SAN ANTONIO--The risk-to-benefit ratio for the use of adjuvant
tam-oxifen therapy should be considered "outside of the narrow
confines of survival or death from metastatic breast cancer,"
Monica Morrow, MD, said at the tamoxifen roundtable.
For women with node-positive breast cancer, "the overwhelming
force of mortality is always the breast cancer," but in women
with smaller, node-negative breast cancers, other causes of mortality,
eg, cardiovascular disease, complications of osteoporosis, and
other cancers, are "a bigger issue," she said.
Dr. Morrow, director of the Comprehensive Breast Program at Northwestern
University Medical School, cited data suggesting that, besides
prevention of breast cancer recurrence, tamoxifen has additional
benefits that might impact on overall survival.
"Namely, it can lower cholesterol levels and reduce hospital
admissions for cardiovascular disease, as demonstrated in the
Stockholm trial," she said, "and, as shown in the Scottish
studies, even in older women, tamoxifen may reduce mortality from
On the other hand, Dr. Morrow noted, the recent overview analysis
of adjuvant tamoxifen from the Early Breast Cancer Trialists'
Collaborative Group failed to demonstrate a reduction in non-breast
cancer mortality with use of tamoxifen. I. Craig Henderson, MD,
of the University of California, San Francisco, said he was "a
little disconcerted" with the overview analysis results,
and he remains unconvinced that the current analysis provides
the final word on the subject.
He pointed out that the contributions of various trials to the
overview have not been analyzed. "For example," he said,
"the effect on cardiovascular and non-breast cancer mortality,
which was rather striking at the last overview analysis, may be
less so now because of the inclusion of many more trials with
V. Craig Jordan, PhD, DSc, of Northwestern University, who chaired
the tamoxifen roundtable, agreed with Dr. Henderson. He stated
that patients in many of the trials in the metaanalysis have not
necessarily used tamoxifen for 5 years, whereas the data on hormone
replacement therapy in postmenopausal women suggest that "longer
is better in regard to maintaining protection against cardiovascular