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Home: Oncology Leader Commentary: Richard Margolese, MD

Click on the topic below for comments by Dr Richard Margolese to comment on. You will also find links to related articles and clinical trials.

Surgery and breast cancer
Philosophy of DCIS management
Excision alone for DCIS
DCIS subsets
Margins and DCIS
Is DCIS a surgical disease?
Tamoxifen for DCIS
NSABP DCIS trials
Tamoxifen: Prevention or delay of clinical onset of disease
Risk-benefits of tamoxifen for DCIS
Tamoxifen and venous thrombosis
Duration of preventive effect of tamoxifen
Mortality effects of tamoxifen in high-risk women
Raloxifene as chemoprevention

Tamoxifen and venous thrombosis

Interview with Neil Love, MD from Breast Cancer Update for Surgeons, Program 1 2000

Play Audio Below:

Women who’ve talked to me about tamoxifen and say, "Well, I don’t want to take tamoxifen. I’m worried about the blood clots. I am going to stick with my estrogens." Well, didn’t your doctor tell you that estrogens cause thromboembolic problems? The incidence of those problems is the same as it is with tamoxifen. It probably comes from the same characteristics of the molecule, and that’s why tamoxifen acts like an estrogen in so many of its other characteristics in the body. And, of course, gynecologists and family doctors never tell women about the side effects of estrogen: uterine cancer risks, which is not zero even with progestins, and so on. So it’s all a question of consent, information, and perspective. And one of the things I tell people is the risk of blood clots is the same as it is with birth control pills and the same as it is with estrogens. So that’s not to say that those are dangerous, that’s to say you don’t think of those things as dangerous, don’t think of these things as dangerous.

Relevant Articles:

Selective estrogen receptor modulators: Structure, function, and clinical use [Review].
Osborne, C. K. and Fuqua, S. A. W. Journal of Clinical Oncology. 18(17):3172-3186, 2000 Sep.

Differences in immunoreactivity of estrogen receptor (ER) in tamoxifen-sensitiveand -resistant breast carcinomas: preclinical and first clinical investigations.
Naundorf, H.; Jost-Reuhl, B.; Becker, M.; Reuhl, T.; Neumann, C., and Fichtner, I. (Reprint available from: Fichtner I Max Delbruck Ctr Mol Med Robert Rossle Str 10 D-13125 Berlin Germany).. Breast Cancer Research & Treatment. 60(1):81-92, 2000 Mar.

Development and characterization of a tamoxifen resistant breast carcinoma xenograft.
Naundorf, H.; Becker, M.; Lykkesfeldt, A. E.; Elbe, B.; Neumann, C.; Buttner, B., and Fichtner, I (Reprint available from: Fichtner I Max Delbruck Ctr Mol Med Robert Rossle Str 10 D-13092 Berlin Germany).. British Journal of Cancer. 82(11):1844-1850, 2000 Jun.

Combined treatment with buserelin and tamoxifen in premenopausal metastatic breast cancer: A randomized study.
Klijn, J. G. M.; Beex LVAM; Mauriac, L.; van Zijl, J. A.; Veyret, C.; Wildiers, J.; Jassem, J.; Piccart, M.; Burghouts, J.; Becquart, D.; Seynaeve, C.; Mignolet, F., and Duchateau, L. (Reprint available from: Klijn JGM Dr Daniel den Hoed Klin, Rotterdam Canc Inst, Dept Med Oncol Groene Hilledijk 301 NL-3075 EA Rotterdam Netherlands). Journal of the National Cancer Institute. 92(11):903-911, 2000 Jun 7.

Effects of high dose raloxifene in selected patients with advanced breast carcinoma.
Gradishar, W.; Glusman, J.; Lu, Y.; Vogel, C.; Cohen, F. J., and Sledge, G. W. Cancer. 88(9):2047-2053, 2000 May 1.

Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: A prospective long-term study using transvaginal ultrasound.
Gerber, B.; Krause, A.; Muller, H.; Reimer, T.; Kulz, T.; Makovitzky, J.; Kundt, G., and Friese, K. Journal of Clinical Oncology. 18(20):3464-3470, 2000 Oct 15.

Results of two or five years of adjuvant tamoxifen correlated to steroid receptor and S-phase levels.
Ferno, M.; Stal, O.; Baldetrop, B.; Hatschek, T.; Kallstrom, A. C.; Malmstrom, P.; Nordenskjold, B., and Ryden, S.. Breast Cancer Research & Treatment. 59(1):69-76, 2000 Jan.

Tamoxifen adjuvant treatment duration in early breast cancer: Initial results of a randomized study comparing short-term treatment with long-term treatment.
Delozier, T.; Spielmann, M.; Mace-Lesec'h, J.; Janvier, M.; Hill, C.; Asselain, B.; Julien, J. P.; Weber, B.; Mauriac, L.; Petit, J. C.; Kerbrat, P.; Malhaire, J. P.; Vennin, P.; Leduc, B., and Namer, M.. Journal of Clinical Oncology. 18(20):3507-3512, 2000 Oct 15.

Biomarkers and outcome after tamoxifen treatment in node-positive breast cancers from elderly women.
Daidone, M. G.; Luisi, A.; Martelli, G.; Benini, E.; Veneroni, S.; Tomasic, G.; De Palo G, and Silvestrini, R. (Reprint available from: Daidone MG Ist Nazl Studio & Cura Tumori Via Venezian 1 I-20133 Milan Italy). British Journal of Cancer. 82(2):270-277, 2000 Jan.

Effect of adjuvant tamoxifen on the endometrium in women with breast cancer: A prospective study using office endometrial biopsy.
Barakat, R. R.; Gilewski, T. A.; Almadrones, L.; Saigo, P. E.; Venkatraman, E.; Hudis, C., and Hoskins, W. J. Journal of Clinical Oncology. 18(20):3459-3463, 2000 Oct 15.

Surveillance for uterine abnormalities in tamoxifen-treated breast carcinoma survivors - A community-based study.
Althuis, M. D.; Sexton, M.; Langenberg, P.; Bush, T. L.; Tkaczuk, K.; Magaziner, J., and Khoo, L. Cancer. 89(4):800-810, 2000 Aug 15.

Similarities and distinctions in the mode of action of different classes of antioestrogens [Review].
Wakeling, A. E. Endocrine-Related Cancer. 7(1):17-28, 2000 Mar. No abstract

Approaches targeted to estrogen receptors for treatment of tamoxifen-resistant breast cancer: A brief overview.
Terakawa, N. (Reprint available from: Terakawa N Tottori Univ, Sch Med, Dept Obstet & Gynecol Yonago Tottori 683 Japan).. Oncology. 59(Suppl 1):3-4, 2000. No abstract

Preliminary assessment of cognitive function in breast cancer patients treated with tamoxifen.
Paganini-Hill, A. and Clark, L. J. Breast Cancer Res.earch & Treatment. 64(2):165-176, 2000 Nov.

Symposium overview: Estrogens and antiestrogens in managing the patient with breast cancer.
Newman, L. A.; Wood, W. C.; Sellin, R. V.; Morrow, M.; Vogel, C., and Singletary, S. E. (Reprint available from: Singletary SE Univ Texas, MD Anderson Canc Ctr, Dept Surg Oncol 1515 Holcombe Blvd,Box 106 Houston, TX 77030 USA).. Annals of Surgical Oncology. 7(8):568-574, 2000 Sep. In process

The ovary: cysts, screening, and tamoxifen.
Mourits, M. J. E.; van der Zee, A. G. J.; Willemse, P. H. B., and de Vries, E. G. E. (Reprint available from: de Vries EGE Univ Groningen Hosp, Dept Med Oncol POB 30 001 NL-9700 RB Groningen Netherlands). Lancet. 355(9220):2078-2079, 2000 Jun 10.

Concentrations of tamoxifen and its major metabolites in hormone
responsive and resistant breast tumours.
MacCallum, J.; Cummings, J.; Dixon, J. M., and Miller, W. R. (Reprint available from: MacCallum J Napier Univ, Dept Life Sci Merchiston Campus,Colinton Rd Edinburgh EH10 5DT Midlothian Scotland).. British Journal of Cancer. 82(10):1629-1635, 2000 May.

How is tamoxifen's action subverted?
Jordan, V. C. (Reprint available from: Jordan VC Northwestern Univ, Sch Med, Rober H Lurie Comprehens Canc Ctr 303 E Chicago Ave,Olson Pavil 8258 Chicago, IL 60611 USA). Journal of the National Cancer Institute. 92(2):92-94, 2000 Jan 19. No abstract

Serum lipid levels during and after adjuvant toremifene or tamoxifen therapy for breast cancer.
Joensuu, H.; Holli, K.; Oksanen, H., and Valavaara, R. (Reprint available from: Joensuu H Univ Helsinki, Cent Hosp, Dept Oncol Haartmaninkatu 4,POB 180 FIN-00029 Helsinki Finland). Breast Cancer Research & Treatment. 63(3):225-234, 2000 Oct. In process

One step forward or one step back with tamoxifen?
Gelmon, K. (Reprint available from: Gelmon K British Columbia Canc Agcy Vancouver BC V5Z 4E6 Canada). Lancet. 356(9233):868-869, 2000 Sep 9. No abstract

Endometrial protection from tamoxifen-stimulated changes by a evonorgestrel-releasing intrauterine system: a randomised controlled trial.
Gardner, F. J. E.; Konje, J. C.; Abrams, K. R.; Brown, L. J. R.; Khanna, S.; Al-Azzawi, F.; Bell, S. C., and Taylor, D. J.. Lancet. 356(9243):1711-1717, 2000 Nov 18. No abstract

Combined endocrine therapy for breast cancer - New life for an old idea?
Davidson, N. E. (Reprint available from: Davidson NE Johns Hopkins Oncol Ctr 1650 Orleans St, Rm 409 Baltimore, MD 21231 USA). Journal of the National Cancer Institute. 92(11):859-860, 2000 Jun 7. No abstract

Risk and prognosis of endometrial cancer after tamoxifen for breast cancer.
Bergman, L.; Beelen, M. L. R.; Gallee, M. P. W.; Hollema, H.; Benraadt, J., and van LeeuwenF. E.. Lancet. 356(9233):881-887, 2000 Sep 9. IN PROCESS

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