Annals of Oncology 11:1537-1543, 2000
© 2000 European Society for Medical Oncology
research-article |
Second cancers after adjuvant tamoxifen therapy for breast cancer in Japan
1Biostatistics/Epidemiology and Preventive Health Sciences, School of Health Sciences and Nursing, University of Tokyo
2Department of Surgery, Tokyo Metropolitan Komagome Hospital
3Department of Breast Surgery, National Kyushu Cancer Center
4Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
5Division of Surgery, Gunma Cancer Center Hospital
6Division of Surgery, Niigata Cancer Center Hospital
7Department of Breast Surgery, Aicht Cancer Center Hospital
8Department of Surgery, Shikoku Cancer Center Hospital
9Department of Surgery, Kitakyushu Municipal Medical Center
10Department of Surgery, Oita Prefectural Hospital
Correspondence to: Y. Matsuyama, PhD Department of Biostatistics Kyoto University School of Public Health Yoshida Konoe-cho, Sakyo-Ku Kyoto 606-8501 Japan E-mail: matuyama{at}pbh.med.kyoto-u.ac.jp
Background: Women treated with tamoxifen for breast cancer are at increased risk of endometrial cancer. We conducted a retrospective cohort study to evaluate the risk of second primary cancers after adjuvant tamoxifen therapy for breast cancer in Japan.
Patients and methods: The subjects of the study were 6148 women who had been diagnosed with stage I, II, or IIIA unilateral primary breast cancer and had received surgical treatment during the period from January 1982 through December 1990 at nine institutions in Japan. The information on each patient was obtained from medical records or a prospectively compiled computer database at each institution.
Results: Of the 6148 women, 3588 (58.4%) were administered tamoxifen as an adjuvant treatment and 2560(41.6%) were not administered. Median follow-up periods were 7.64 years for tamoxifen-treated patients and 8.10 years for non-tamoxifen-treated patients, respectively. The duration of tamoxifen treatment was mostly two years or less (80.7%), and few patients received tamoxifen for more than five years. The cumulative incidence rates of all second cancers at 10 years were 4.61% and 4.09% among tamoxifen-treated and non-tamoxifen-treated patients (P=0.62), respectively, and the incidence rate ratio (IRR) for all second cancers was 1.06 (95% confidence interval (CI): 0.77–1.47) after adjustment of several covariates. The numbers of endometrial cancers was 9 and 3 among tamoxifen-treated and non-tamoxifen-treated patients, respectively, and the IRR was 2.37 (95% CI: 0.64–8.77, P=0.20). Of the 12 patients who developed endometrial cancer, 4 died of cancer (for 3 of them, the cause of death was breast cancer), and the other 8 patients were alive as of March 1996. Stomach cancer was the most frequent second cancer and the IRR was 1.34 (95% CI: 0.76–2.38, P=0.31). There was no substantial increase in any other type of gastrointestinal cancer such as colorectal and liver cancers among tamoxifen-treated patients.
Conclusions: 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.
adjuvant therapy, breast cancer, second cancer, tamoxifen
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