Originally published as JCO Early Release 10.1200/JCO.2006.10.2699 on June 18 2007

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Impact of Randomized Clinical Trial Results in the National Comprehensive Cancer Network on the Use of Tamoxifen After Breast Surgery for Ductal Carcinoma in Situ

Tina W.F. Yen, Henry M. Kuerer, Rebecca A. Ottesen, Layla Rouse, Joyce C. Niland, Stephen B. Edge, Richard L. Theriault, Jane C. Weeks

From the Departments of Surgical Oncology and Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Information Sciences, City of Hope National Medical Center, Duarte, CA; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY; and the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA

Address reprint requests to Tina W.F. Yen, MD, MS, Division of General Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226; e-mail: tyen{at}mcw.edu

Purpose: The National Surgical Adjuvant Breast and Bowel Project B-24 trial, published in June 1999, demonstrated that tamoxifen after breast-conserving surgery (BCS) and radiotherapy for ductal carcinoma in situ (DCIS) reduced the absolute occurrence of ipsilateral and contralateral breast cancer. We assessed the impact of B-24 on practice patterns at selected National Comprehensive Cancer Network (NCCN) centers.

Patients and Methods: Tamoxifen use after surgery was examined among 1,622 patients presenting for treatment of unilateral DCIS between July 1997 and December 2003 at eight NCCN centers. Associations of clinicopathologic and treatment factors with tamoxifen use were assessed in univariate and multivariable logistic regression analyses.

Results: Overall, 41% of patients (665 of 1,622) received tamoxifen. The proportion increased from 24% before July 1, 1999, to 46% on or after July 1, 1999. Factors significantly associated with receipt of tamoxifen included diagnosis on or after July 1, 1999 (odds ratio [OR], 3.85; P < .0001), BCS in patients younger than 70 years (OR, 3.21; P = .0073), no history of cerebrovascular or peripheral vascular disease (OR, 3.13; P = .0071), receipt of radiotherapy (OR, 1.82; P = .0009), and previous hysterectomy (OR, 1.34; P = .0459). Tamoxifen use varied significantly by center, from 34% to 74% after BCS and 17% to 53% after mastectomy (P < .0001).

Conclusion: Tamoxifen use after surgery for DCIS at NCCN centers increased after presentation of the B-24 results. Rates varied substantially by institution, suggesting that physicians differ in how they weigh the modest reduction in breast cancer risk with tamoxifen against its potential adverse effects in this population.

published online ahead of print at www.jco.org on June 18, 2007.

Presented at the 29th Annual San Antonio Breast Cancer Symposium, December 14-17, 2006, San Antonio, TX.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.