PMID- 23076938
OWN - NLM
STAT- MEDLINE
DCOM- 20121116
LR  - 20181221
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 10
DP  - 2012 Oct 17
TI  - Postoperative tamoxifen for ductal carcinoma in situ.
PG  - CD007847
LID - 10.1002/14651858.CD007847.pub2 [doi]
AB  - BACKGROUND: Ductal carcinoma in situ (DCIS) is a non-invasive carcinoma of the 
      breast. The incidence of DCIS has increased substantially over the last twenty 
      years, largely as a result of the introduction of population-based mammographic 
      screening. The treatment of DCIS tumours involves surgery with or without 
      radiotherapy to prevent recurrent DCIS and invasive carcinoma. However, there is 
      clinical uncertainty as to whether postoperative hormonal treatment (tamoxifen) 
      after surgery confers benefit in overall survival and incidence of recurrent 
      carcinoma. OBJECTIVES: To assess the effects of postoperative tamoxifen in women 
      having local surgical resection of DCIS. SEARCH METHODS: We searched the Cochrane 
      Central Register of Controlled Trials (CENTRAL, The Cochrane Library), the 
      Cochrane Breast Cancer Group's Specialised Register, and the World Health 
      Organization's International Clinical Trials Registry Platform (WHO ICTRP) on 16 
      August 2011. SELECTION CRITERIA: Published and unpublished randomised controlled 
      trials (RCTs) and quasi-randomised controlled trials comparing tamoxifen after 
      surgery for DCIS (regardless of oestrogen receptor status), with or without 
      adjuvant radiotherapy. DATA COLLECTION AND ANALYSIS: Two authors independently 
      assessed trial quality and extracted data. Statistical analyses were performed 
      using the fixed-effect model and the results were expressed as relative risks 
      (RRs) or hazard ratios (HRs) with 95% confidence intervals (CIs). MAIN RESULTS: 
      We included two RCTs involving 3375 women. Tamoxifen after surgery for DCIS 
      reduced recurrence of both ipsilateral (same side) DCIS (HR 0.75; 95% CI 0.61 to 
      0.92) and contralateral (opposite side) DCIS (RR 0.50; 95% CI 0.28 to 0.87). 
      There was a trend towards decreased ipsilateral invasive cancer (HR 0.79; 95% CI 
      0.62 to 1.01) and reduced contralateral invasive cancer (RR 0.57; 95% CI 0.39 to 
      0.83). The number needed to treat in order for tamoxifen to have a protective 
      effect against all breast events is 15. There was no evidence of a difference 
      detected in all cause mortality (RR 1.11; 95% CI 0.89 to 1.39). Only one study, 
      involving 1799 participants followed-up for 163 months (median) reported on 
      adverse events (i.e. toxicity, mood changes, deep vein thrombosis, pulmonary 
      embolism, endometrial cancer) with no significant difference between tamoxifen 
      and placebo groups, but there was a non-significant trend towards more 
      endometrial cancer in the tamoxifen group. AUTHORS' CONCLUSIONS: While tamoxifen 
      after local excision for DCIS (with or without adjuvant radiotherapy) reduced the 
      risk of recurrent DCIS (in the ipsi- and contralateral breast), it did not reduce 
      the risk of overall mortality.
FAU - Staley, Helen
AU  - Staley H
AD  - Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, 
      North Shields, UK.
FAU - McCallum, Iain
AU  - McCallum I
FAU - Bruce, Julie
AU  - Bruce J
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20121017
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Antineoplastic Agents, Hormonal)
RN  - 094ZI81Y45 (Tamoxifen)
SB  - IM
CIN - Int J Nurs Pract. 2014 Dec;20(6):685. PMID: 25532882
MH  - Antineoplastic Agents, Hormonal/*therapeutic use
MH  - Breast Neoplasms/*drug therapy/surgery
MH  - Carcinoma, Intraductal, Noninfiltrating/*drug therapy/surgery
MH  - Female
MH  - Humans
MH  - Neoplasm Recurrence, Local/prevention & control
MH  - Postoperative Care
MH  - Randomized Controlled Trials as Topic
MH  - Tamoxifen/*therapeutic use
EDAT- 2012/10/19 06:00
MHDA- 2012/12/10 06:00
CRDT- 2012/10/19 06:00
PHST- 2012/10/19 06:00 [entrez]
PHST- 2012/10/19 06:00 [pubmed]
PHST- 2012/12/10 06:00 [medline]
AID - 10.1002/14651858.CD007847.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2012 Oct 17;10:CD007847. doi: 
      10.1002/14651858.CD007847.pub2.