Faculty Collaboration Database

Impact of randomized clinical trial results in the national comprehensive cancer network on the use of tamoxifen after breast surgery for ductal carcinoma in situ. J Clin Oncol 2007 Aug 01;25(22):3251-8

Date

06/20/2007

Pubmed ID

17577019

DOI

10.1200/JCO.2006.10.2699

Scopus ID

2-s2.0-34548277592 (requires institutional sign-in at Scopus site)   45 Citations

Abstract

PURPOSE: The National Surgical Adjuvant Breast and Bowel Project B-24 trial, published in June 1999, demonstrated that tamoxifen after breast-conserving surgery (BCS) and radiotherapy for ductal carcinoma in situ (DCIS) reduced the absolute occurrence of ipsilateral and contralateral breast cancer. We assessed the impact of B-24 on practice patterns at selected National Comprehensive Cancer Network (NCCN) centers.

PATIENTS AND METHODS: Tamoxifen use after surgery was examined among 1,622 patients presenting for treatment of unilateral DCIS between July 1997 and December 2003 at eight NCCN centers. Associations of clinicopathologic and treatment factors with tamoxifen use were assessed in univariate and multivariable logistic regression analyses.

RESULTS: Overall, 41% of patients (665 of 1,622) received tamoxifen. The proportion increased from 24% before July 1, 1999, to 46% on or after July 1, 1999. Factors significantly associated with receipt of tamoxifen included diagnosis on or after July 1, 1999 (odds ratio [OR], 3.85; P < .0001), BCS in patients younger than 70 years (OR, 3.21; P = .0073), no history of cerebrovascular or peripheral vascular disease (OR, 3.13; P = .0071), receipt of radiotherapy (OR, 1.82; P = .0009), and previous hysterectomy (OR, 1.34; P = .0459). Tamoxifen use varied significantly by center, from 34% to 74% after BCS and 17% to 53% after mastectomy (P < .0001).

CONCLUSION: Tamoxifen use after surgery for DCIS at NCCN centers increased after presentation of the B-24 results. Rates varied substantially by institution, suggesting that physicians differ in how they weigh the modest reduction in breast cancer risk with tamoxifen against its potential adverse effects in this population.

Author List

Yen TW, Kuerer HM, Ottesen RA, Rouse L, Niland JC, Edge SB, Theriault RL, Weeks JC

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
Aged, 80 and over
Antineoplastic Agents, Hormonal
Breast Neoplasms
Carcinoma in Situ
Carcinoma, Ductal, Breast
Chemotherapy, Adjuvant
Combined Modality Therapy
Double-Blind Method
Female
Humans
Logistic Models
Middle Aged
Practice Patterns, Physicians'
Randomized Controlled Trials as Topic
Tamoxifen
United States