First do no harm: extending the debate on the provision of preventive tamoxifen
| Autor: | D. Logan, B P Will, Jean-Marie Berthelot, Michael Wolfson, William M. Flanagan, W K Evans, K M Nobrega |
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| Rok vydání: | 2001 |
| Předmět: |
Adult
Oncology Cancer Research medicine.medical_specialty Anastrozole Breast Neoplasms Risk Assessment Cataract breast cancer Breast cancer prevention Breast Cancer Prevention Trial Internal medicine Odds Ratio medicine Anticarcinogenic Agents Humans Risk factor skin and connective tissue diseases Aged Gynecology Clinical Trials as Topic tamoxifen business.industry Endometrial cancer Regular Article Middle Aged Models Theoretical Antiestrogen medicine.disease population health impacts Endometrial Neoplasms Cardiovascular Diseases Female microsimulation model Risk assessment business Tamoxifen Forecasting medicine.drug |
| Zdroj: | British Journal of Cancer |
| ISSN: | 1532-1827 0007-0920 |
| DOI: | 10.1054/bjoc.2001.2125 |
| Popis: | The Breast Cancer Prevention Trial (BCPT-P-1) demonstrated that tamoxifen could reduce the risk of invasive breast cancer in high-risk women by 49%, but that it could also increase the risk of endometrial cancer, vascular events and cataracts. This paper provides an estimate of the net health impacts of tamoxifen administration on high-risk Canadian women with no prior history of breast cancer. The results of the BCPT-P-1 were incorporated into the breast cancer and other modules of Statistics Canada’s microsimulation POpulation HEalth Model (POHEM). While the main intervention scenario conformed as closely as possible to the eligibility criteria for tamoxifen in the BCPT-P-1 protocol, 3 additional scenarios were simulated. Predicted absolute risks of breast cancer at 5 years of 1.66%, 3.32% and 4.15% were calculated for women 35 to 70 years of age. When the BCPT-P-1 results were incorporated into the simulation model, the analysis suggests no increase in life expectancy in this risk group. Tamoxifen appeared to be beneficial for women with a 5-year predicted risk of 3.32% or greater. The results of these simulations are particularly sensitive to the reduction in mortality observed in the BCPT-P-1, as well as being sensitive to other characteristics of the simulation model. Overall, the analysis raises questions about the use of tamoxifen in otherwise healthy women at high risk of breast cancer. © 2001 Cancer Research Campaign |
| Databáze: | OpenAIRE |
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