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25 October 2005
Duration Of Treatment And Age Key To Tamoxifen Effectiveness 
After breast cancer surgery, tamoxifen is generally regarded as the best ongoing treatment option for women to remain free of the disease. But despite its demonstrated improvements in patient survival, the duration of therapy and the length of time to find significant survival improvements remains unclear. Studies have suggested that the longer the duration of treatment, the longer the patient will remain disease-free. But questions remain, however, on whether longer treatment results in longer overall survival and whether it takes many years after treatment to see the benefits. Now, a study in the journal CANCER, has found that the survival benefits of longer-term therapy using tamoxifen may take at least nine years to develop. Additionally, improvements in survival were observed only in postmenopausal women younger than 55 years with estrogen receptor positive tumors. In these patients, prolonging tamoxifen to five years was associated with a 44 percent reduction in the risk of death. The study was conducted by researchers at the Department of Clinical Pharmacology and Epidemiology at Consorzio Mario Negri Sud in Italy who followed 1,900 women with early stage breast cancer who were treated with surgery and either two- or five-year courses of tamoxifen. After 115 months, the investigators found that women with estrogen receptor positive tumors who took tamoxifen for five years started to show significantly improved overall survival 90 months after enrollment. But it seems that only women aged between 50 and 55 years showed overall survival improvement. The researchers concluded that: "5 years of tamoxifen are superior to 2 years of treatment in reducing total mortality in estrogen receptor positive patients 55 years and younger." They speculate that in older patients, the previously documented benefit in terms of disease free survival did not translate into a longer overall survival, probably as a consequence of competing causes of death.
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