An expert panel of seven cancer researchers and a patient advocate
came together at the San Antonio Breast Cancer Symposium for a
roundtable discussion on tamoxifen (Nolvadex), sponsored by PRR,
Inc., publisher of Oncology News International and the journal
This report covers the first part of the discussion on the
risks of secondary cancers with tamoxifen use. Subsequent reports
will focus on such subjects as the appropriate duration of tamoxifen
use and how to deal with side effects such as hot flashes and
SAN ANTONIO--"Tamoxifen is the endocrine therapy of choice
for selected patients with all stages of breast cancer,"
V. Craig Jordan, PhD, DSc, of Northwestern University Medical
School, said at the outset of the Tamoxifen Roundtable, which
he moderated. "We've seen clear-cut demonstration of its
biological efficacy in the clinic and, obviously, some troublesome
side effects as well," he said.
Dr. Jordan's first goal for the panel was to look at tamoxifen
use from the patient's point of view, and to help physicians put
the benefits and side effects into perspective for the patient.
Monica Morrow, MD, also of Northwestern, noted that patients'
concerns about tamoxifen have changed over the last 5 years. "Five
years ago, most patients' concerns were what I would consider
the primary and appropriate concern, namely, what will tamoxifen
do to keep me from dying of breast cancer."
More recently, she said, secondary to adverse publicity surrounding
the Breast Cancer Prevention Trial and the National Surgical Adjuvant
Breast and Bowel Project (NSABP) studies, the main issue now among
patients is side effects, primarily endometrial cancer, but also,
to a much lesser extent, liver cancer and, among premenopausal
women, the misconception that tamoxifen will induce premature
Amy Langer, executive director of NABCO, said that as knowledge
of a drug's benefits increases over the years, so does knowledge
of its side effects, and this is often what the media pick up.
"When women taking tamoxifen call us with concerns about
endometrial cancer, we stress the importance of routine gynecologic
surveillance," she said.