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Home: Oncology Leader Commentary: Richard Margolese, MD

Click on the topic below for comments by Dr Richard Margolese to comment on. You will also find links to related articles and clinical trials.

Surgery and breast cancer
Philosophy of DCIS management
Excision alone for DCIS
DCIS subsets
Margins and DCIS
Is DCIS a surgical disease?
Tamoxifen for DCIS
NSABP DCIS trials
Tamoxifen: Prevention or delay of clinical onset of disease
Risk-benefits of tamoxifen for DCIS
Tamoxifen and venous thrombosis
Duration of preventive effect of tamoxifen
Mortality effects of tamoxifen in high-risk women
Raloxifene as chemoprevention

Duration of preventive effect of tamoxifen

Interview with Neil Love, MD from Breast Cancer Update for Surgeons, Program 1 2000

Play Audio Below:

Malcolm Pike has, for a long time now, been showing that oral contraceptives suppress the incidence of cancer of the uterus and cancer of the ovary, and I think the mechanism is the same. And that is, suppression of activity in these organs, no ovulation therefore, no epithelial disruption, therefore no epithelial repair, therefore no cell division, and so on. No mutations. Interestingly, the protection from breast cancer is proportionate to the number of years the woman takes the birth control pills, and it’s possible to show that, for a woman not taking the pills, the risk of cancer goes up in a linear fashion, in log plot. If you take the pills, then the slope of the curve shallows out and the risk goes up much slower, so the two curves start to diverge. When they resume not taking the birth control pills, they revert to the old slope but they’re lower on this graph than they were and they never catch up, there’s always a vertical difference between these two lines and the proportion of difference is determined by the amount of years they took the pills. And I think it’s reasonable to presume the same thing happens with tamoxifen. That all we are doing is putting the cells into suspended animation so to speak. They’re not dividing, they’re not reproducing, therefore mutations aren’t happening, therefore you’ve retarded the whole disease process by five years and they’ll stay behind.

Relevant Articles:

Tamoxifen should be cost-effective in reducing breast cancer risk in high-risk women
Smith, T. J. and Hillner, B. E.. Journal of Clinical Oncology. 18(2):284-286, 2000 Jan.

Estimation of tamoxifen's efficacy for preventing the formation and growth of breast tumors.
Radmacher, M.D., Simon, R. -- (Reprint available from: Radmacher MD NIH 7550 Wisconsin Ave,MS 9015 Bethesda, MD 20892 USA).. Journal of the National Cancer Institute. 92(1):48-53, 2000 Jan 5.

Tamoxifen and risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers: a case-control study
Narod, S. A.; Brunet, J. S.; Ghadirian, P.; Robson, M.; Heimdal, K.; Neuhausen, S. L.; Stoppa-Lyonnet, D.; Lerman, C.; Pasini, B.; de los Rios, P.; Weber, B., and Lynch, H.. Lancet. 356(9245):1876-1881, 2000 Dec 2.

Chemoprevention options for BRCA1 and BRCA2 mutation carriers.
Eeles, R. A. and Powles, T. J. Journal of Clinical Oncology. 18(21 Suppl S):93S-99S, 2000 Nov 1.

Chemoprevention of breast cancer [Review].
Brown, P. H. and Lippman, S. M. (Reprint available from: Lippman SM Univ Texas, MD Anderson Canc Ctr, Dept Clin Canc Prevent 1515 Holcombe Blvd,Box 236 Houston, TX 77030 USA). Breast Cancer Research & Treatment. 62(1):1-17, 2000 Jul.

Hormonal approaches to the chemoprevention of endocrine-dependent tumors.
Manni, A.. Endocrine-Related Cancer. 6(4):483-485, 1999 Dec.

Pilot trial of the safety, tolerability, and retinoid levels of N-(4-hydroxyphenyl) retinamide in combination with tamoxifen in patients at high risk for developing invasive breast cancer.
Conley, B.; O'Shaughnessy, J.; Prindiville, S.; Lawrence, J.; Chow, C.; Jones, E.; Merino, M. J.; Kaiser-Kupfer, M. I.; Caruso, R. C.; Podger, M.; Goldspiel, B.; Venzon, D.; Danforth, D.; Wu, S. L.; Noone, M.; Goldstein, J.; Cowan, K. H., and Zujewski, J.. Journal of Clinical Oncology. 18(2):275-283, 2000 Jan.

Vitamin A analogue for breast cancer prevention: a grade of F or incomplete? Response
Piantadosi, S. (Reprint available from: Piantadosi S Johns Hopkins Univ, Sch Med, Johns Hopkins Oncol Ctr 550 N Broadway,Suite 1103 Baltimore, MD 21205 USA).. Journal of the National Cancer Institute. 92(3):274-275, 2000 Feb 2. No abstract

Tamoxifen for the prevention of breast cancer in the high-risk woman.
Morrow, M. and Jordan, V. C. (Reprint available from: Morrow M 676 N St Clair St,13th Floor, Room 13-104 Chicago, IL 60611 USA).. Annals of Surgical Oncology. 7(1):67-71, 2000 Jan-Feb. No abstract

Relevant Clinical Trials:

Study of Tamoxifen and Raloxifene (STAR) for the Prevention of Breast Cancer

Randomized, Double-Blind, Placebo-Controlled Study of Tamoxifen for the Prevention of Breast Cancer in High-Risk Women: International Breast Cancer Intervention Study

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