment

Cyclin A is a prognostic indicator in early stage breast cancer with and without tamoxifen treatment

Ten-year follow-up results of a randomised controlled study comparing level-I vs level-III axillary lymph node dissection for primary breast cancer

Advanced age and adjuvant tamoxifen prescription in early‐stage breast carcinoma patients

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