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Breast Cancer Research and Treatment

, Volume 154, Issue 3, pp 609–616 | Cite as

Benefit/risk for adjuvant breast cancer therapy with tamoxifen or aromatase inhibitor use by age, and race/ethnicity

  • R. T. ChlebowskiEmail author
  • R. Haque
  • H. Hedlin
  • N. Col
  • E. Paskett
  • J. E. Manson
  • J. T. Kubo
  • K. C. Johnson
  • J. Wactawski-Wende
  • K. Pan
  • G. Anderson
Epidemiology

Abstract

In early adjuvant breast cancer trial reports, aromatase inhibitors more effectively reduced breast recurrence with lower risk of thromboembolic events and endometrial cancer than tamoxifen, while aromatase inhibitors had higher fracture and cardiovascular disease risk. We used data from updated patient-level meta-analyses of adjuvant trials in analyses to summarize the benefits and risks of these agents in various clinical circumstances. Baseline incidence rates for health outcomes by age and race/ethnicity, absent aromatase inhibitor, or tamoxifen use were estimated from the Women’s Health Initiative. Aromatase inhibitor and tamoxifen effects on distant recurrence were obtained from a meta-analysis of the Arimidex, Tamoxifen, Alone or in Combination (ATAC) and Breast International Group (Big-1-98) clinical trials. Impact on other health outcomes were obtained from meta-analyses of randomized trials comparing aromatase inhibitor to tamoxifen use and from placebo-controlled chemoprevention trials. All health outcomes were given equal weight when modeling net benefit/risk for aromatase inhibitor compared to tamoxifen use by breast cancer recurrence risk, age (decade), race/ethnicity, hysterectomy (yes/no), and by prior myocardial infarction. Over a 10-year period, the benefit/risk index was more favorable for aromatase inhibitor than for tamoxifen as adjuvant breast cancer therapy in almost all circumstances regardless of patient age, race/ethnicity, breast cancer recurrence risk, or presence or absence of a uterus. Only in older women with prior myocardial infarction and low recurrence risk was an advantage for tamoxifen seen. Using a benefit/risk index for endocrine adjuvant breast cancer therapy in postmenopausal women, benefit was higher for aromatase inhibitor use in almost all circumstances.

Keywords

Adjuvant breast cancer Benefit/risk assessment Endocrine therapy Aromatase inhibitor Tamoxifen Race/ethnicity 

Notes

Acknowledgments

We acknowledge the dedicated efforts of investigators and staff at the Women’s Health Initiative (WHI) clinical centres, the WHI Clinical Coordinating Center, and the National Heart, Lung and Blood program office (listing available at http://www.whi.org). We also recognize the WHI participants for their extraordinary commitment to the WHI programme. The WHI programme was funded by the National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services through contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221. Additional funding support was provided by Kaiser Permanente Southern California award #13RHAqu-02-UCLA.

Compliance with ethical standards

Conflict of interest

RTC has received speaker’s fees and honorarium from Novartis and Genetech; honorarium for advisory boards and consulting for Novartis, Astra-Zeneca, Pfizer, Novo-Nordisk, Genentech, Genomic Health, and Amgen. No other author has conflicts to declare.

Supplementary material

10549_2015_3647_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 23 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • R. T. Chlebowski
    • 1
    Email author
  • R. Haque
    • 2
  • H. Hedlin
    • 3
  • N. Col
    • 4
  • E. Paskett
    • 5
  • J. E. Manson
    • 6
  • J. T. Kubo
    • 3
  • K. C. Johnson
    • 7
  • J. Wactawski-Wende
    • 8
  • K. Pan
    • 9
  • G. Anderson
    • 10
  1. 1.Los Angeles Biomedical Research Institute at Harbor-UCLA Medical CenterTorranceUSA
  2. 2.Department of Research and EvaluationSouthern California Permanente Medical GroupPasadenaUSA
  3. 3.Department of Medicine, Stanford Prevention Research CenterStanford UniversityStanfordUSA
  4. 4.School of Osteopathic MedicineUniversity of New EnglandBiddefordUSA
  5. 5.Division of Epidemiology, College of Public HealthThe Ohio State UniversityColumbusUSA
  6. 6.Brigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  7. 7.Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisUSA
  8. 8.Department of Social and Preventive MedicineState University of New YorkBuffaloUSA
  9. 9.Harbor-UCLA Medical CenterTorranceUSA
  10. 10.Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA

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