Younger tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer and the risk could be reduced by sequenced aromatase inhibitor use: A population-based study in Taiwan
Objective: Previous Western studies reported that older (≥50 years) breast cancer survivors with tamoxifen treatment had higher risk of endometrial cancer. This study aims to disclose whether younger (<50 years) tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer a...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2020-01-01
|
| Series: | Tzu-Chi Medical Journal |
| Subjects: | |
| Online Access: | http://www.tcmjmed.com/article.asp?issn=1016-3190;year=2020;volume=32;issue=2;spage=175;epage=180;aulast=Chu |
| _version_ | 1818450501889425408 |
|---|---|
| author | Sung-Chao Chu Chia-Jung Hsieh Tso-Fu Wang Mun-Kun Hong Tang-Yuan Chu |
| author_facet | Sung-Chao Chu Chia-Jung Hsieh Tso-Fu Wang Mun-Kun Hong Tang-Yuan Chu |
| author_sort | Sung-Chao Chu |
| collection | DOAJ |
| description | Objective: Previous Western studies reported that older (≥50 years) breast cancer survivors with tamoxifen treatment had higher risk of endometrial cancer. This study aims to disclose whether younger (<50 years) tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer and to examine whether sequenced aromatase inhibitor (AI) use could reduce the risk. Materials and Methods: A population-based cohort of 39,216 newly diagnosed breast cancer patients was identified from Taiwan National Health Insurance Database from 1999 to 2012. The risk of endometrial cancer in nonusers (n = 14,588), tamoxifen-only (n = 19,302), and sequenced AI (n = 5326) users was compared with Cox regression analysis and was adjusted with age, diabetes, hypertension, and chemotherapy. Results: During the 14-year study period, 133 patients were diagnosed with subsequent endometrial cancers. Compared with nonusers, tamoxifen-only users had higher risk of endometrial cancer (14-year incidence 1.7% vs. 0.3%; adjusted hazard ratio [HR] 3.90; 95% confidence interval [CI], 2.37–6.42). This was observed in both older (≥50 years) and younger (40–50 years) age groups. Adjusted HR (95% CI) for the latter was 3.74 (1.65–8.48). This risk persisted after cessation of tamoxifen use. The risk of endometrial cancer was lower in sequenced AI when compared with tamoxifen-only users (adjusted HR 0.43; 95% CI, 0.25–0.72). Conclusions: Not only patients ≥50 years but also younger (40–49 years) patients with tamoxifen treatment had higher risk of subsequent endometrial cancer in this nation-wide cohort. We suggest regular gynecologic monitoring not only during active use but also during follow-up phase. Sequenced AI use may reduce the risk of endometrial cancer in tamoxifen-treated breast cancer patients. |
| first_indexed | 2024-12-14T20:52:19Z |
| format | Article |
| id | doaj.art-b31de04a36a347dca122b245d1c0bbc7 |
| institution | Directory Open Access Journal |
| issn | 1016-3190 2223-8956 |
| language | English |
| last_indexed | 2024-12-14T20:52:19Z |
| publishDate | 2020-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Tzu-Chi Medical Journal |
| spelling | doaj.art-b31de04a36a347dca122b245d1c0bbc72022-12-21T22:47:47ZengWolters Kluwer Medknow PublicationsTzu-Chi Medical Journal1016-31902223-89562020-01-0132217518010.4103/tcmj.tcmj_17_19Younger tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer and the risk could be reduced by sequenced aromatase inhibitor use: A population-based study in TaiwanSung-Chao ChuChia-Jung HsiehTso-Fu WangMun-Kun HongTang-Yuan ChuObjective: Previous Western studies reported that older (≥50 years) breast cancer survivors with tamoxifen treatment had higher risk of endometrial cancer. This study aims to disclose whether younger (<50 years) tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer and to examine whether sequenced aromatase inhibitor (AI) use could reduce the risk. Materials and Methods: A population-based cohort of 39,216 newly diagnosed breast cancer patients was identified from Taiwan National Health Insurance Database from 1999 to 2012. The risk of endometrial cancer in nonusers (n = 14,588), tamoxifen-only (n = 19,302), and sequenced AI (n = 5326) users was compared with Cox regression analysis and was adjusted with age, diabetes, hypertension, and chemotherapy. Results: During the 14-year study period, 133 patients were diagnosed with subsequent endometrial cancers. Compared with nonusers, tamoxifen-only users had higher risk of endometrial cancer (14-year incidence 1.7% vs. 0.3%; adjusted hazard ratio [HR] 3.90; 95% confidence interval [CI], 2.37–6.42). This was observed in both older (≥50 years) and younger (40–50 years) age groups. Adjusted HR (95% CI) for the latter was 3.74 (1.65–8.48). This risk persisted after cessation of tamoxifen use. The risk of endometrial cancer was lower in sequenced AI when compared with tamoxifen-only users (adjusted HR 0.43; 95% CI, 0.25–0.72). Conclusions: Not only patients ≥50 years but also younger (40–49 years) patients with tamoxifen treatment had higher risk of subsequent endometrial cancer in this nation-wide cohort. We suggest regular gynecologic monitoring not only during active use but also during follow-up phase. Sequenced AI use may reduce the risk of endometrial cancer in tamoxifen-treated breast cancer patients.http://www.tcmjmed.com/article.asp?issn=1016-3190;year=2020;volume=32;issue=2;spage=175;epage=180;aulast=Chuantiestrogenaromatase inhibitorbreast cancerendometrial cancertamoxifen |
| spellingShingle | Sung-Chao Chu Chia-Jung Hsieh Tso-Fu Wang Mun-Kun Hong Tang-Yuan Chu Younger tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer and the risk could be reduced by sequenced aromatase inhibitor use: A population-based study in Taiwan Tzu-Chi Medical Journal antiestrogen aromatase inhibitor breast cancer endometrial cancer tamoxifen |
| title | Younger tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer and the risk could be reduced by sequenced aromatase inhibitor use: A population-based study in Taiwan |
| title_full | Younger tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer and the risk could be reduced by sequenced aromatase inhibitor use: A population-based study in Taiwan |
| title_fullStr | Younger tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer and the risk could be reduced by sequenced aromatase inhibitor use: A population-based study in Taiwan |
| title_full_unstemmed | Younger tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer and the risk could be reduced by sequenced aromatase inhibitor use: A population-based study in Taiwan |
| title_short | Younger tamoxifen-treated breast cancer patients also had higher risk of endometrial cancer and the risk could be reduced by sequenced aromatase inhibitor use: A population-based study in Taiwan |
| title_sort | younger tamoxifen treated breast cancer patients also had higher risk of endometrial cancer and the risk could be reduced by sequenced aromatase inhibitor use a population based study in taiwan |
| topic | antiestrogen aromatase inhibitor breast cancer endometrial cancer tamoxifen |
| url | http://www.tcmjmed.com/article.asp?issn=1016-3190;year=2020;volume=32;issue=2;spage=175;epage=180;aulast=Chu |
| work_keys_str_mv | AT sungchaochu youngertamoxifentreatedbreastcancerpatientsalsohadhigherriskofendometrialcancerandtheriskcouldbereducedbysequencedaromataseinhibitoruseapopulationbasedstudyintaiwan AT chiajunghsieh youngertamoxifentreatedbreastcancerpatientsalsohadhigherriskofendometrialcancerandtheriskcouldbereducedbysequencedaromataseinhibitoruseapopulationbasedstudyintaiwan AT tsofuwang youngertamoxifentreatedbreastcancerpatientsalsohadhigherriskofendometrialcancerandtheriskcouldbereducedbysequencedaromataseinhibitoruseapopulationbasedstudyintaiwan AT munkunhong youngertamoxifentreatedbreastcancerpatientsalsohadhigherriskofendometrialcancerandtheriskcouldbereducedbysequencedaromataseinhibitoruseapopulationbasedstudyintaiwan AT tangyuanchu youngertamoxifentreatedbreastcancerpatientsalsohadhigherriskofendometrialcancerandtheriskcouldbereducedbysequencedaromataseinhibitoruseapopulationbasedstudyintaiwan |