Faculty Collaboration Database

Physician recommendations regarding tamoxifen and patient utilization of tamoxifen after surgery for ductal carcinoma in situ. Cancer 2004 Mar 01;100(5):942-9

Date

02/26/2004

Pubmed ID

14983489

DOI

10.1002/cncr.20085

Scopus ID

2-s2.0-10744233171 (requires institutional sign-in at Scopus site)   48 Citations

Abstract

BACKGROUND: To date, the impact of the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-24 trial reported in 1999 on the use of tamoxifen after surgery for ductal carcinoma in situ (DCIS) is unknown. The current study was designed to evaluate the impact of NSABP B-24 on current practices at a comprehensive cancer center.

METHODS: The records of 350 consecutive patients with DCIS who were treated at the authors' institution between July 1999 and June 2002 were obtained from a prospective database and analyzed. Whether patients were offered tamoxifen, whether patients accepted tamoxifen, and the associated reasons were recorded along with tamoxifen-related side effects and patient compliance with therapy. Clinical and pathologic factors were evaluated for their impact on recommendations regarding tamoxifen. Differences were assessed by chi-square analysis.

RESULTS: Of the 350 patients, 73 were excluded because of evidence of invasive carcinoma on final pathology review. Of the remaining 277 patients, 166 patients (60%) were offered tamoxifen, and 90 patients (54%) chose to take tamoxifen. Of 111 patients who were not offered tamoxifen, 39 patients (35%) had documented explanations, which included bilateral mastectomy (n = 25 patients), medical reasons (n = 10 patients), and already received tamoxifen for other reasons at the time of diagnosis (n = 4 patients). Of 94 patients who received tamoxifen, 20 patients (21%) discontinued use because of side effects or complications. Tamoxifen was more likely to be recommended for women who underwent segmental resection compared with women who underwent total mastectomy (P = 0.002) and for women with smaller pathologic DCIS tumors (P = 0.001). In addition, these two factors were interrelated.

CONCLUSIONS: Physicians and patients remain cautious regarding the use of tamoxifen after local treatment for DCIS. The current findings have implications for current trials evaluating aromatase inhibitors and other chemopreventive agents for this disease.

Author List

Yen TW, Hunt KK, Mirza NQ, Thomas ES, Singletary SE, Babiera GV, Meric-Bernstam F, Buchholz TA, Feig BW, Ross MI, Ames FC, Theriault RL, Kuerer HM

Author

Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Biopsy, Needle
Breast Neoplasms
Carcinoma, Intraductal, Noninfiltrating
Combined Modality Therapy
Female
Health Planning Guidelines
Humans
Immunohistochemistry
Mastectomy, Segmental
Middle Aged
Neoplasm Staging
Patient Participation
Patient Selection
Physician-Patient Relations
Probability
Prognosis
Prospective Studies
Registries
Risk Assessment
Statistics, Nonparametric
Survival Analysis
Tamoxifen
Treatment Outcome