title: Outcome of patients with early breast cancer receiving nitrogen-containing bisphosphonates: a comparative analysis from the Metropolitan Detroit Cancer Surveillance System.
abstract: BACKGROUND
  Preclinical data suggest that bisphosphonates exhibit antitumor activity. However, clinical studies indicated conflicting results. In this study, we compared the overall survival (OS) of postmenopausal patients with nonmetastatic invasive breast cancer who received any of the second-generation nitrogen-containing bisphosphonates for osteopenia or osteoporosis, with the survival of those who did not.
  
  
  METHODS
  We conducted a retrospective study at the Wayne State University/Karmanos Cancer institute (KCI) in Detroit, Michigan and extracted data from the Metropolitan Detroit Cancer Surveillance System (MDCSS), a Surveillance, Epidemiology and End Results (SEER) registry. Patients > 50 years of age with stage I, II, or III invasive breast cancer between the years 2000 through 2003 were included. Information regarding medications was extracted from the patients' medical records.
  
  
  RESULTS
  A total of 696 women with stage I-III breast cancer were included. Ninety-seven women (14%) used nitrogen-containing bisphosphonates. The difference in OS between bisphosphonate users and nonusers was not statistically significant (P = .32) at 3 years. After adjusting for differences between the groups in age, stage of disease, hormone receptor status, endocrine therapy, vitamin D, and calcium use, there was a marginally significant (P = .07) difference in survival; bisphosphonate users had poorer survival than nonusers.
  
  
  CONCLUSIONS
  Our results indicate that the use of nitrogen-containing bisphosphonates is not associated with improved OS in patients with nonmetastatic breast cancer, even after adjusting for known prognostic factors, but with a marginally worse OS. Further research is awaited to clarify the role of bisphosphonates in the adjuvant setting.
authors.affiliation: Breast Oncology Multidisciplinary Team, Division of Hematology-Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R., Detroit, MI 48201, USA. nahlehz@karmanos.org
authors.forename: Zeina
authors.initials: Z
authors.lastname: Nahleh
authors.forename: Judith
authors.initials: J
authors.lastname: Abrams
authors.forename: Ashish
authors.initials: A
authors.lastname: Bhargaval
authors.forename: Kavita
authors.initials: K
authors.lastname: Nirmal
authors.forename: John J
authors.initials: JJ
authors.lastname: Graff
mesh_terms: D000368:Aged; D019386:Alendronate / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000737:chemistry / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D004164:Diphosphonates / Q000627:therapeutic use*; D012968:Etidronic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000077557:Ibandronic Acid; D007093:Imidazoles / Q000627:therapeutic use*; D008824:Michigan; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance; D012042:Registries; D012189:Retrospective Studies; D000068296:Risedronic Acid; D016019:Survival Analysis; D016896:Treatment Outcome; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000068296:Risedronic Acid; D012968:Etidronic Acid; D000077557:Ibandronic Acid; D019386:Alendronate