Breast Cancer Research and Treatment

, Volume 156, Issue 3, pp 567–576 | Cite as

Medication use trajectories of postmenopausal breast cancer survivors and matched cancer-free controls

  • Kathy Pan
  • Rowan T. ChlebowskiEmail author
  • Michael S. Simon
  • Roberta M. Ray
  • Jennifer Livaudais-Toman
  • Shannon D. Sullivan
  • Marcia L. Stefanick
  • Robert B. Wallace
  • Meryl LeBoff
  • Elizabeth Carhart Bluhm
  • Electra D. Paskett


While adverse medical sequelae are associated with breast cancer therapies, information on breast cancer impact on medication use is limited. Therefore, we compared medication use before and after diagnosis of early stage breast cancer to medication use in matched, cancer-free controls. Of 68,132 Women’s Health Initiative participants, 3726 were diagnosed with breast cancer and, after exclusions, in 1731 breast cancer cases, medication use before and >3 years after diagnosis (mean 5.3 ± 2.1 SD) was compared to use in 1731 cancer-free matched controls on similar inventory dates. The medication category number at follow-up inventory was the primary study outcome. Medication category use (n, mean, SD) was comparable at baseline and significantly increased at follow-up in both cases (2.48 ± 1.66 vs. 4.15 ± 2.13, baseline vs follow-up, respectively, P < .0001) and controls (2.44 ± 1.67 vs. 3.95 ± 2.13, respectively, P < .0001), with clinically marginal but statistically significant additional medication category use by cases (0.20 ± 2.40, P < .0001). Tamoxifen users used somewhat more selected medication categories at follow-up assessment (mean 3.40 ± 1.89 vs. 3.21 ± 1.99, respectively, P = 0.05), while aromatase inhibitor users used more medication categories (mean 4.85 ± 2.10 vs. 4.44 ± 1.94, respectively, P = 0.02). No increase in medication category was seen in cases who were not current endocrine therapy users. Breast cancer survivors having only a clinically marginal increase in medication use compared to cancer-free controls. These findings highlight the importance of incorporation of control populations in studies of cancer survivorship.


Breast cancer Medication Survivorship Control group Women’s Health Initiative Comorbidity 



The WHI program is reported 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.

Role of the sponsor

The WHI Project Office at the US National Heart, Lung, and Blood Institute (NHLBI) reviewed and approved the final manuscript but had no other role in the preparation of this report.

Author contributions

KP and RTC wrote the analysis proposal and initial draft of the report. KP and RTC had full access to the data in the study and take full responsibility for the integrity of the data and the accuracy of the data analysis. RR undertook the statistical analysis. RTC, JEM, MLS, MSS, KCJ, JW, MJO, and RLP collected the data and obtained study funding. Additional contributions: We thank the Women’s Health Initiative investigators, staff, and the trial participants for their outstanding dedication and commitment.

Women’s Health Initiative investigators

Program office (National Heart, Lung, and Blood Institute, Bethesda, MD) Jacques Roscoe, Shari Ludlum, Dale Burden, Joan McGowan, Leslie Ford, and Nancy Geller. Clinical coordinating center (Fred Hutchinson Cancer Research Center, Seattle, WA) Garnet Anderson, Ross Prentice, Andrea LaCroix, and Charles Kooperberg. Investigators and academic centers (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA) JoAnn E, Manson; (MedStar Health Research Institute/Howard University, Washington, DC) Barbara V Howard; (Stanford Prevention Research Center, Stanford, CA) Marcia L. Stefanick; (The Ohio State University, Columbus, OH) Rebecca Jackson; (University of Arizona, Tucson/Phoenix, AZ) Cynthia A. Thompson; (University at Buffalo, Buffalo, NY) Jean Wactawski-Wende; (University of Florida, Gainesville/Jacksonville, FL) Marian Limacher; (University of Iowa, Iowa City/Davenport, IA) Robert Wallace; (University of Pittsburgh, Pittsburgh, PA) Lewis Kuller; (Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA) Rowan T. Chlebowski; (Wake Forest University School of Medicine, Winston Salem, NC) Sally Shumaker. Women’s Health Initiative memory study (Wake Forest University School of Medicine, Winston Salem, NC) Sally Shumaker. Additional information A full list of all the investigators who have contributed to Women’s Health Initiative science appears at

Compliance with ethical standards

Conflict of interest

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Chlebowski reported being a consultant for AstraZenea, Novartis, Amgen, Genomic Health and Novo Nordisk, receiving funding support from Amgen, and serving on the speaker’s bureau for Novartis and Genentech.

Supplementary material

10549_2016_3773_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 kb)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Kathy Pan
    • 1
  • Rowan T. Chlebowski
    • 2
    Email author
  • Michael S. Simon
    • 3
  • Roberta M. Ray
    • 4
  • Jennifer Livaudais-Toman
    • 5
  • Shannon D. Sullivan
    • 6
  • Marcia L. Stefanick
    • 7
  • Robert B. Wallace
    • 8
  • Meryl LeBoff
    • 9
  • Elizabeth Carhart Bluhm
    • 9
  • Electra D. Paskett
    • 10
  1. 1.Harbor-UCLA Medical CenterTorranceUSA
  2. 2.Los Angeles BioMedical Research Institute at Harbor-UCLA Medical CenterTorranceUSA
  3. 3.Karmanos Cancer Institute at Wayne State UniversitDetroitUSA
  4. 4.Fred Hutchinson Cancer Research Center Division of Public Health SciencesSeattleUSA
  5. 5.University of California at San FranciscoSan FranciscoUSA
  6. 6.MedStar Washington Hospital CenterWashingtonUSA
  7. 7.Stanford Prevention Research CenterStanfordUSA
  8. 8.University of Iowa College of Public HealthIowa CityUSA
  9. 9.Brigham and Women’s HospitalBoston Harvard Medical SchoolBostonUSA
  10. 10.The Ohio State University Comprehensive Cancer CenterColumbusUSA

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