Lavie O, Barnett-Griness O, Narod S A, Rennert G
Department of Obstetrics & Gynecology, Division of Gynecology & Oncology, Carmel Medical Center, Haifa, Israel.
Int J Gynecol Cancer. 2008 Mar-Apr;18(2):352-6. doi: 10.1111/j.1525-1438.2007.01025.x.
The treatment of breast cancer with tamoxifen results in an increased risk of uterine cancer. The objective of this study was to evaluate the association between tamoxifen use and the risk of developing uterine sarcomas and endometrial carcinomas in a historical cohort of women diagnosed with breast cancer in 1987-1988. The medical records of all women diagnosed in Israel with breast cancer in the years 1987-1988 were sought. Clinical data, including use of hormone therapy, were extracted from oncology records. In 2004, patient identifiers were linked to the Israel Cancer Registry database to identify all uterine cancers that occurred within 15 years of the diagnosis of breast cancer. The records for 1507 breast cancer cases (84%) were retrieved. Among these cases, 32 uterine malignancies were identified; 11 occurred prior to the diagnosis of breast cancer and 21 occurred during the follow-up period. Eight hundred seventy-five women in the cohort had used tamoxifen (59%). There were 17 uterine cancers observed among the 875 exposed to tamoxifen (1.9%), compared to 4 uterine cancers among the 621 women (0.6%) who did not use tamoxifen (odds ratio = 3.1; 95% CI: 1.0-9.1; P = 0.04). There were four uterine sarcomas among the tamoxifen users, but none among nonusers (P = 0.15). Five of the 875 tamoxifen users (0.6%) died of uterine cancer, compared to no deaths among nonusers (P = 0.08). We conclude that in this national breast cancer cohort, tamoxifen use was associated with elevated risks of uterine cancer incidence and mortality. Uterine sarcomas appear to be overrepresented among women who use tamoxifen.
使用他莫昔芬治疗乳腺癌会增加患子宫癌的风险。本研究的目的是评估在1987 - 1988年被诊断为乳腺癌的女性历史队列中，使用他莫昔芬与发生子宫肉瘤和子宫内膜癌风险之间的关联。我们查找了1987 - 1988年在以色列被诊断为乳腺癌的所有女性的医疗记录。从肿瘤学记录中提取了包括激素治疗使用情况在内的临床数据。2004年，将患者标识符与以色列癌症登记数据库相链接，以识别在乳腺癌诊断后15年内发生的所有子宫癌。检索到了1507例乳腺癌病例（84%）的记录。在这些病例中，确定了32例子宫恶性肿瘤；11例发生在乳腺癌诊断之前，21例发生在随访期间。该队列中有875名女性使用了他莫昔芬（59%）。在875名使用他莫昔芬的女性中观察到17例子宫癌（1.9%），而在未使用他莫昔芬的621名女性中有4例子宫癌（0.6%）（比值比 = 3.1；95%可信区间：1.0 - 9.1；P = 0.04）。使用他莫昔芬的女性中有4例子宫肉瘤，而未使用者中无子宫肉瘤（P = 0.15）。875名使用他莫昔芬的女性中有5例（0.6%）死于子宫癌，而未使用者中无死亡病例（P = 0.08）。我们得出结论，在这个全国性乳腺癌队列中，使用他莫昔芬与子宫癌发病率和死亡率升高相关。子宫肉瘤在使用他莫昔芬的女性中似乎占比过高。
