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Adherence and discontinuation of adjuvant hormonal therapy in breast cancer patients: a population-based study.

https://arctichealth.org/en/permalink/ahliterature127527
Source
Breast Cancer Res Treat. 2012 May;133(1):367-73
Publication Type
Article
Date
May-2012
Author
Annette Wigertz
Johan Ahlgren
Marit Holmqvist
Tommy Fornander
Jan Adolfsson
Henrik Lindman
Leif Bergkvist
Mats Lambe
Author Affiliation
Regional Cancer Centre, Uppsala University Hospital, 751 85 Uppsala, Sweden. Annette.Wigertz@akademiska.se
Source
Breast Cancer Res Treat. 2012 May;133(1):367-73
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Antineoplastic Agents, Hormonal - therapeutic use
Aromatase Inhibitors - therapeutic use
Breast Neoplasms - prevention & control
Chemotherapy, Adjuvant
Female
Humans
Logistic Models
Maintenance Chemotherapy
Medication Adherence - statistics & numerical data
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local - prevention & control
Neoplasms, Hormone-Dependent - prevention & control
Sweden
Tamoxifen - therapeutic use
Abstract
Adherence to long-term pharmacological treatment for chronic conditions is often less than optimal. Till date, a limited number of population-based studies have assessed adherence to adjuvant hormonal therapy in breast cancer, a therapy with proven benefits in terms of reductions of recurrence and mortality. We aimed to examine rates of adherence and early discontinuation in Sweden where prescribed medications are subsidized for all residents and made available at reduced out-of-pocket costs. Individual-level data were obtained from Regional Clinical Quality Breast Cancer Registers, the Swedish Prescribed Drug Register, and several other population-based registers. Multivariate logistic regression was used to analyze factors associated with adherence to prescribed medication for a period of 3 years. Between January 1 and December 31, 2005, 1,741 patients in central Sweden were identified with estrogen receptor positive breast cancer, and at least one prescription dispensation of either tamoxifen or an aromatase inhibitor. Of these women, 1,193 (69%) were fully adherent to therapy for 3 years (medication possession ratio of 80% or higher and a maximum of 180 days between refills). During the 3-year follow-up, 215 women (12%) had prematurely discontinued therapy. Adherence was positively associated with younger age, large tumor size, being married, and being born in the Nordic countries, while no clear association was observed with education or income. During the 3 years of follow-up, 31% of women were non-adherent to therapy. Further efforts must be undertaken to promote adherence over the entire recommended treatment period.
PubMed ID
22286315 View in PubMed
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Androgen blockade in prostate cancer in 2002: major benefits on survival in localized disease.

https://arctichealth.org/en/permalink/ahliterature186754
Source
Mol Cell Endocrinol. 2002 Dec 30;198(1-2):77-87
Publication Type
Article
Date
Dec-30-2002
Author
Fernand Labrie
Author Affiliation
Molecular Endocrinology and Oncology Research Center, Laval University Medical Center (CHUL), Laval University, 2705 Laurier Boulevard, Quebec City, Quebec, Canada G1V 4G2. fernand.labrie@crchul.ulaval.ca
Source
Mol Cell Endocrinol. 2002 Dec 30;198(1-2):77-87
Date
Dec-30-2002
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Androgen Antagonists - therapeutic use
Androgens - metabolism
Antineoplastic Agents, Hormonal - therapeutic use
Combined Modality Therapy
Humans
Male
Mass Screening
Middle Aged
Prostatic Neoplasms - diagnosis - drug therapy - metabolism - pathology
Quebec
Randomized Controlled Trials as Topic
Survival Rate
Time Factors
Treatment Outcome
Abstract
The last 20 years have witnessed major advances in the field of prostate cancer, both in terms of diagnosis and treatment. Using screening with PSA, 99% of prostate cancers can now be diagnosed at a clinically localized or potentially curable stage. Over a 11-year period starting in 1988, the Québec screening study performed among 45,000 men aged 45-80 years has shown that the prostate cancer death incidence has decreased by 64% in men who had screening. The impact of screening, however, requires early application of the most efficacious treatments. In this context, the most important recent therapeutic advance in the field of prostate cancer is androgen blockade, namely medical castration with LHRH agonists, the availability of pure antiandrogens and combined androgen blockade (CAB) using medical or surgical castration in association with a pure antiandrogen. In the six studies performed in localized or locally advanced disease, the improved cancer-specific survival ranges between 37 and 81% at 5 years of follow-up for patients who received androgen blockade. On the other hand, data already available show that long term and continuous (not intermittent) androgen blockade is highly efficient and can achieve long term control or possible cure of localized prostate cancer.
PubMed ID
12573817 View in PubMed
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Association of tamoxifen with meningioma: a population-based study in Sweden.

https://arctichealth.org/en/permalink/ahliterature276427
Source
Eur J Cancer Prev. 2016 Jan;25(1):29-33
Publication Type
Article
Date
Jan-2016
Author
Jianguang Ji
Jan Sundquist
Kristina Sundquist
Source
Eur J Cancer Prev. 2016 Jan;25(1):29-33
Date
Jan-2016
Language
English
Publication Type
Article
Keywords
Aged
Antineoplastic Agents, Hormonal - therapeutic use
Breast Neoplasms - drug therapy - pathology
Female
Follow-Up Studies
Humans
Incidence
Meningeal Neoplasms - epidemiology - pathology - prevention & control
Meningioma - epidemiology - pathology - prevention & control
Middle Aged
Neoplasm Staging
Prognosis
Risk assessment
Sweden - epidemiology
Tamoxifen - therapeutic use
Abstract
Previous studies suggest that hormone therapy may play an important role in the development of meningioma. However, it is unclear whether medication with tamoxifen can prevent meningioma. Our study cohort included all women who were diagnosed with breast cancer between 1961 and 2010, and a total of 227?535 women were identified with breast cancer with a median age at diagnosis of 63 years. Women diagnosed with breast cancer after 1987 were defined as tamoxifen exposed; those diagnosed with breast cancer before or during 1987 were defined as not exposed to tamoxifen. Standardized incidence ratios (SIRs) were used to calculate the risk of subsequent meningioma. Of these women, 223 developed meningioma. For women without tamoxifen exposure, the risk of meningioma was significantly increased, with an SIR of 1.54 (95% confidence interval 1.30-1.81); the risk was not increased in those with tamoxifen exposure (SIR=1.06, 95% confidence interval 0.84-1.32). The increased risk of meningioma in women without tamoxifen exposure persisted during 10 years of follow-up. In this historical cohort study, we found that women diagnosed with breast cancer but not treated with tamoxifen had an increased incidence of meningioma, whereas the incidence was close to that of the general population in patients treated with tamoxifen. This suggests that tamoxifen may prevent the development of meningioma.
PubMed ID
25642792 View in PubMed
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Breast cancer recurrence risk related to concurrent use of SSRI antidepressants and tamoxifen.

https://arctichealth.org/en/permalink/ahliterature98055
Source
Acta Oncol. 2010 Apr;49(3):305-12
Publication Type
Article
Date
Apr-2010
Author
Timothy L Lash
Deirdre Cronin-Fenton
Thomas P Ahern
Carol L Rosenberg
Kathryn L Lunetta
Rebecca A Silliman
Stephen Hamilton-Dutoit
Jens Peter Garne
Marianne Ewertz
Henrik Toft Sørensen
Lars Pedersen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. tl@dce.au.dk
Source
Acta Oncol. 2010 Apr;49(3):305-12
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antidepressive Agents, Second-Generation - administration & dosage - adverse effects
Antineoplastic Agents, Hormonal - therapeutic use
Breast Neoplasms - epidemiology - prevention & control
Citalopram - administration & dosage - adverse effects
Cytochrome P-450 CYP2D6 - antagonists & inhibitors
Denmark - epidemiology
Depression - drug therapy
Estrogen Receptor Modulators - therapeutic use
Female
Humans
Middle Aged
Neoplasm Recurrence, Local - epidemiology - prevention & control
Registries
Risk assessment
Risk factors
Serotonin Uptake Inhibitors - administration & dosage - adverse effects
Tamoxifen - therapeutic use
Abstract
BACKGROUND: Up to one-quarter of breast cancer patients suffer clinically significant depression in the year after diagnosis, which may respond to intervention. About half may be prescribed a psychotropic medication, such as a selective serotonin reuptake inhibitor (SSRI), while completing breast cancer therapy. Cytochrome P-450 2D6 (CYP2D6) metabolizes SSRIs and also metabolizes tamoxifen to more active forms. Therefore, concurrent use of SSRIs may reduce tamoxifen's effectiveness at preventing breast cancer recurrence. The SSRI citalopram has limited potency to inhibit CYP2D6 activity, so has been recommended for breast cancer patients taking tamoxifen. This study provides epidemiologic evidence to support this recommendation. MATERIAL AND METHODS: We conducted a case-control study of breast cancer recurrence nested in the population of female residents of Denmark who were diagnosed with non-metastatic estrogen-receptor positive breast cancers between 1994 and 2001 and who took tamoxifen for at least one year. We ascertained complete prescription histories by linking cases' and controls' civil registration numbers to the Danish national prescription registry. We estimated the association between SSRI use while taking tamoxifen and risk of recurrent breast cancer. RESULTS: About the same proportion of recurrent cases (37 of 366) and matched controls (35 of 366) received at least one prescription for citalopram or its s-stereoisomer while taking tamoxifen (adjusted odds ratio = 1.1, 95% confidence interval = 0.7, 1.7). Breast cancer patients taking other SSRIs were also at no increased risk of recurrence (adjusted odds ratio = 0.9, 95% confidence interval = 0.5, 1.8). DISCUSSION: Breast cancer patients with indications for an SSRI may be prescribed citalopram - and possibly other SSRI - without adversely affecting the outcome of adjuvant therapy with tamoxifen.
PubMed ID
20156115 View in PubMed
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Breast cancer treatment and chemoprevention.

https://arctichealth.org/en/permalink/ahliterature201054
Source
Can Fam Physician. 1999 Aug;45:1917-24
Publication Type
Article
Date
Aug-1999
Author
C A Kotwall
Author Affiliation
Department of Surgery, University of North Carolina at Chapel Hill, USA. canuck@med.unc.edu
Source
Can Fam Physician. 1999 Aug;45:1917-24
Date
Aug-1999
Language
English
Publication Type
Article
Keywords
Anticarcinogenic Agents - therapeutic use
Antineoplastic Agents, Hormonal - therapeutic use
Breast Neoplasms - diagnosis - mortality - prevention & control - surgery
Canada - epidemiology
Evidence-Based Medicine
Family Practice
Female
Humans
Mastectomy, Segmental
Patient Selection
Radiotherapy, Adjuvant
Survival Analysis
Tamoxifen - therapeutic use
Treatment Outcome
Abstract
To outline modern principles of surgery, radiation therapy, and systemic treatment of breast cancer, and to review preliminary data on breast cancer prevention.
A MEDLINE search was conducted from 1966 to the beginning of 1999; most of the studies reviewed are randomized clinical trials.
Breast conservation surgery should be offered to all women with early breast cancer because studies demonstrate survival rates equivalent to those with mastectomy. If mastectomy is chosen, breast reconstruction should be offered. Most women with breast cancer are treated systemically with either chemotherapy or tamoxifen, or both, and mortality is substantially reduced. Data indicating that tamoxifen prevents breast cancer are promising; more studies with both tamoxifen and raloxifene are under way. All women should be strongly encouraged to enter clinical trials.
Because many issues face women recently diagnosed with breast cancer, they often seek out family physicians as advisors to help negotiate a complex treatment path. The possibility of preventing breast cancer will undoubtedly raise questions among family members of women with breast cancer that should appropriately be answered and referred, if necessary, by family physicians.
Notes
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Comment In: Can Fam Physician. 1999 Aug;45:1849-5410463080
PubMed ID
10463092 View in PubMed
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Breast cancer treatment and ethnicity in British Columbia, Canada.

https://arctichealth.org/en/permalink/ahliterature144089
Source
BMC Cancer. 2010;10:154
Publication Type
Article
Date
2010
Author
Parvin Yavari
Maria Cristina Barroetavena
T Greg Hislop
Chris D Bajdik
Author Affiliation
BC Cancer Agency, Vancouver, BC, Canada.
Source
BMC Cancer. 2010;10:154
Date
2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antineoplastic Agents, Hormonal - therapeutic use
Asia - ethnology
Asian Continental Ancestry Group - statistics & numerical data
Breast Neoplasms - diagnosis - ethnology - therapy
British Columbia - epidemiology
Chemotherapy, Adjuvant - statistics & numerical data
Chi-Square Distribution
China - ethnology
Cultural Characteristics
Female
Healthcare Disparities - statistics & numerical data
Humans
Iran - ethnology
Logistic Models
Mastectomy - statistics & numerical data
Middle Aged
Neoplasm Staging
Physician's Practice Patterns - statistics & numerical data
Radiotherapy, Adjuvant - statistics & numerical data
Registries
Time Factors
Treatment Outcome
Abstract
Racial and ethnic disparities in breast cancer incidence, stage at diagnosis, survival and mortality are well documented; but few studies have reported on disparities in breast cancer treatment. This paper compares the treatment received by breast cancer patients in British Columbia (BC) for three ethnic groups and three time periods. Values for breast cancer treatments received in the BC general population are provided for reference.
Information on patients, tumour characteristics and treatment was obtained from BC Cancer Registry (BCCR) and BC Cancer Agency (BCCA) records. Treatment among ethnic groups was analyzed by stage at diagnosis and time period at diagnosis. Differences among the three ethnic groups were tested using chi-square tests, Fisher exact tests and a multivariate logistic model.
There was no significant difference in overall surgery use for stage I and II disease between the ethnic groups, however there were significant differences when surgery with and without radiation were considered separately. These differences did not change significantly with time. Treatment with chemotherapy and hormone therapy did not differ among the minority groups.
The description of treatment differences is the first step to guiding interventions that reduce ethnic disparities. Specific studies need to examine reasons for the observed differences and the influence of culture and beliefs.
Notes
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PubMed ID
20406489 View in PubMed
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Breast cancer treatment and older women.

https://arctichealth.org/en/permalink/ahliterature201362
Source
CMAJ. 1999 Jul 13;161(1):15
Publication Type
Article
Date
Jul-13-1999

[Breast density: a biomarker to better understand and prevent breast cancer].

https://arctichealth.org/en/permalink/ahliterature167463
Source
Bull Cancer. 2006 Sep;93(9):847-55
Publication Type
Article
Date
Sep-2006
Author
Jacques Brisson
Sylvie Bérubé
Caroline Diorio
Author Affiliation
Unité de recherche en santé des populations (URESP), Centre hospitalier affilié universitaire de Québec, 1050 chemin Sainte-Foy, Québec, Qc, Canada G1S 4L8. jacques.brisson@uresp.ulaval.ca
Source
Bull Cancer. 2006 Sep;93(9):847-55
Date
Sep-2006
Language
French
Publication Type
Article
Keywords
25-Hydroxyvitamin D 2 - blood
Antineoplastic Agents, Hormonal - therapeutic use
Breast - drug effects - pathology
Breast Neoplasms - blood - pathology - prevention & control
Calcium, Dietary - administration & dosage - blood
Female
Humans
Mammography
Polymorphism, Genetic
Premenopause
Quebec
Receptors, Calcitriol - genetics
Risk assessment
Somatomedins - genetics - metabolism
Tamoxifen - therapeutic use
Tumor Markers, Biological - blood
Vitamin D - administration & dosage - analogs & derivatives - blood
Abstract
In Quebec, cancer is the principal cause of mortality. This epidemiologic research program includes two components. The first component takes place at the "Institut national de santé publique du Québec" and involves surveillance and evaluation of practices in oncology with the aim of providing the Quebec Ministry of Health with some of the evidence needed to determine its policies in cancer control. The second component takes place at the "Unité de recherche en santé des populations (URESP)" of Laval University and is devoted to studying the etiology and prevention of breast cancer. This paper focuses on this second research component which uses mammographic breast density as an intermediate biomarker to study the causes of breast cancer and strategies to prevent it. Breast cancer risk is much higher among women with very dense breasts than among those with little or no breast density. Recently, we were among the first to show that women with high vitamin D or calcium intakes have less breast density than those with low intakes, especially among premenopausal women. Furthermore, we have confirmed that breast density was increased among premenopausal women with high levels of IGF-I and low levels of IGFBP3 which is consistent with the observed effect of these molecules on breast cancer risk. Studies are now being conducted to assess whether breast density varies according to blood levels of vitamin D and of additional growth factors, as well as to genetic polymorphisms involved in the pathways of vitamin D, calcium and growth factors. The increase in vitamin D and calcium intakes may prove to be a safe and inexpensive approach to breast cancer prevention; this possibility should be carefully examined as quickly as possible.
PubMed ID
16980227 View in PubMed
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c-erbB-2 positivity is a factor for poor prognosis in breast cancer and poor response to hormonal or chemotherapy treatment in advanced disease.

https://arctichealth.org/en/permalink/ahliterature19966
Source
Eur J Cancer. 2001 Feb;37(3):347-54
Publication Type
Article
Date
Feb-2001
Author
A. Jukkola
R. Bloigu
Y. Soini
E R Savolainen
K. Holli
G. Blanco
Author Affiliation
Department of Oncology, University of Oulu, Finland.
Source
Eur J Cancer. 2001 Feb;37(3):347-54
Date
Feb-2001
Language
English
Publication Type
Article
Keywords
Antineoplastic Agents, Hormonal - therapeutic use
Blotting, Southern
Breast Neoplasms - drug therapy - genetics - metabolism
Disease-Free Survival
Female
Genes, erbB-2 - genetics
Humans
Immunohistochemistry
Polymerase Chain Reaction - methods
Prognosis
Receptor, erbB-2 - metabolism
Regression Analysis
Retrospective Studies
Treatment Outcome
Abstract
The aim of this work was to evaluate the prognostic and predictive values of c-erbB-2 in breast cancer. 650 patients were enrolled. The amplification/overexpression of c-erbB-2 from fresh frozen or paraffin-embedded breast tumour tissue samples was analysed by polymerase chain reaction (PCR) technique (75%), immunohistochemically (17%) or by Southern blot analysis (8%). 126 patients (19%) were positive for c-erbB-2. 148 patients developed metastatic disease, but only 35 were positive for c-erbB-2. Positivity for c-erbB-2 was significantly associated with node positivity, large tumour size, high grade of malignancy, low receptor status, postmenopausal status, and with a shorter overall survival. In multivariate regression analysis, only tumour size and nodal involvement were risk factors for poor survival when analysed separately together with c-erbB-2 and receptor status. Metastatic patients with c-erbB-2 positivity had a significantly shorter survival and disease-free survival (DFS) than the c-erbB-2-negative patients. 29 advanced patients with c-erbB-2 positivity showed a poor response rate to hormonal, non-anthracycline-based and anthracycline-based therapies. Positivity for the c-erbB-2 is a poor prognostic factor in breast cancer, but it also emerges as predictive of the response to hormonal or chemotherapy treatment once the disease has recurred.
PubMed ID
11239756 View in PubMed
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Chemoprevention: drug pricing and mortality: the case of tamoxifen.

https://arctichealth.org/en/permalink/ahliterature168200
Source
Cancer. 2006 Sep 1;107(5):950-8
Publication Type
Article
Date
Sep-1-2006
Author
Joy Melnikow
Christina Kuenneth
L Jay Helms
Amber Barnato
Miriam Kuppermann
Stephen Birch
James Nuovo
Author Affiliation
Department of Family and Community Medicine, University of California-Davis, Sacramento, California 95817, USA. jamelnikow@ucdavis.edu
Source
Cancer. 2006 Sep 1;107(5):950-8
Date
Sep-1-2006
Language
English
Publication Type
Article
Keywords
Anticarcinogenic Agents - economics - therapeutic use
Antineoplastic Agents, Hormonal - therapeutic use
Breast Neoplasms - drug therapy - economics - mortality - prevention & control
Canada
Cost-Benefit Analysis
Endometrial Neoplasms - chemically induced
Female
Humans
Markov Chains
Middle Aged
Monte Carlo Method
Neoplasms, Hormone-Dependent - economics
Risk
Tamoxifen - adverse effects - economics - therapeutic use
Time Factors
United States
Abstract
Tamoxifen is a prototypic cancer chemopreventive agent, yet clinical trials have not evaluated its effect on mortality or the impact of drug pricing on its cost-effectiveness.
A state-transition Markov model for a hypothetical cohort of women age 50 years was used to evaluate the effects of tamoxifen on mortality and tamoxifen price on cost-effectiveness. Incidence and mortality rates for breast and endometrial cancers were derived from Surveillance, Epidemiology and End Results statistics, and noncancer outcomes were obtained from published studies. Relative risks of outcomes were derived from the National Surgical Adjuvant Breast and Bowel Project P-1 trial. Costs were based on Medicare reimbursements.
Projected overall mortality for women at 1.67% 5-year breast cancer risk showed little difference with or without tamoxifen, resulting in a cost-effectiveness ratio of $1,335,690 per life-year saved as a result of tamoxifen use. Adjusting for the differential impact of estrogen receptor-negative cancers, tamoxifen increased mortality for women with a uterus until the 5-year breast cancer risk reached > or =2.1%. Assigning the Canadian price for tamoxifen dramatically reduced the incremental cost (to $123,780 per life-year saved). At that price, the use of tamoxifen was less costly and more effective for women with 5-year breast cancer risks >4%.
Tamoxifen may increase mortality in women at the lower end of the "high-risk" range for breast cancer. If prices in the U.S. approximated Canadian prices, then tamoxifen use for breast cancer risk reduction in women with a 5-year risk >3% could be a reasonable strategy to reduce the incidence of breast cancer. Because they are used by many unaffected individuals, the price of chemopreventive agents has a major influence on their cost-effectiveness.
PubMed ID
16865680 View in PubMed
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86 records – page 1 of 9.