Abstract
Background: Earlier studies have indicated a relatively higher risk of occurring meningioma among female breast cancer survivors and have suggested that tamoxifen might decrease this risk. The present study evaluated whether tamoxifen use in breast cancer patients can reduce the risk of meningioma. Methods: We designed a population-based cohort study by using data from the National Health Insurance system of Taiwan to assess this issue. Between January 1, 2000, and December 31, 2008, women with breast cancer and of age ≥20 years were included. They were divided into two groups: those who had not received tamoxifen therapy and those who had. The Cox’s proportion hazard regression analysis was conducted to estimate the effects of tamoxifen treatment and the subsequent meningioma risk. Results: We identified a total of 50,442 tamoxifen users and 30,929 non-tamoxifen users. Tamoxifen users had a borderline significantly lower overall risk of meningioma than non-tamoxifen users [adjusted hazard ratio (aHR) = 0.64, 95% confidence interval (95% CI) = 0.40–1.02]. A statistically significant difference was found in those patients with tamoxifen treatment duration longer than 1,500 days (aHR = 0.42, 95% CI = 0.19–0.91) or with cumulative dosage exceeding 26,320 mg (aHR = 0.44, 95% CI = 0.22–0.88). Furthermore, no statistically significant joint effect of aromatase inhibitors and tamoxifen on the occurrence of meningioma among breast cancer patients was seen. Conclusion: Tamoxifen users had a non-significantly (36%) lower risk of developing meningioma than did tamoxifen non-users; however, our data indicated that tamoxifen therapy is associated with a reduced meningioma risk for Taiwanese breast cancer patients receiving long duration or high cumulative dosage treatment with tamoxifen.
Highlights
Among women in low, middle, and high-income countries, breast cancer is the most frequently occurring cancer, with an estimated 2.09 million new cases diagnosed worldwide in 2018 International Agency for Research on Cancer (IARC) and World Health Organization (WHO)
We evaluated the effects of tamoxifen use duration (≤365, 366–1,500, and >1,500 days) and cumulative dosage (≤4,280, 4,281–12,980, 12,981–26,320, and >26,320 mg) on the risk of meningioma in patients with breast cancer
At the end of the 12-year follow-up period, per the Kaplan–Meier analysis, the cumulative incidence of meningioma was significantly lower in the tamoxifen cohort than in the non-tamoxifen cohort (Figure 1)
Summary
Among women in low-, middle-, and high-income countries, breast cancer is the most frequently occurring cancer, with an estimated 2.09 million new cases diagnosed worldwide in 2018 International Agency for Research on Cancer (IARC) and World Health Organization (WHO). In Taiwan, breast cancer has been the most prevalent cancer among women for two decades, during which the age-adjusted incidence rate has risen gradually from 55.88 per 100,000 people in 2002 to 89.21 per 100,000 people in 2012 (Chiang et al, 2016). 66% of all breast cancers (and even higher in older women) are hormone receptor–positive (Rakha et al, 2007; Morrison et al, 2012). Evidence suggests that tamoxifen—among the most extensively administered selective estrogen receptor modulators in hormone receptor–positive breast cancer patients—increases disease-free and overall survival rates (Lin and Winer, 2008). Earlier studies have indicated a relatively higher risk of occurring meningioma among female breast cancer survivors and have suggested that tamoxifen might decrease this risk. The present study evaluated whether tamoxifen use in breast cancer patients can reduce the risk of meningioma
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