Stroke Risk and Tamoxifen Therapy for Breast Cancer

Geiger, Ann M.; Fischberg, Glenn M; Chen, Wansu; Bernstein, Leslie

doi:10.1093/jnci/djh285

Cited by 49 publications

(23 citation statements)

References 28 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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“…Whether tamoxifen increases the incidence of stroke is still debatable. The possibility was raised by data from P-1 and NASB-24 trials, but retrospective data on 11,045 women in another study did not support those findings (51). A meta-analysis of controlled trials published since 1980 has shown that, at a median followup of 4.9 years, the risk of stroke was 0.71% with tamoxifen and 0.39% in controls (52).…”

Section: Tamoxifenmentioning

confidence: 98%

Thromboembolism in Cancer Patients: Pathogenesis and Treatment

Adess¹,

Eisner²,

Nand³

et al. 2006

Clin Appl Thromb Hemost

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In this review we summarize the causes of cancer related thrombosis as well as modern treatment approaches. Malignancy as a risk factor for thromboembolism is becoming increasingly recognized by clinicians caring for these patients. The probability of thrombosis occurring in an individual patient is dependent on several factors, including accompanying medical problems, the type of cancer, the clinical stage, performance status, and the treatment modalities employed. Thrombophilia with a history of thromboembolism is important as well. The overall risk of thrombosis is sevenfold that of noncancer patients. Though much has been learned about the pathogenesis of cancer-related thrombosis, we are in fact just beginning to understand the cross-talk between cancer cells and their related microenvironment, and such investigations are likely to increase our knowledge of cancer-related thrombosis mechanisms. Research in these areas may also suggest new strategies for cancer prevention, metastasis suppression, and new treatments. Drugs used in cancer therapy are increasingly recognized to directly contribute to the thrombotic tendency. Few studies provide data on the optimal management of cancer patients with thrombosis. It has been learned that retreating with the same drug can be very hazardous. In general the approach to prevention of thrombosis is the same as for noncancer patients, recognizing that specific cancer types and stage can place a patient in a high-risk category. Initial coumadin therapy fails in a significant number of patients with cancer. Recognition of the cancer patients at highest risk for coumadin failure is challenging. Low-molecular-weight heparins appear to be more effective in such situations where coumadin is likely to fail or has failed, but these drugs are thought to be costlier. Newer agents such as Factor Xa inhibitors and TF inhibitors are currently under investigation and may be found useful in the management of cancer-related thrombosis.

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“…The data are controversial as to whether tamoxifen treatment can increase the risk of stroke (107) or implies a small risk (108), or whether the only risk factor is chemotherapy (109) and not the use of tamoxifen.…”

Section: Miscellaneousmentioning

confidence: 99%