OBJECTIVE: Tamoxifen reduces the risk of developing breast cancer but also affects the risks of certain vascular and neoplastic events. Our purpose was to estimate the effects of tamoxifen on potentially life-threatening vascular and neoplastic outcomes. DESIGN: Random effects meta-analysis of published randomized controlled trials. PATIENTS: Participants in all trials in which a treatment arm that included tamoxifen was compared to a similar control arm. Breast cancer risk reduction and treatment trials were included. INTERVENTIONS: Tamoxifen at variable dose and duration. MEASUREMENTS AND MAIN RESULTS: Thirty-two trials (52,929 patients) reported one or more outcomes of interest. Tamoxifen was associated with significantly increased risks of endometrial cancer (relative risk [RR] 2.70; 95% CI, 1.94 to 3.75), gastrointestinal cancers (RR 1.31; 95% CI, 1.01 to 1.69), strokes (RR 1.49; 95% CI, 1.16 to 1.90), and pulmonary emboli (RR 1.88; 95% CI, 1.77 to 3.01). Tamoxifen had no effect on secondary malignancies other than endometrial and gastrointestinal cancers (RR 0.96; 95% CI, 0.81 to 1.13). In contrast, tamoxifen significantly decreased myocardial infarction deaths (RR 0.62; 95% CI, 0.41 to 0.93) and was associated with a statistically insignificant decrease in myocardial infarction incidence (RR 0.90; 95% CI, 0.66 to 1.23). Postmenopausal women had greater risk increases for neoplastic outcomes. CONCLUSIONS: This meta-analysis of randomized trials found tamoxifen use to be significantly associated with several neoplastic and vascular outcomes. Consideration of tamoxifen use requires balance of potential benefits and risks.
OBJECTIVE:Tamoxifen reduces the risk of developing breast cancer but also affects the risks of certain vascular and neoplastic events. Our purpose was to estimate the effects of tamoxifen on potentially life-threatening vascular and neoplastic outcomes. DESIGN: Random effects meta-analysis of published randomized controlled trials. PATIENTS: Participants in all trials in which a treatment arm that included tamoxifen was compared to a similar control arm. Breast cancer risk reduction and treatment trials were included. INTERVENTIONS:Tamoxifen at variable dose and duration. MEASUREMENTS AND MAIN RESULTS: Thirty-two trials (52,929 patients) reported one or more outcomes of interest. Tamoxifen was associated with significantly increased risks of endometrial cancer (relative risk [RR] 2.70; 95% CI, 1.94 to 3.75), gastrointestinal cancers (RR 1.31; 95% CI, 1.01 to 1.69), strokes (RR 1.49; 95% CI, 1.16 to 1.90), and pulmonary emboli (RR 1.88; 95% CI, 1.77 to 3.01). Tamoxifen had no effect on secondary malignancies other than endometrial and gastrointestinal cancers (RR 0.96; 95% CI, 0.81 to 1.13). In contrast, tamoxifen significantly decreased myocardial infarction deaths (RR 0.62; 95% CI, 0.41 to 0.93) and was associated with a statistically insignificant decrease in myocardial infarction incidence (RR 0.90; 95% CI, 0.66 to 1.23). Postmenopausal women had greater risk increases for neoplastic outcomes. CONCLUSIONS: This meta-analysis of randomized trials found tamoxifen use to be significantly associated with several neoplastic and vascular outcomes. Consideration of tamoxifen use requires balance of potential benefits and risks.
Authors: J N Ingle; L K Everson; H S Wieand; J K Martin; H J Votava; L E Wold; J E Krook; S A Cullinan; J K Paulsen; D I Twito Journal: J Clin Oncol Date: 1988-09 Impact factor: 44.544
Authors: B Fisher; J Dignam; N Wolmark; D L Wickerham; E R Fisher; E Mamounas; R Smith; M Begovic; N V Dimitrov; R G Margolese; C G Kardinal; M T Kavanah; L Fehrenbacher; R H Oishi Journal: Lancet Date: 1999-06-12 Impact factor: 79.321
Authors: Rowan T Chlebowski; Nananda Col; Eric P Winer; Deborah E Collyar; Steven R Cummings; Victor G Vogel; Harold J Burstein; Andrea Eisen; Isaac Lipkus; David G Pfister Journal: J Clin Oncol Date: 2002-08-01 Impact factor: 44.544
Authors: J N Ingle; L K Everson; H S Wieand; S A Cullinan; L E Wold; J B Hagen; J K Martin; J E Krook; R G Fitzgibbons; J F Foley Journal: Cancer Date: 1989-04-01 Impact factor: 6.860
Authors: S G Taylor; L A Kalish; J E Olson; F Cummings; J M Bennett; G Falkson; D C Tormey; P P Carbone Journal: J Clin Oncol Date: 1985-02 Impact factor: 44.544
Authors: Peter Blaha; Ruth Exner; Andrea Dal Borgo; Sinda Bigenzahn; Peter Panhofer; Otto Riedl; Sebastian Schoppmann; Thomas Bachleitner-Hofmann; Emanuel Sporn; Ursula Pluschnig; Florian Fitzal; Guenther Steger; Raimund Jakesz; Peter Dubsky; Michael Gnant Journal: Breast Care (Basel) Date: 2009-06-23 Impact factor: 2.860
Authors: Přemysl Mladěnka; Lenka Applová; Jiří Patočka; Vera Marisa Costa; Fernando Remiao; Jana Pourová; Aleš Mladěnka; Jana Karlíčková; Luděk Jahodář; Marie Vopršalová; Kurt J Varner; Martin Štěrba Journal: Med Res Rev Date: 2018-01-05 Impact factor: 12.944
Authors: Stefan Paepke; Volker R Jacobs; Ralf Ohlinger; Mathias Warm; Sherko Kümmel; Anke Thomas; Nadia Harbeck; Marion Kiechle-Bahat Journal: J Cancer Res Clin Oncol Date: 2007-09-06 Impact factor: 4.553