Limits...
Time dependent effects of adjuvant tamoxifen therapy on cerebrovascular disease: results from a randomised trial.

Rosell J, Nordenskjöld B, Bengtsson NO, Fornander T, Hatschek T, Lindman H, Malmström PO, Wallgren A, Stål O, Carstensen J - Br. J. Cancer (2011)

Bottom Line: Tamoxifen has been associated with an increased risk of stroke.There is, however, little information on the effect in the post-treatment period.In an adjuvant setting, tamoxifen was associated with an increased risk of cerebrovascular disease during treatment, but a decreased risk in the post-treatment period.

View Article: PubMed Central - PubMed

Affiliation: Oncologic center, Linköping University Hospital, S-581 85 Linköping, Sweden. johan.rosell@lio.se

ABSTRACT

Background: Tamoxifen has been associated with an increased risk of stroke. There is, however, little information on the effect in the post-treatment period. Using data from the Swedish Breast Cancer Group adjuvant trial of 5 vs 2 years of tamoxifen treatment, we now report both short-term and long-term effects on morbidity as well as mortality because of cerebrovascular disease.

Methods: Data from the Swedish National Hospital Discharge Registry combined with information from the Swedish Cause of Death Registry was used to define events of disease. Hazard ratios (HRs) were estimated using Cox regression.

Results: Comparing patients randomised to 5 years of tamoxifen with patients randomised to 2 years of tamoxifen, the incidence of cerebrovascular diseases was increased (HR 1.70, 95% CI 1.05-2.75) during the active treatment phase and reduced after the active treatment period (HR 0.78, 95% CI 0.63-0.96), and the difference in HR between the two time-periods was significant (P=0.0033). The mortality from cerebrovascular diseases was increased during the treatment period (HR 3.18, 95% CI 1.03-9.87) and decreased during the post-treatment period (HR 0.60, 95% CI 0.40-0.90) with a significant difference in HR between the two periods of follow-up (P=0.0066). Similar results were seen for subgroups of cerebrovascular diseases, such as stroke and ischaemic stroke.

Conclusion: In an adjuvant setting, tamoxifen was associated with an increased risk of cerebrovascular disease during treatment, but a decreased risk in the post-treatment period.

Show MeSH

Related in: MedlinePlus

Cumulative morbidity and mortality from cerebrovascular diseases among patients randomly assigned to 2 years (n=2114) or 5 years (n=2036) of adjuvant tamoxifen therapy. Patients at risk and cumulative risk estimates with 95% confidence intervals (CI) are given at 5, 10, 15 and 20 years after start of treatment.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3065281&req=5

fig1: Cumulative morbidity and mortality from cerebrovascular diseases among patients randomly assigned to 2 years (n=2114) or 5 years (n=2036) of adjuvant tamoxifen therapy. Patients at risk and cumulative risk estimates with 95% confidence intervals (CI) are given at 5, 10, 15 and 20 years after start of treatment.

Mentions: An intention-to-treat analysis revealed that 5 years of tamoxifen treatment compared with 2 years of tamoxifen treatment was associated with an increased risk of cerebrovascular diseases (HR 1.70, 95% CI 1.05–2.75) during the active treatment phase and a reduced risk after the active treatment period (HR 0.78, 95% CI 0.63–0.96) (Table 1 and Figure 1). The difference in HR associated with cerebrovascular diseases between the two periods was statistically significant (P=0.0033). We also saw significant differences in HR between the periods of follow-up for stroke (P=0.0056) and ischaemic stroke (P=0.014), and similar tendencies for haemorrhagic stroke, other and unspecified cerebrovascular diseases and for TIA (Table 1). The mortality from cerebrovascular diseases was increased during the treatment period (HR 3.18, 95% CI 1.03–9.87) and decreased during the post-treatment period (HR 0.60, 95% CI 0.40–0.90), with a significant difference in HR between the periods of follow-up (P=0.0066). Similar significant differences in HR were obtained when the data were not censored for contralateral breast cancer or any recurrence (data not shown).


Time dependent effects of adjuvant tamoxifen therapy on cerebrovascular disease: results from a randomised trial.

Rosell J, Nordenskjöld B, Bengtsson NO, Fornander T, Hatschek T, Lindman H, Malmström PO, Wallgren A, Stål O, Carstensen J - Br. J. Cancer (2011)

Cumulative morbidity and mortality from cerebrovascular diseases among patients randomly assigned to 2 years (n=2114) or 5 years (n=2036) of adjuvant tamoxifen therapy. Patients at risk and cumulative risk estimates with 95% confidence intervals (CI) are given at 5, 10, 15 and 20 years after start of treatment.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3065281&req=5

fig1: Cumulative morbidity and mortality from cerebrovascular diseases among patients randomly assigned to 2 years (n=2114) or 5 years (n=2036) of adjuvant tamoxifen therapy. Patients at risk and cumulative risk estimates with 95% confidence intervals (CI) are given at 5, 10, 15 and 20 years after start of treatment.
Mentions: An intention-to-treat analysis revealed that 5 years of tamoxifen treatment compared with 2 years of tamoxifen treatment was associated with an increased risk of cerebrovascular diseases (HR 1.70, 95% CI 1.05–2.75) during the active treatment phase and a reduced risk after the active treatment period (HR 0.78, 95% CI 0.63–0.96) (Table 1 and Figure 1). The difference in HR associated with cerebrovascular diseases between the two periods was statistically significant (P=0.0033). We also saw significant differences in HR between the periods of follow-up for stroke (P=0.0056) and ischaemic stroke (P=0.014), and similar tendencies for haemorrhagic stroke, other and unspecified cerebrovascular diseases and for TIA (Table 1). The mortality from cerebrovascular diseases was increased during the treatment period (HR 3.18, 95% CI 1.03–9.87) and decreased during the post-treatment period (HR 0.60, 95% CI 0.40–0.90), with a significant difference in HR between the periods of follow-up (P=0.0066). Similar significant differences in HR were obtained when the data were not censored for contralateral breast cancer or any recurrence (data not shown).

Bottom Line: Tamoxifen has been associated with an increased risk of stroke.There is, however, little information on the effect in the post-treatment period.In an adjuvant setting, tamoxifen was associated with an increased risk of cerebrovascular disease during treatment, but a decreased risk in the post-treatment period.

View Article: PubMed Central - PubMed

Affiliation: Oncologic center, Linköping University Hospital, S-581 85 Linköping, Sweden. johan.rosell@lio.se

ABSTRACT

Background: Tamoxifen has been associated with an increased risk of stroke. There is, however, little information on the effect in the post-treatment period. Using data from the Swedish Breast Cancer Group adjuvant trial of 5 vs 2 years of tamoxifen treatment, we now report both short-term and long-term effects on morbidity as well as mortality because of cerebrovascular disease.

Methods: Data from the Swedish National Hospital Discharge Registry combined with information from the Swedish Cause of Death Registry was used to define events of disease. Hazard ratios (HRs) were estimated using Cox regression.

Results: Comparing patients randomised to 5 years of tamoxifen with patients randomised to 2 years of tamoxifen, the incidence of cerebrovascular diseases was increased (HR 1.70, 95% CI 1.05-2.75) during the active treatment phase and reduced after the active treatment period (HR 0.78, 95% CI 0.63-0.96), and the difference in HR between the two time-periods was significant (P=0.0033). The mortality from cerebrovascular diseases was increased during the treatment period (HR 3.18, 95% CI 1.03-9.87) and decreased during the post-treatment period (HR 0.60, 95% CI 0.40-0.90) with a significant difference in HR between the two periods of follow-up (P=0.0066). Similar results were seen for subgroups of cerebrovascular diseases, such as stroke and ischaemic stroke.

Conclusion: In an adjuvant setting, tamoxifen was associated with an increased risk of cerebrovascular disease during treatment, but a decreased risk in the post-treatment period.

Show MeSH
Related in: MedlinePlus