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Annals of Oncology Advance Access published online on January 15, 2009
Annals of Oncology, doi:10.1093/annonc/mdn688
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Hormonal therapy for oestrogen receptor-negative breast cancer is associated with higher disease-specific mortality

A. Merglen1, H. M. Verkooijen1,2, G. Fioretta1, I. Neyroud-Caspar1, V. Vinh-Hung1,5, G. Vlastos6, P. O. Chappuis3,4, M. Castiglione1, E. Rapiti1 and C. Bouchardy1,*

1 Geneva Cancer Registry, Institute of Social and Preventive Medicine, University of Geneva, Geneva, Switzerland
2 Department of Community Occupational and Family Medicine, National University of Singapore, Singapore
3 Division of Oncology, Division of Genetic medicine
4 Division of Genetic Medicine, Division of Genetic Medicine and Laboratory, Geneva University Hospitals, Geneva, Switzerland
5 Department of Radiotherapy, Oncologisch Centrum, Universitair Ziekenhuis, Brussel, Belgium
6 Division of Gynecology, Senology Unit, Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland

* Correspondence to: Prof. C. Bouchardy, Geneva Cancer Registry, 55 Boulevard de la Cluse, 1205 Geneva, Switzerland. Tel: +41-22-379-49-50; Fax: +41-22-379-49-71; E-mail: christine.bouchardymagnin{at}unige.ch

Background: Tamoxifen has a remarkable impact on the outcome of oestrogen receptor (ER)-positive breast cancer. Without proven benefits, tamoxifen is occasionally prescribed for women with ER-negative disease. This population-based study aims to estimate the impact of tamoxifen on the outcome of ER-negative disease.

Methods: We identified all women (n = 528) diagnosed with ER-negative invasive breast cancer between 1995 and 2005. With Cox regression analysis, we calculated breast cancer mortality risks of patients treated with tamoxifen compared with those treated without tamoxifen. We adjusted these risks for the individual probabilities (propensity scores) of having received tamoxifen.

Results: Sixty-nine patients (13%) with ER-negative disease were treated with tamoxifen. Five-year disease-specific survival for women treated with versus without tamoxifen were 62% [95% confidence interval (CI) 48% to 76%] and 79% (95% CI 75% to 83%), respectively (PLog-rank < 0.001). For ER-negative patients, risk of death from breast cancer was significantly increased in those treated with tamoxifen compared with patients treated without tamoxifen (adjusted hazard ratio = 1.7, 95% CI 1.1–2.9, P = 0.031).

Conclusion: Our results show that patients with ER-negative breast cancer treated with tamoxifen have an increased risk of death from their disease. Tamoxifen use should be avoided for these patients.

breast cancer, cancer registry, hormonal therapy, oestrogen receptor status, survival

Received for publication July 14, 2008. Accepted for publication September 30, 2008.


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V. Vinh-Hung, H. M. Verkooijen, G. Vlastos, G. Fioretta, I. Neyroud-Caspar, E. Rapiti, and C. Bouchardy
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