39 research outputs found
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Aromatase Inhibitors, Tamoxifen, and Endometrial Cancer in Breast Cancer Survivors
BackgroundBoth endometrial cancer and postmenopausal breast cancer risk are increased by obesity and higher endogenous estrogen levels. While aromatase inhibitors reduce breast cancer incidence, their influence on endometrial cancer risk is uncertain. Methods We addressed this issue in a cohort of 17,064 women diagnosed with hormone receptor positive breast cancer in an integrated group practice health plan. Information on demographics, comorbidities and adjuvant endocrine therapy use was available from electronic medical and pharmacy records, respectively. Endometrial cancer information was obtained from the health plan’s SEER-affiliated tumor registry and rates were compared across endocrine therapy groups(aromatase inhibitor [n=5,303], tamoxifen [n=5155] , switchers [both n=3787] or none [n=2819]using multi-variable adjusted Cox proportional hazard models. Results Endometrial cancer incidence was a statistically significant, 48% lower in the aromatase inhibitor versus tamoxifen group (HR 0.52, 95% CI 0.31-0.87, P=0.01). Endometrial cancer incidence was 29% lower in the aromatase inhibitor versus no endocrine therapy group (HR 0.71, 95% CI 0.37-1.35, P=0.30) and was 36% higher in the tamoxifen versus no endocrinetherapy group (HR 1.36, 95% CI 0.84-2.22, P=0.22), but neither difference was statisticallysignificant. Associations were stronger among those with good drug adherence. Conclusions In a real world experience, endometrial cancer incidence was lower in women on aromatase inhibitor compared to tamoxifen. Additionally, aromatase inhibitors may mitigate tamoxifen-associated endometrial cancer incidence. While there were somewhat fewer endometrial cancers diagnosed in aromatase inhibitor versus no endocrine therapy users, further studies areneeded for definitive assessment of aromatase inhibitor endometrial cancer influence
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Aromatase inhibitors, tamoxifen, and endometrial cancer in breast cancer survivors.
BackgroundThe risks of both endometrial cancer and postmenopausal breast cancer are increased by obesity and higher endogenous estrogen levels. Although aromatase inhibitors reduce breast cancer incidence, their influence on endometrial cancer is uncertain.MethodsThe authors investigated this issue in a cohort of 17,064 women who were diagnosed with hormone receptor-positive breast cancer in an integrated group practice health plan. Information on demographics, comorbidities, and the receipt of adjuvant endocrine therapy was available from electronic medical records and pharmacy records, respectively. Endometrial cancer information was obtained from the health plan's Surveillance, Epidemiology, and End Results-affiliated tumor registry, and rates were compared across endocrine therapy groups (aromatase inhibitor, n = 5303; tamoxifen, n = 5155; switchers: both [n = 3787] or none [n = 2819]) using multivariable adjusted Cox proportional-hazards models.ResultsEndometrial cancer incidence was a statistically significant 48% lower in the aromatase inhibitor group versus the tamoxifen group (hazard ratio, 0.52; 95% confidence interval, 0.31-0.87; P = .01). Endometrial cancer incidence was 29% lower in the aromatase inhibitor group versus the no endocrine therapy group (hazard ratio, 0.71; 95% confidence interval, 0.37-1.35; P = .30) and 33% lower in the aromatase inhibitor group versus the tamoxifen group (hazard ratio, 0.67; 95% confidence interval, 0.42-1.06; P = .08), but neither difference was statistically significant. Associations were stronger among those with good drug adherence.ConclusionsIn a community-based, integrated health plan setting, endometrial cancer incidence was lower in women who were receiving an aromatase inhibitor compared with those who were receiving tamoxifen. In addition, aromatase inhibitors may mitigate the incidence of tamoxifen-associated endometrial cancer. Although there were somewhat fewer endometrial cancers in the aromatase inhibitor group versus the no endocrine therapy group, further studies are needed for the definitive assessment of this potential association
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Aromatase Inhibitors, Tamoxifen, and Endometrial Cancer in Breast Cancer Survivors
BackgroundBoth endometrial cancer and postmenopausal breast cancer risk are increased by obesity and higher endogenous estrogen levels. While aromatase inhibitors reduce breast cancer incidence, their influence on endometrial cancer risk is uncertain. Methods We addressed this issue in a cohort of 17,064 women diagnosed with hormone receptor positive breast cancer in an integrated group practice health plan. Information on demographics, comorbidities and adjuvant endocrine therapy use was available from electronic medical and pharmacy records, respectively. Endometrial cancer information was obtained from the health plan’s SEER-affiliated tumor registry and rates were compared across endocrine therapy groups(aromatase inhibitor [n=5,303], tamoxifen [n=5155] , switchers [both n=3787] or none [n=2819]using multi-variable adjusted Cox proportional hazard models. Results Endometrial cancer incidence was a statistically significant, 48% lower in the aromatase inhibitor versus tamoxifen group (HR 0.52, 95% CI 0.31-0.87, P=0.01). Endometrial cancer incidence was 29% lower in the aromatase inhibitor versus no endocrine therapy group (HR 0.71, 95% CI 0.37-1.35, P=0.30) and was 36% higher in the tamoxifen versus no endocrinetherapy group (HR 1.36, 95% CI 0.84-2.22, P=0.22), but neither difference was statisticallysignificant. Associations were stronger among those with good drug adherence. Conclusions In a real world experience, endometrial cancer incidence was lower in women on aromatase inhibitor compared to tamoxifen. Additionally, aromatase inhibitors may mitigate tamoxifen-associated endometrial cancer incidence. While there were somewhat fewer endometrial cancers diagnosed in aromatase inhibitor versus no endocrine therapy users, further studies areneeded for definitive assessment of aromatase inhibitor endometrial cancer influence
Cardiovascular Toxicity Following Aromatase Inhibitor Use in 13,273 Women Cared for in an HMO
Background/Aims: Aromatase inhibitors (AIs) reduce breast cancer incidence in primary prevention trials (MAP3, IBIS2). However, controversy regarding AI’s influence on cardiovascular disease (MI, angina and cardiac failure) (Amir et al., J Natl Cancer Inst., 2011) could limit use in prevention settings.
Methods: We assembled a cohort of 13,273 postmenopausal breast cancer patients initially cardiovascular disease (CVD)-free at diagnosis in a large managed care organization. Women were diagnosed 1991–2010, and followed through 2012. The outcome, CVD risk, was compared across endocrine treatments (AI, tamoxifen [TAM], both, or neither). Information on demographics, comorbidity (diabetes, hypertension, etc.) and covariate medications (antihyperlipidemics, antihypertensives and other CVD drugs) were available from electronic medical records. We conducted Cox models using time-dependent endocrine drug use variables adjusted for age, demographics, comorbidity, CVD drug use, cancer treatment, tumor characteristics and tumor laterality.
Results: Among the 13,273-patient cohort, postmenopausal women who used AIs exclusively had a similar risk of ischemic disease (hazard ratio [HR]: 0.97, 95% confidence interval [CI]: 0.78–1.22) and stroke (HR: 0.97, 95% CI: 0.70–1.33) versus those who used TAM only (HR: 1.00, reference). However, women who used AIs only had a higher risk of other CVD disease combined (congestive heart failure, cardiomyopathy, dysrhythmia, valvular dysfunction, pericarditis) (HR: 1.26, 95% CI: 1.11–1.43) than those exposed to TAM only. The risk of other CVD disease was greater among women exposed to sequential TAM and AI treatment. The results are based on 3,711 CVD events occurring in 72,886 woman-years of follow-up. Based on a subset of 7,982 patients who underwent breast irradiation, the risk of CVD overall was greater among women who used AIs only and received left-sided irradiation (HR: 1.21, 95% CI: 1.02–1.44).
Discussion: Results indicate that variation exists in the type of CVD events that occur in breast cancer patients receiving AIs compared to tamoxifen users. For example, the risk of ischemic disease or stroke was not elevated in those who used AIs only versus TAM users. However, overall CVD events were greater in women who used AIs only (or sequentially after TAM), especially if they received left-sided breast irradiation. While these observational study results require cautious interpretation, they provide a basis for comparing the benefits and risks of endocrine treatments