title: Risk of Gastric and Colorectal Cancer After Tamoxifen Use for Breast Cancer: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  It is still controversial whether tamoxifen use for breast cancer will simultaneously cause gastric and colorectal cancer. In this study, we aimed to evaluate the association between tamoxifen use and the risk of gastric and colorectal cancer by performing a systematic review and meta-analysis.
  
  
  METHODS
  A comprehensive literature search for relevant studies published from 1969 to October 2013 was performed in PubMed, MEDLINE, and ISI Web of Science. Only articles in which gastric and colorectal cancer was reported after tamoxifen therapy for breast cancer were included. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using both the random-effects and fixed-effects models.
  
  
  RESULTS
  We found a total of 9 studies that met the inclusion criteria for the analysis of tamoxifen use and incidence of gastric and colorectal cancer. Among these studies, 7 were involved with both gastric and colorectal cancer, 1 with gastric cancer and 1 with colorectal cancer. The random-effects model results showed that tamoxifen use for breast cancer was not a risk factor for either gastric cancer (RR=0.92; 95% CI, 0.41-2.07, P=0.84) or colorectal cancer (RR=1.05; 95% CI, 0.90-1.21, P=0.54). Sensitivity analysis indicated that the duration or dose of tamoxifen use had no effect on these 2 gastrointestinal tumors (P>0.05). Stratified analysis showed that tamoxifen use was not associated with the increased risk of gastric and colorectal cancer regardless of whether the latency interval after breast cancer diagnosis was <5 or ≥5 years.
  
  
  CONCLUSIONS
  Our meta-analysis results indicate that there was no substantial increase in gastric and colorectal cancer among the tamoxifen-treated female patients.
authors.affiliation: Department of Gastrointestinal Tumor Surgery, Cancer Center of Guangzhou Medical University, Guangzhou, Guangdong Province, China.
authors.forename: Shicai
authors.initials: S
authors.lastname: Chen
authors.forename: Haiying
authors.initials: H
authors.lastname: Liu
authors.forename: Jianchang
authors.initials: J
authors.lastname: Li
authors.forename: Guohua
authors.initials: G
authors.lastname: Yang
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000209:etiology*; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen