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Low-dose tamoxifen in the treatment of breast ductal intraepithelial neoplasia: Results of a large observational study
Annals of Oncology, 10/29/09

Guerrieri-Gonzaga A et al. – Tamoxifen's cost–benefit ratio for breast ductal intraepithelial neoplasia (DIN) is unclear. Since low-dose tamoxifen showed a favorable modulation of breast cancer biomarkers in phase II trials, a monoinstitutional cohort of women with DIN treated with low-dose tamoxifen or no systemic treatment was analyzed. High ER and especially high PgR expression is a significant adverse prognostic indicator of DIN, and low-dose tamoxifen appears to be an active treatment. Women with low-expression ER or PgR DIN do not seem to benefit from tamoxifen.

Methods

309 patients with DIN received low-dose tamoxifen as part of institutional guidelines
Compared with 371 patients with DIN who received no systemic treatment after surgery

Results

Women with estrogen receptor (ER)/progesterone receptor (PgR) > 50% DIN not treated had higher incidence of breast events than women on tamoxifen [hazard ratio (HR) 1.76; 95% confidence interval (CI) 1.00–3.12] or women with ER/PgR <50% DIN (HR 1.72; 95% CI 1.14–2.58)
Among untreated patients with ER > 50% DIN, recurrence higher in PgR 50% DIN than in PgR < 50% DIN, whereas similar among low PgR (< 50%) DIN against which tamoxifen had no effect
No difference in endometrial cancer incidence noted

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