FLORENCE, ItalyLong-term follow-up of node-negative
postmenopausal breast cancer patients has shown that using tamoxifen
(Nolvadex) as an adjunct to breast-conserving surgery and
postoperative radiotherapy markedly improves event-free survival in
these low-risk women.
The positive effect of avoiding salvage mastectomies,
re-excisions, and contralateral breast surgery justifies the use of
tamoxifen even in the low-risk group with an expected 10-year
survival rate of 90%, Kristina Dalberg, MD, of the Karolinska
Hospital, Stockholm, Sweden, said at the First European Breast Cancer
Conference. The 432 study subjects comprised a separate stratum of
the more than 2,700 women enrolled in the Stockholm Adjuvant
Tamoxifen trial. These largely estrogen-receptor (ER)-positive
patients were randomized to receive either tamoxifen, 40 mg/day for a
mean duration of 3.2 years, or no further treatment, and were
monitored for a median follow-up period of 8 years.
Ten-Year Event-Free Survival
Ten-year event-free survival was 80% among women treated with
tamoxifen, which was significantly greater than the 70% rate
documented among control patients.
This benefit stemmed from a 60% reduction in the relative hazard of
invasive or noninvasive ipsilateral breast cancer recurrence and a
similar drop in the incidence of contralateral breast tumor
development. Dr. Dalberg emphasized that the 3% 10-year rate of
ipsilateral recurrence observed among tamoxifen-treated enrollees in
the Stockholm study is one of the lowest reported to date.
Although there were trends suggesting a protective effect of
tamoxifen against distant metastases and death due to breast cancer,
the benefits failed to reach statistical significance.
The study investigators detected six cases of endometrial cancer
among tam-oxifen-treated women and two cases in control patients.
The Stockholm results raise the question of whether low-risk women
with node-negative, ER-positive breast cancer might be successfully
managed with tamoxifen instead ofrather than in addition