Twenty First Century View of Tamoxifen as a Treatment for Breast Cancer

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The impact of the clinical introduction of tamoxifen on healthcare can be assessed through the work of the Early Breast Cancer Trialists Collaborative Group (EBCTCG) that meets in Oxford, UK every 5 years. The international group has met since 1984 to evaluate the impact of therapies on the treatment of breast cancer. The method is to integrate the positive and negative findings of all the world's randomized prospective clinical trials to reach a consensus on the merits of a treatment approach. Reports on the value of long-term adjuvant tamoxifen therapy in the treatment of node-positive and node-negative estrogen receptor-positive breast cancer can be documented through the EBCTCG publications.138-140 Overall, the reports document the enhanced survival and disease-free survival conferred by tamoxifen. The recent report by the EBCTG141 analyzes the results from 145 000 women in 194 trials of chemotherapy or hormonal therapy begun before 1995. The treatment of estrogen receptor-positive breast cancer with about 5 years of adjuvant tamoxifen reduces the annual breast cancer death rate by 31% (+ 3 SE) irrespective of the use of chemotherapy, age, progesterone receptor status, or other tumor charac teristics. Tamoxifen given for 5 years is significantly (^<0.01) more effective than for 1-2 years. Most importantly, the annual mortality rates during the first few years and the subsequent 5-14 years are similar. This results in the cumulative reduction in mortality being twice as large at 15 years than at 5 years. Overall, the EBCTG conclude that for women under 70 years of age with estrogen receptor-positive breast cancer, their death rate could be halved over the next 15 years if treated with 6 months of an anthracycline-based chemotherapy followed by 5 years of adjuvant tamoxifen.

These important analyses suggest that the introduction of widespread long-term tamoxifen treatment to postmenopausal patients (two-thirds of the total incidence of breast cancer) during the 1980s would contribute substantially to the decreases in mortality by 25-30% observed by others in the USA and UK.142

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