Monday, August 1, 2011

Breast Cancer News (8/1): Tamoxifen, Screening and Race

Deja vu in breast cancer news? Didn't we discuss tamoxifen, screening mammography and race last week? Although the topics seem familiar, today's studies approach these issues from different directions.

Long-term efficacy of tamoxifen to prevent recurrence

Last week, we highlighted a study on the side effects of tamoxifen when used to prevent breast cancer (July 29 blog.) Today, we'll look at the latest research on adjuvant tamoxifen to prevent breast cancer recurrence. Links to the studies and news below may be found on the tamoxifen page of our website.

Back in March, a Journal of Clinical Oncology study found that, for women over 50, 5 years of tamoxifen reduced the risk of recurrence 15 years after starting treatment. It also reduced the risk of cardiovascular disease and death. US News and World Report/HealthDay, Vancouver Sun and Medical News Today all covered the study.

On Friday, a review in The Lancet Oncology analyzed patient data from 20 trials of tamoxifen. The simple conclusion was that "5 years of adjuvant tamoxifen safely reduces 15-year risks of breast cancer recurrence and death" for women with estrogen receptor positive breast cancer. Media coverage included stories in US News and World Report/HealthDay and Medical News Today and a written story and video by ABC News.

The study, however, was anything but simple. It was a complex statistical analysis, which considered the risk of fatal side effects, variations in estrogen receptor status, risk by time period and absolute risks without tamoxifen.

Kathleen Kolb, author of the blog, read the full text of the study with a critical eye. Her piece, Tamoxifen Efficacy Revisited: Behind The Hype delves into the details of the statistical findings in search of practical meaning. For those interested in adjuvant tamoxifen, her analysis is an additional resource.

More fuel in the screening mammography debate

Last week, we looked at a study on mammography and the use of computer-aided detection (July 28 blog). This week, a British Medical Journal study evaluated whether screening mammography affects mortality, adding more fuel to the debate on when to start and how often to have a screening mammogram.

What's the issue? In one corner, advocates of yearly screening starting at age 40 argue that early detection saves lives. In the other corner, opponents argue that for women in their 40s with average risk, the benefits of annual screening mammography are small and not worth the exposure to radiation and high rates of false positives, which result in higher anxiety and unnecessary follow-up procedures. They question the relationship between screening mammography and breast cancer mortality.

There is research to support both sides. The screening mammography page of our website has many pages of news and study links. Recently, a June 28 Swedish study in Radiology found that an invitation to screening mammography resulted in a "highly significant decrease in breast cancer-specific mortality."

The July 28 British Medical Journal study reached an opposite conclusion. (Follow the link for the full text of the study.) The study compared breast cancer mortality rates for pairs of European countries which implemented breast cancer screening programs at different times. Using World Health Organization (WHO) data, the analysis suggested that "screening did not play a direct part in the reductions of breast cancer mortality." US News and World Report/HealthDay and Reuters both covered the study.

We'll continue to follow the controversy and highlight the latest research.

Racial differences in receipt of breast cancer treatment

On July 26, we discussed three studies which failed to explain why African American women with advanced breast cancer tend to have a worse prognosis than Caucasian women. On July 29, Reuters covered a July 15 study in Cancer which approached this issue from a different angle.

The study authors acknowledged the racial difference in mortality rates and examined if there were racial differences in treatment received by women with the same health insurance. The women in the study were all covered by the Department of Defense Military Health System. Results showed no statistical difference in type of surgery received - mastectomy or breast conserving surgery plus radiation. For women with "local stage tumors," African Americans were just as likely as Caucasians to receive chemotherapy and hormonal therapy. However, for women with "regional stage tumors," or advanced breast cancer, African Americans were significantly less likely than Caucasians to receive chemotherapy and hormonal therapy.

Questions remain as to why the treatments were different. Were the options not offered? Were they offered and rejected? Further studies are needed to address the disparity.

Please check back tomorrow for more breast cancer news and research updates from As always, all the latest news and research on any breast cancer test, treatment option or complementary therapy may be found on the treatment pages of our website anytime.

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