Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial

Fisher, Bernard; Dignam, James J.; Wolmark, Norman; Wickerham, D. Lawrence; Fisher, Edwin R.; Mamounas, Eleftherios P.; Smith, Roy E.; Begovič, Mirsada; Dimitrov, Nikolay V.; Margolese, Richard G.; Kardinal, Carl G.; Kavanah, Maureen; Fehrenbacher, Louis; Oishi, Robert H.

doi:10.1016/s0140-6736(99)05036-9

Cited by 942 publications

(571 citation statements)

References 23 publications

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“…Age,tumour size (p9,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]50 þ mm,unknown), nodal status (negative, positive, unknown) and histologic grade (well, moderately, or poorly differentiated and unknown) were examined as potential prognostic factors. As it was assumed that the 10-year breast cancer survival from a diagnosis of DCIS was 100% (Fisher et al, 1999;Julien et al, 2000), DCIS was not included in the model. Tests of significance were based on the partial likelihood method.…”

Section: Analytic Schema/statistical Methodsmentioning

confidence: 99%

Comparison of 1- and 2-year screening intervals for women undergoing screening mammography

et al. 2005

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We compared the long-term impact of 1-and 2-year screening mammography intervals using prognostic, screening, and outcome information for women aged 50 -74 years obtained from the Screening Mammography Program of British Columbia in two time periods, prior to 1997 (policy of annual mammography) and after 1997 (biennial mammography). Survival was estimated for both periods using a prognostic model and the expected rate of interval and screen-detected cancers. The likelihood of a screen-detected cancer with annual screening was 2.32 per thousand screens and with biennial screening was 3.32 per thousand screens. The prognostic profile of screen-detected cancers was better than that of interval cancers. Among both screen-detected and interval cancers, the prognostic profiles with annual and biennial screening were similar. The estimated breast cancer-specific survival rates for women undergoing annual and biennial screening mammography were 95.2 and 94.6% at 5 years, and 90.4 and 89.2% at 10 years, respectively. Annual compared to biennial mammography was associated with a 1.2% increase in the estimated 10-year breast cancer-specific survival for women aged 50 -74 years, diagnosed with invasive breast cancer after screening programme attendance.

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Section: Analytic Schema/statistical Methodsmentioning

confidence: 99%

Comparison of 1- and 2-year screening intervals for women undergoing screening mammography

et al. 2005

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“…The ubiquitous use of tamoxifen for the treatment of node negative women [135] during the 1990's, the use of tamoxifen plus radiotherapy following lumpectomy for the treatment of ductal carcinoma in situ (DCIS) [136] as well as the option to use tamoxifen for chemoprevention in high risk pre and postmenopausal women [137] enhanced awareness of the menopausal side effects experienced by women when taking tamoxifen. Up to 45% of women with hot flashes grade them as severe [137] therefore there have been efforts to improve quality of life.…”

Section: Tamoxifen Metabolism Todaymentioning

confidence: 99%

New insights into the metabolism of tamoxifen and its role in the treatment and prevention of breast cancer

2007

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The metabolism of tamoxifen is being redefined in the light of several important pharmacological observations. Recent studies have identified 4-hydroxy N-desmethyl tamoxifen (endoxifen) as an important metabolite of tamoxifen necessary for antitumor actions. The metabolite is formed through the enzymatic product of CYP2D6 which also interacts with specific selective serotonin reuptake inhibitors (SSRIs) used to prevent the hot flashes observed in up to 45% of patients taking tamoxifen. Additionally, the finding that enzyme variants of CYP2D6 do not promote the metabolism of tamoxifen to endoxifen means that significant numbers of women might not receive optimal benefit from tamoxifen treatment. Clearly these are particularly important issues not only for breast cancer treatment but also for selecting premenopausal women, at high risk for breast cancer, as candidates for chemoprevention using tamoxifen.

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“…In the NSABP B-24 trial, a randomized trial of breast conservation therapy with or without tamoxifen for patients with DCIS, 54 of the 150 patients with a local recurrence (36%) underwent a second lumpectomy rather than a mastectomy as their definitive treatment. 28 Women were significantly more likely to undergo a second lumpectomy if they had a noninvasive recurrence. The results of this NSABP study indicate that repeat conservative surgery is offered to some women in the U.S.…”

Section: Patient Outcomes After Conservative Surgery Alone For Inbreamentioning

confidence: 99%

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

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Mastectomy is the current standard of care for in-breast local recurrence of breast carcinoma. The objective of the current study was to critically review the rationale for and the theoretic and actual risks and benefits of repeat breast-conserving surgery followed by partial breast irradiation (PBI) for in-breast local recurrence of breast carcinoma. The main outcomes of interest were local control and survival after in-breast local recurrence and side effects, complications, and cosmesis after reirradiation of the breast. The risk of local recurrence was not found to be eliminated with mastectomy; approximately 2-32% of patients treated with mastectomy develop a chest wall recurrence. The interpretation of local control rates in evaluating repeat breast-conserving surgery studies is difficult because of the lack of information regarding preoperative diagnostic mammography to rule out concurrent multicentric disease and microscopic margin status after surgery. Rates of subsequent local recurrence in these studies appeared to be between 19 -50%, similar to reported rates of in-breast local recurrence in patients with a first diagnosis of breast carcinoma who were treated with conservative surgery without irradiation. Early follow-up studies of breast reirradiation suggest that catheterbased interstitial brachytherapy and standard external beam radiation therapy can be delivered to the breast more than once without significant side effects in most patients and with acceptable cosmesis in some patients. Mastectomy may not be necessary in all patients with an in-breast local recurrence of breast carcinoma. KEYWORDS: recurrent breast carcinoma, breast surgery, radiation therapy, accelerated partial breast irradiation, three-dimensional conformal radiation therapy, brachytherapy.A t present, the standard surgical approach for the treatment of in-breast local recurrence of breast carcinoma is mastectomy. The rationale for the general consensus for this recommendation is threefold. First, a third local recurrence after repeat conservative surgery is reported in approximately 35% of patients. Second, a second lumpectomy would yield a cosmetically unacceptable outcome. Third, reirradiation of the whole breast after breast-conserving surgery is considered inappropriate because of the likelihood of serious tissue damage. Recently, novel brachytherapy devices and three-dimensional conformal radiation therapy techniques have brought accelerated partial breast irradiation (APBI) to the forefront as a potential treatment approach in women with in-breast local recurrence of 2269

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Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial

Cited by 942 publications

References 23 publications

Comparison of 1- and 2-year screening intervals for women undergoing screening mammography

Comparison of 1- and 2-year screening intervals for women undergoing screening mammography

New insights into the metabolism of tamoxifen and its role in the treatment and prevention of breast cancer

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

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