Abstract
Tamoxifen or aromatase inhibitor (AI) therapy may prevent breast cancer recurrence, however, adverse effects may lead to treatment discontinuation. Evidence regarding the occurrence of AI-associated musculoskeletal problems among Asians is scarce. We identified women with breast cancer-initiating tamoxifen or AIs from the Taiwan National Health Insurance Research Database (2007–2012). Using multivariable cause-specific hazard models, we examined the association between endocrine therapy and the risk of any arthritis and carpal tunnel syndrome, adjusting for age, prior cancer treatment, and other health status factors. Among 32,055 eligible women with breast cancer (mean age = 52.6 ± 11.5 years), 87.4% initiated tamoxifen, 3.9% initiated anastrozole, 8.0% initiated letrozole, and 0.7% initiated exemestane. AI users had a higher 1-year cumulative incidence for any arthritis (13.0% vs. 8.2%, p < 0.0001) and carpal tunnel syndrome (1.4% vs. 0.8%, p = 0.008). Compared to tamoxifen users, AI users had a higher risk of any arthritis [adjusted hazard ratio (aHR) = 1.21, 95%CI = 1.09–1.34] and carpal tunnel syndrome (aHR = 1.68, 95%CI = 1.22–2.32). No significant difference was observed in the risks of any arthritis and carpal tunnel syndrome across different AIs. Taxane use was not associated with any arthritis (aHR = 0.92, 95%CI = 0.81–1.05) or carpal tunnel syndrome (aHR = 0.97, 95%CI = 0.67–1.40) compared to other chemotherapies. Taiwanese women with breast cancer-initiating AIs had an increased risk of arthritis and carpal tunnel syndrome compared to those who initiated tamoxifen.
Highlights
Breast cancer is the most common newly diagnosed and prevalent female cancer, with 1.7 million new and 6.3 million prevalent cases worldwide in 2012 [1]
We aimed to examine the risk of any arthritis and carpal tunnel syndrome between women with breast cancer-initiating aromatase inhibitor (AI) versus tamoxifen using nationwide claims data in Taiwan
Among 32,055 eligible Taiwanese women with breast cancer, 87.4% initiated with tamoxifen, 3.9% with anastrozole, 8.0% with letrozole, and 0.7% with exemestane
Summary
Breast cancer is the most common newly diagnosed and prevalent female cancer, with 1.7 million new and 6.3 million prevalent cases worldwide in 2012 [1]. 70% of breast cancers are hormone receptor-positive. Based on stage and menopausal status, women are recommended to receive adjuvant endocrine therapy either with tamoxifen or aromatase inhibitors (AIs) to prevent recurrence [2]. Despite significantly decreased recurrence with AI therapy among post-menopausal women, AIs are associated with adverse effects that may impact patient quality of life, leading to discontinuation of treatment and an increased risk of recurrence. AI-related musculoskeletal problems such as arthritis and carpal tunnel syndrome may cause substantial pain, impact physical activity and quality of life [5], leading to non-adherence or early discontinuation of AI therapy [7]. Little is known whether the risk of musculoskeletal problems varies across different AIs
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