title: Incidence and risk factors for non-alcoholic steatohepatitis in females treated with tamoxifen for breast cancer.
abstract: OBJECTIVE
  Tamoxifen used in the treatment of breast cancer is reported to cause hepatic steatosis. This study aimed to assess the incidence and risk factors of the development of fatty liver disease, resulting from tamoxifen use, in females with breast cancer.
  
  
  METHODS
  Seventy females aged between 28 and 80years with breast cancer were recruited from Shahid Sadoughi Clinic, Yazd, Iran in 2006-2008. The patients underwent chemotherapy followed by 20mg tamoxifen daily as postoperative endocrine treatment. Only in patients with normal baseline liver function, negative test for hepatitis C virus (HCV) and hepatitis B surface antigen (HbsAg) and normal liver ultrasonography were included. The development of fatty changes over a 6-months period of treatment was the main outcome measurement assessed by ultrasonography.
  
  
  RESULTS
  Thirty-five of 70 patients developed fatty change during follow-up, in which nine were in grade one, 20 in grade two and six patients in grade three. Risk factors associated with the development of fatty change were elevation of triglycerides (2.4, 1.2-4.8), elevation of fasting blood sugar (FBS) and low high-density lipoprotein (HDL) (3.4, 1.4-7.8). No relation was found between the development of fatty change and age (1.3, 0.87-2.00), menopause (1.13, 0.69-1.9), previous history of diabetes (2.4, 0.7-8.4), previous chemotherapy regimen and receptors type (c-erbB2, P53, progesterone receptor (PR), oestrogen receptor (ER)) and stage of breast cancer. Further, there was no relation between the development of fatty change and hypercholesterolemia, low-density lipoprotein (LDL), arterial hypertension and body mass index (BMI).
  
  
  CONCLUSIONS
  Tamoxifen was associated with a high risk of development of non-alcoholic steatohepatitis in patients with higher triglycerides and FBS and lower HDL. However, no relationship was found with the level of BMI, LDL, hypertension, overweight and obesity.
authors.affiliation: Shahid Sadoughi Medical University of Yazd, Yazd, Iran. akhondei@yahoo.com
authors.forename: Mohsen
authors.initials: M
authors.lastname: Akhondi-Meybodi
authors.forename: Mohammad-Reza
authors.initials: MR
authors.lastname: Mortazavy-Zadah
authors.forename: Zahra
authors.initials: Z
authors.lastname: Hashemian
authors.forename: Mahdiah
authors.initials: M
authors.lastname: Moaiedi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005234:Fatty Liver / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007492:Iran; D008099:Liver / Q000000981:diagnostic imaging / Q000187:drug effects*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects*; D014463:Ultrasonography
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen