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Annals of Oncology Advance Access published online on October 9, 2006
Annals of Oncology, doi:10.1093/annonc/mdl334
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© 2006 European Society for Medical Oncology
Received March 28, 2006
Revised July 15, 2006
Accepted August 14, 2006

original article

Late risk of relapse and mortality among postmenopausal women with estrogen responsive early breast cancer after 5 years of tamoxifen

H. F. Kennecke 1 *, I. A. Olivotto 2, C. Speers 3, B. Norris 4, S. K. Chia 1, C. Bryce 1, and K. A. Gelmon 1

1 Division of Medical Oncology, British Columbia (BC) Cancer Agency, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Breast Cancer Outcomes Unit, BC Cancer Agency, Canada
2 Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Breast Cancer Outcomes Unit, BC Cancer Agency, Canada; Population and Preventive Oncology Programs, BC Cancer Agency, Canada; Victoria, BC Cancer Agency, Canada
3 Breast Cancer Outcomes Unit, BC Cancer Agency, Canada; Population and Preventive Oncology Programs, BC Cancer Agency, Canada
4 Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Breast Cancer Outcomes Unit, BC Cancer Agency, Canada; Fraser Valley, BC Cancer Agency, Canada

* To whom correspondence should be addressed.
H. F. Kennecke, E-mail: hkenneck{at}bccancer.bc.ca


  Abstract

Background: Letrozole after 5 years of adjuvant tamoxifen results in a significant reduction in risk of recurrence from estrogen receptor (ER) positive breast cancer. An individualized estimate of the risk of relapse and death after 5 years of tamoxifen could improve decisions regarding extended hormonal therapy.

Methods: The British Columbia Breast Cancer Outcomes database was used to identify women aged 45 years or older at the time of diagnosis with early-stage (I-IIIA) breast cancer who received tamoxifen and were disease free 5 years after diagnosis. Ten-year breast cancer event rates and mortality were calculated as well as annualized hazard rates of recurrence.

Results: A total of 1086 women were identified with a median age of 64 years and follow-up of 10.5 years. The relative risk (RR) of death was 3.1 (P = 0.003) and for recurrence was 1.7 (P = 0.037) for N1 (one to three positive nodes) versus N0 (zero nodes positive) disease. N2 (four to nine nodes positive) had a RR of 5.8 (P < 0.001) for death and 3.0 (P = 0.002) for recurrence. Low tumor grade and high ER level subgroups had a more favorable prognosis. Annual breast cancer risk between years 6 and 10 was, respectively, 2.2%, 3.5% and 7.6% for N0, N1 and N2 disease and 2.6% and 4.5% for T1 and T2 breast cancer.

Conclusion: T and N stages predicted late relapse and death from breast cancer in a population-based cohort of postmenopausal women. Risk estimates reported herein may be used to optimize decision making regarding adjuvant therapy after 5 years of tamoxifen.

Keywords: breast cancer; estrogen receptor; mortality; relapse; risk; tamoxifen.
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