Breast Cancer Drug Tamoxifen Saves Lives, Medical Costs:
MONDAY, March 14 (HealthDay News) -- For certain women at
increased risk of breast cancer, tamoxifen can protect against the
disease for a decade after treatment ends, save lives and reduce
medical costs, new research suggests.
For years, women considered at increased risk of breast cancer
have taken tamoxifen as a preventive measure. But previous
cost-effectiveness research has only accounted for breast cancer
risk reduction while it is being taken, not after treatment
This new study shows that protection persists for 10 years after
"Whether a woman who meets these criteria should take tamoxifen is a personal decision that should be made with her doctor," said researcher Joyce Noah-Vanhoucke, a scientist at Archimedes Inc., an independent health-care modeling organization in San Francisco.
For the study, published online March 14 in the journal
Cancer, Noah-Vanhoucke and her colleagues constructed a computer model to simulate a population of postmenopausal women under age 55 in a virtual clinical trial that compared five years of tamoxifen treatment with no treatment.
The researchers assessed the effects tamoxifen, known as a
chemopreventative, would have on a woman's risk of breast cancer
for 10 years after that treatment ended.
Because tamoxifen therapy interferes with estrogenic activity,
it is effective against breast cancers known as estrogen
receptor-positive, which need estrogen to grow. In the model, 78
percent of breast cancers were ER-positive, reflecting real
Women in the model had a breast cancer risk score of 1.66
percent or higher as computed by the Gail model, a commonly used
risk-assessment tool. A score of 1.66 or more is termed
For instance, Noah-Vanhoucke said, a 54-year-old childless woman
who underwent menopause at age 52, started menstruating at age 15
and had two breast biopsies would be scored as high risk.
Among other factors, a woman who is childless or has her first
child after age 30 is at higher risk, as are women who menstruate
before age 12 or undergo late menopause (after 55), according to
the American Cancer Society.
Because age alone (60 and older) can make a woman high risk, the
researchers limited the study pool to women under 55, who are also
at lower risk of getting side effects linked with tamoxifen, such
as blood clots and a higher likelihood of endometrial cancer and
The researchers found that tamoxifen's benefits in reducing
breast cancer risk for 10 years after treatment stopped outweighed
the side effects. Tamoxifen prevented 29 breast cancer cases and
nine breast cancer deaths for every 1,000 women treated, the
For women with a score of 1.66 or higher, the benefits of breast
cancer prevention outweighed adverse side effects by a ratio of
Tamoxifen also saved $47,580 in health-care costs per 1,000
''To be able to prevent that many breast cancers for 1,000 women, I think it's a significant number to be prevented," said researcher Dr. Peter Alperin, vice president of medicine at Archimedes. Women are more interested in lives saved than cost savings, he added.
Dr. Harold Burstein, co-chair of the Endocrine Therapy for
Breast Cancer Update Committee for the American Society of Clinical
Oncology, reviewed the findings but was not involved in the
The study "puts a dollar value on the potential saving if one
were to have more widespread use of this drug," said Burstein, also
an associate professor of medicine at Harvard Medical School and
Dana-Farber Cancer Institute.
Until now, ''it has been very difficult'' to generate enthusiasm
for tamoxifen as a preventive agent, Burstein said.
In 2005, only .08 percent of U.S. women, aged 40 to 79, without
a personal history of breast cancer took tamoxifen as a preventive,
according to a report published in 2010 in
Cancer Epidemiology, Biomarkers & Prevention.
The new study and the cost modeling, Burstein said, "'will help
health-care policy specialists weigh the role of tamoxifen versus
other prevention strategies that may emerge."
To learn more about tamoxifen, visit the
U.S. National Cancer Institute.
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