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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


Tamoxifen in younger women

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

Play Audio Below:

The new evidence — actually, the 1995 evidence, which is even clearer in the year 2000 — is that there’s some areas where tamoxifen really would be effective, where it’s still being underused. And the chief one is younger women.

The fact is that tamoxifen, if you had a young woman with receptor-positive disease or an older woman with receptor-positive disease, the benefits of tamoxifen are about the same, and they’re really quite substantial.

Now, if you’re producing an absolute difference of say 10 or 15 percent in the risk of recurrence — if you’re changing, say, a 40 percent risk of recurrence into a 30 percent risk or 25 percent risk — and this is long-term outcome — then doing this for a younger woman is actually more important than doing it for an older woman, because that young woman, if she’s 40, she could have 40 years of life ahead of her if the disease doesn’t come back, whereas, if you’re 60 or 70, you don’t have 40 years of life ahead of you. So, the absolute benefit of five years of tamoxifen is about as great in the younger woman with ER+ disease as in the older women with ER+ disease. The absolutely benefit in terms of 10-year outcome. But, because the younger woman’s got more years ahead of her, it’s actually more important. And yet, unfortunately, there’s still this tradition that some medical oncologists haven’t been using hormonal therapy in younger women. They’ve been using chemotherapy and then not following it with hormonal therapy, even if the woman had ER+ disease. And that does seem to be a mistake. I think it’s a long-established tradition. I think it’s a mistaken one.

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

Relevant Clinical Trials:

Study of Tamoxifen in the Prevention of Skeletal and Cardiovascular Morbidity of Adjuvant Chemotherapy in Premenopausal Women With Stage I or II Breast Cancer

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