Abstract:
Importance:Within 10 years after breast cancer diagnosis, roughly 5% of patients develop contralateral breast cancer (CBC). Randomized trials have found that therapy including tamoxifen citrate and aromatase inhibitors (AIs) reduces CBC risk. But little is known about the magnitude and duration of protective associations within the context of real-world clinical management settings, where varying durations of and gaps in treatment are common. Objective:To determine the association between adjuvant tamoxifen and AI therapy and CBC risk within a general community setting. Design, Setting, and Participants:A retrospective cohort study of CBC risk among 7541 patients diagnosed with a first primary unilateral invasive breast cancer at Kaiser Permanente Institute for Health Research (Colorado) or Kaiser Permanente Northwest Center for Health Research (Oregon) between January 1, 1990, and December 31, 2008. Data were analyzed from 1 year after diagnosis of the first breast cancer through the earliest of the following events: CBC diagnosis, other second cancer diagnosis, death, last tumor registry follow-up, exit from the Kaiser Permanente health care plan, or end of study follow-up (December 31, 2010, for Oregon and December 31, 2011, for Colorado). Exposures:Adjuvant tamoxifen use and AI therapy were treated as time-dependent exposures, assessed using electronic prescription records. Main Outcomes and Measures:Incident CBC based on long-term systematic follow-up. Results:Among 7541 women with invasive breast cancer, median age at initial breast cancer diagnosis was 60.6 years (age range, 24.9-84.9 years). Women were predominantly (92.9% [7009 of 7541]) of white race. During a median of 6.3 years (range, 1-20.9 years) of follow-up, 248 women developed CBC (45 in situ and 203 invasive). Contralateral breast cancer risk decreased significantly with increasing tamoxifen therapy duration. In current users, the relative risk (RR) per year of tamoxifen use was 0.76 (95% CI, 0.64-0.89), with an estimated 66% (RR, 0.34; 95% CI, 0.29-0.40) RR reduction for 4 years of use compared with nonusers. Risk reductions were slightly smaller for past users but were still significant at least 5 years after stopping tamoxifen therapy (RR per year of use, 0.85; 95% CI, 0.71-0.995). In addition, AI use without tamoxifen therapy was associated with reduced CBC risk (RR for AI users compared with nonusers, 0.48; 95% CI, 0.22-0.97). Risk reductions were most apparent among women whose primary and CBCs were estrogen receptor positive. Conclusions and Relevance:Tamoxifen therapy was associated with reduced CBC risk during treatment and after its cessation, with risk progressively decreasing as tamoxifen therapy duration increased. Among those surviving at least 5 years, tamoxifen use for at least 4 years was estimated to prevent 3 CBCs per 100 women by 10 years after an estrogen receptor-positive first breast cancer, an absolute risk reduction that is consistent with findings from clinical trials. If adjuvant endocrine therapy is indicated for breast cancer treatment, these findings in concert with trial data suggest that women should be encouraged to complete the full course.
journal_name
JAMA Oncoljournal_title
JAMA oncologyauthors
Gierach GL,Curtis RE,Pfeiffer RM,Mullooly M,Ntowe EA,Hoover RN,Nyante SJ,Feigelson HS,Glass AG,Berrington de Gonzalez Adoi
10.1001/jamaoncol.2016.3340subject
Has Abstractpub_date
2017-02-09 00:00:00pages
186-193issue
2eissn
2374-2437issn
2374-2445pii
2565154journal_volume
3pub_type
杂志文章相关文献
JAMA Oncology文献大全abstract:Importance:There are long-standing interests in the potential benefits of vitamin D for preventing breast cancer recurrence and mortality, yet data from prospective cohort studies are limited. Objective:To investigate a serum biomarker of vitamin D status, 25-hydroxyvitamin D (25OHD) measured at the time of breast can...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2016.4188
更新日期:2017-03-01 00:00:00
abstract:Importance:Financial conflicts of interest (FCOIs) among authors of clinical practice guidelines have the potential to influence treatment recommendations. Objective:To quantify FCOIs with industry among authors of the National Comprehensive Cancer Network (NCCN) guidelines. Design, Setting, and Participants:We asses...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2016.2710
更新日期:2016-12-01 00:00:00
abstract:Importance:Capecitabine is not considered a standard agent in the adjuvant treatment of early breast cancer. The results of this study suggest that addition of adjuvant capecitabine to a regimen that contains docetaxel, epirubicin, and cyclophosphamide improves survival outcomes of patients with triple-negative breast ...
journal_title:JAMA oncology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamaoncol.2016.6120
更新日期:2017-06-01 00:00:00
abstract:Importance:The association between increasing body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) and risk of breast cancer is unique in cancer epidemiology in that a crossover effect exists, with risk reduction before and risk increase after menopause. The inverse association w...
journal_title:JAMA oncology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamaoncol.2018.1771
更新日期:2018-11-01 00:00:00
abstract:Importance:Although stereotactic radiosurgery (SRS) is preferred for limited brain metastases from most histologies, whole-brain radiotherapy (WBRT) has remained the standard of care for patients with small cell lung cancer. Data on SRS are limited. Objective:To characterize and compare first-line SRS outcomes (withou...
journal_title:JAMA oncology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamaoncol.2020.1271
更新日期:2020-07-01 00:00:00
abstract:Purpose:To harmonize the eligibility criteria and radiologic disease assessment definitions in clinical trials of adjuvant therapy for renal cell carcinoma (RCC). Method:On November 28, 2017, US-based experts in RCC clinical trials, including medical oncologists, urologic oncologists, regulators, biostatisticians, rad...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2019.4117
更新日期:2019-11-21 00:00:00
abstract:Importance:The benefit of adjuvant chemotherapy after resection of pancreatic cancer following neoadjuvant combination treatment with folinic acid, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) is unclear. Objective:To assess the association of adjuvant chemotherapy with overall survival (OS) in patients afte...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2020.3537
更新日期:2020-09-10 00:00:00
abstract:Importance:The role of epidermal growth factor receptor (EGFR) inhibition in chemoradiation strategies in the nonoperative treatment of patients with esophageal cancer remains uncertain. Objective:To evaluate the benefit of cetuximab added to concurrent chemoradiation therapy for patients undergoing nonoperative treat...
journal_title:JAMA oncology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamaoncol.2017.1598
更新日期:2017-11-01 00:00:00
abstract:IMPORTANCE:Substantial progress has been made in cancer diagnosis and treatment, resulting in a steady improvement in cancer survival. The degree of improvement by age, race, and sex remains unclear. OBJECTIVE:To quantify the degree of survival improvement over time by age, race, and sex in the United States. DESIGN,...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2014.161
更新日期:2015-04-01 00:00:00
abstract:Importance:Administration of anti-programmed cell death protein 1 (anti-PD-1) is now standard therapy in advanced non-small cell lung cancer (NSCLC). However, immune checkpoint inhibitors, including anti-PD-1, have not been assessed in patients with subclinical disease with advanced NSCLC, and no useful clinical biomar...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2018.5860
更新日期:2019-03-01 00:00:00
abstract:Importance:Hereditary cancer syndromes infer high cancer risks and require intensive cancer surveillance, yet the prevalence and spectrum of these conditions among unselected patients with early-onset colorectal cancer (CRC) is largely undetermined. Objective:To determine the frequency and spectrum of cancer susceptib...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2016.5194
更新日期:2017-04-01 00:00:00
abstract:IMPORTANCE:BRCA genetic testing has substantial public health impact, yet little is known of the real-world experiences of the more than 100 000 Americans undergoing testing annually. OBJECTIVE:To identify factors associated with use of BRCA testing, assess whether delivery of genetic counseling and testing services a...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2015.3048
更新日期:2015-12-01 00:00:00
abstract:IMPORTANCE:Hepatocellular carcinoma (HCC) has the second-highest cancer-related mortality rate in the world because most patients are diagnosed at an intermediate to advanced stage when surgery is not suitable. Transcatheter arterial chemoembolization (TACE) is currently considered a first-line therapy for unresectable...
journal_title:JAMA oncology
pub_type: 杂志文章,meta分析,评审
doi:10.1001/jamaoncol.2015.2189
更新日期:2015-09-01 00:00:00
abstract:Importance:Dietary fiber (the main source of prebiotics) and yogurt (a probiotic food) confer various health benefits via modulating the gut microbiota and metabolic pathways. However, their associations with lung cancer risk have not been well investigated. Objective:To evaluate the individual and joint associations ...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2019.4107
更新日期:2020-02-01 00:00:00
abstract:Importance:Primary tumor location is emerging as an important prognostic factor owing to distinct biological features. However, the side of origin of colon cancer (CC) still does not represent a prognostic parameter when deciding for adjuvant or palliative chemotherapy. Objective:To determine the prognostic role of le...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2016.4227
更新日期:2017-02-01 00:00:00
abstract:Importance:Low-cost sequencing of multiple genes is increasingly available for cancer risk assessment. Little is known about uptake or outcomes of multiple-gene sequencing after breast cancer diagnosis in community practice. Objective:To examine the effect of multiple-gene sequencing on the experience and treatment ou...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2018.0644
更新日期:2018-08-01 00:00:00
abstract:Importance:Approximately 50% of the risk for the development of testicular germ cell tumors (TGCTs) is estimated to be heritable, but no mendelian TGCT predisposition genes have yet been identified. It is hypothesized that inherited pathogenic DNA repair gene (DRG) alterations may drive susceptibility to TGCTs. Object...
journal_title:JAMA oncology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamaoncol.2018.6477
更新日期:2019-04-01 00:00:00
abstract:Importance:Colorectal cancer (CRC) incidence and mortality among individuals younger than 50 years (early-onset CRC) are increasing. The reasons for such increases are largely unknown, although the increasing prevalence of obesity may be partially responsible. Objective:To investigate prospectively the association bet...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2018.4280
更新日期:2019-01-01 00:00:00
abstract:Importance:Hyperprogressive disease (HPD) is a new pattern of progression recently described in patients with cancer treated with programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors. The rate and outcome of HPD in advanced non-small cell lung cancer (NSCLC) are unknown. Objectives:To i...
journal_title:JAMA oncology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamaoncol.2018.3676
更新日期:2018-11-01 00:00:00
abstract:IMPORTANCE:Positive phase 3 cancer clinical trials are widely hailed, while trials with negative results are often interpreted as scientific failures. We hypothesized that these interpretations would be reflected in the scientific literature. OBJECTIVE:To compare the scientific impact of positive vs negative phase 3 c...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2015.6487
更新日期:2016-07-01 00:00:00
abstract:Importance:Aromatase inhibitors (AI) are associated with significant urogenital atrophy, affecting quality of life and drug compliance. Objective:To evaluate safety of intravaginal testosterone cream (IVT) or an estradiol-releasing vaginal ring (7.5 μg/d) in patients with early-stage breast cancer (BC) receiving an AI...
journal_title:JAMA oncology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamaoncol.2016.3904
更新日期:2017-03-01 00:00:00
abstract:Importance:To date, the benefit of genome-driven cancer therapy has not been quantified. Objective:We sought to estimate the annual percentage of patients in the United States with advanced or metastatic cancer who could be eligible for and benefit from US Food and Drug Administration (FDA)-approved genome-driven ther...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2018.1660
更新日期:2018-08-01 00:00:00
abstract:Importance:Lay navigators in the Patient Care Connect Program support patients with cancer from diagnosis through survivorship to end of life. They empower patients to engage in their health care and navigate them through the increasingly complex health care system. Navigation programs can improve access to care, enhan...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2016.6307
更新日期:2017-06-01 00:00:00
abstract:Importance:Hand-foot syndrome (HFS) is a common adverse effect of capecitabine treatment. Objective:To compare the incidence and time to onset of grade 2 or greater HFS in patients receiving pyridoxine vs placebo and to identify biomarkers predictive of HFS. Design, Setting, and Participants:This single-center, rando...
journal_title:JAMA oncology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamaoncol.2017.1269
更新日期:2017-11-01 00:00:00
abstract:Importance:Although aspirin is recommended for the prevention of colorectal cancer (CRC) among adults aged 50 to 59 years, recent data from a randomized clinical trial suggest a lack of benefit and even possible harm among older adults. Objective:To examine the association between aspirin use and the risk of incident ...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2020.7338
更新日期:2021-01-21 00:00:00
abstract:Importance:Tumor-treating fields (TTFields) therapy improves both progression-free and overall survival in patients with glioblastoma. There is a need to assess the influence of TTFields on patients' health-related quality of life (HRQoL). Objective:To examine the association of TTFields therapy with progression-free ...
journal_title:JAMA oncology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamaoncol.2017.5082
更新日期:2018-04-01 00:00:00
abstract:Importance:Although adjuvant endocrine therapy confers a survival benefit among females with hormone receptor (HR)-positive breast cancer, the effectiveness of this treatment among males with HR-positive breast cancer has not been rigorously investigated. Objective:To investigate trends, patterns of use, and effective...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2018.1114
更新日期:2018-10-01 00:00:00
abstract:Importance:Androgen-deprivation therapy (ADT) plus docetaxel is the standard of care in hormone-naive metastatic prostate cancer but is of uncertain benefit in a nonmetastatic, high-risk prostate cancer setting. Objective:To assess the benefit of ADT plus docetaxel in patients presenting with rising prostate-specific ...
journal_title:JAMA oncology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamaoncol.2018.6607
更新日期:2019-05-01 00:00:00
abstract:Importance:Remarkable progress has occurred in understanding the pathophysiology and in developing improved personalized therapies in adult acute lymphoblastic leukemia (ALL). Observations:We searched MEDLINE (1990-2018), the American Society of Clinical Oncology, and American Society of Hematology websites (2010-2018...
journal_title:JAMA oncology
pub_type: 杂志文章
doi:10.1001/jamaoncol.2018.1915
更新日期:2018-10-01 00:00:00
abstract:Importance:Three years of adjuvant imatinib mesylate therapy is associated with reduced recurrence rates and improved overall survival in patients with high-risk primary gastrointestinal stromal tumor (GIST) compared with patients who receive 1 year of treatment. The impact of a longer duration of therapy is unknown. ...
journal_title:JAMA oncology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamaoncol.2018.4060
更新日期:2018-12-01 00:00:00