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Home: Oncology Leader Commentary: Sir Richard Peto, MD

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

2000 meta-analysis
Tamoxifen in younger women
Tamoxifen plus chemotherapy
Tamoxifen and second cancers
Tamoxifen in ER-negative patients
Duration of tamoxifen
ATLAS trial; Adjuvant Tamoxifen Longer Against Shorter
Breast cancer recurrence in the second decade after diagnosis
Declining breast cancer mortality rates
Effects of local therapy on breast cancer mortality


Breast cancer recurrence in the second decade after diagnosis

Interview with Neil Love, MD Breast Cancer Update for Medical Oncologists, Program 6 2000

Play Audio Below:

You can get quite a lot of recurrence of the original primary more than 10 years after diagnosis. It’s a disease that can lay quiescent for five, 10, 15 years, and then come back. So, yes, there’s some second primaries in that second decade, but there’s also some recurrences of the original primary. Rather curious. It’s a very weird disease. There’s no other cancer like it — prostate is a bit like it — but really it’s not like most other cancers. Most cancers, if you’re really free of disease five years down the line, you’re probably cured. Breast cancer can come back later, and we’ve really got to be thinking of treatment strategies that provide protection not only in the first decade after diagnosis, but also in the second decade after diagnosis. And when you think on that time scale, then the ten years of tamoxifen versus five years of tamoxifen becomes rather more interesting. It's an unanswered question, and I think it’s actually a very interesting question. I’m quite optimistic that longer hormonal therapy can provide even greater benefit. Ten years might provide even greater benefit than five years, it might do. But that really is a research question, which isn’t answered yet. What we do know is that at least five years of hormonal treatment is very important to protect the women with ER+ disease and that we no longer have any indication from the randomized trials of any adverse effect of continuing beyond that.

Relevant Articles

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.

Relevant Clinical Trials:

Phase III Study of Prolonged Adjuvant Tamoxifen for Curatively Treated Breast Cancer

Phase III Randomized Study of Letrozole Versus Placebo in Women with Resected Breast Cancer After Completion of Treatment with Adjuvant Tamoxifen

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