Tamoxifen and risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers:: a case-control study
Tamoxifen and risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers:: a case-control study
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DOI：
10.1016/s0140-6736(00)03258-x
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发表时间：
2000-12-02
期刊：
影响因子：
168.9
通讯作者：
Lynch, H
中科院分区：
文献类型：
--
作者：
Narod, SA;Brunet, JS;Lynch, H
背景BRCA 1或BRCA 2突变的女性在初次诊断乳腺癌后发生乳腺癌和对侧癌的风险很高。他莫昔芬可以预防普通人群中对侧乳腺癌，但它是否可以预防BRCA 1或BRCA 2突变携带者中对侧乳腺癌尚不清楚。方法我们在一项匹配的病例对照研究中比较了209名患有双侧乳腺癌且BRCA 1或BRCA 2突变的女性（双侧疾病病例），以及384名患有单侧疾病且BRCA 1或BRCA 2突变的女性（对照）。双侧乳腺癌病例组和对照组的年龄和诊断乳腺癌时的年龄（范围24-74岁）基本相同，两组均接受了相同时间的第二原发性乳腺癌随访。他莫昔芬使用的第一次乳腺癌的历史，通过采访，或通过自我管理的questionnaire.Findings的多变量添加与他莫昔芬对侧乳腺癌的比率，使用为0. 50（95% CI 0. 28 - 0. 89）。他莫昔芬保护BRCA 1突变携带者（优势比0.38，95%CI 0.19-0.74）和BRCA 2突变携带者（0.63，0.20-1.50）免受对侧乳腺癌的影响。在使用他莫昔芬2-4年的女性中，对侧乳腺癌的风险降低了75%。卵巢切除术（0.42，0.22-0.83）和化疗（0.40，0.26-0.60）也可降低对侧乳腺癌的风险。解释三苯氧胺的使用可降低BRCA 1或BRCA 2基因致病性突变妇女患对侧乳腺癌的风险。三苯氧胺的保护作用似乎与卵巢切除术无关。
Background Women with a mutation in BRCA1 or BRCA2 have a high risk of developing breast cancer and of contralateral cancer after the initial diagnosis of breast cancer. Tamoxifen protects against contralateral breast cancer in the general population, but whether it protects against contralateral breast cancer in BRCA1 or BRCA2 mutation carriers is not known.Methods We compared 209 women with bilateral breast cancer and BRCA1 or BRCA2 mutation (bilateral-disease cases), with 384 women with unilateral disease and BRCA1 or BRCA2 mutation (controls) in a matched case-control study. Age and age at diagnosis of breast cancer (range 24-74 years) were much the same in bilateral-disease cases and controls, and both groups had been followed up for the same time for a second primary breast cancer. History of tamoxifen use for first breast cancer was obtained by interview, or by self-administered questionnaire.Findings The multivariate adds ratio for contralateral breast cancer associated with tamoxifen;use was 0.50 (95% CI 0.28-0.89). Tamoxifen protected against contralateral breast cancer for carriers of BRCA1 mutations (odds ratio 0.38, 95% CI 0.19-0.74) and for those with BRCA2 mutations (0.63, 0.20-1.50). In women who used tamoxifen for 2-4 years, the risk of contralateral breast cancer was reduced by 75%. A reduction in risk of contralateral cancer was also seen with oophorectomy (0.42, 0.22-0.83) and with chemotherapy (0.40, 0.26-0.60).Interpretation Tamoxifen use reduces the risk of contralateral breast cancer in women with pathogenic mutations in the BRCA1 or BRCA2 gene. The protective effect of tamoxifen seems independent of that of oophorectomy.