title: Risk-benefit profiles of women using tamoxifen for chemoprevention.
abstract: BACKGROUND
  Tamoxifen has been US Food and Drug Administration-approved for primary prevention of breast cancer since 1998 but has not been widely adopted, in part because of increased risk of serious side effects. Little is known about the risk-benefit profiles of women who use chemoprevention outside of a clinical trial. We examined characteristics associated with initiation and discontinuation of tamoxifen for primary prevention of breast cancer within a large cohort of women with a first-degree family history of breast cancer.
  
  
  METHODS
  This research was conducted within The Sister Study, a cohort of 50884 US and Puerto Rican women age 35 to 74 years enrolled from 2003 to 2009. Eligible women were breast cancer-free at enrollment and had a sister who had been diagnosed with breast cancer. Participants reported tamoxifen use, ages started and stopped taking tamoxifen, and total duration of use at enrollment. We identified 788 tamoxifen users and 3131 nonusers matched on age and year of enrollment who had no history of contraindicating factors (stroke, transient ischemic attack, cataract, endometrial or uterine cancer). Characteristics associated with tamoxifen initiation were evaluated with multivariable conditional logistic regression. All statistical tests were two-sided.
  
  
  RESULTS
  Based on published risk-benefit indices, 20% of women who used tamoxifen had insufficient evidence that the benefits of tamoxifen outweigh the risk of serious side effects. After 4.5 years, 46% of women had discontinued tamoxifen.
  
  
  CONCLUSIONS
  While the majority of women who used tamoxifen for primary prevention of breast cancer were likely to benefit, substantial discontinuation of tamoxifen before five years and use by women at risk of serious side effects may attenuate benefits for breast cancer prevention.
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC (HBN); Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway (LAD); Westat, Durham, NC (DS); Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC (DPS). hazel.nichols@unc.edu.
authors.forename: Hazel B
authors.initials: HB
authors.lastname: Nichols
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC (HBN); Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway (LAD); Westat, Durham, NC (DS); Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC (DPS).
authors.forename: Lisa A
authors.initials: LA
authors.lastname: DeRoo
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC (HBN); Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway (LAD); Westat, Durham, NC (DS); Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC (DPS).
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Scharf
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC (HBN); Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway (LAD); Westat, Durham, NC (DS); Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC (DPS).
authors.forename: Dale P
authors.initials: DP
authors.lastname: Sandler
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage* / Q000009:adverse effects; D001943:Breast Neoplasms / Q000517:prevention & control*; D018890:Chemoprevention / Q000379:methods; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004965:Estrogen Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D011322:Primary Prevention / Q000379:methods*; D011647:Puerto Rico; D020849:Raloxifene Hydrochloride / Q000008:administration & dosage; D018570:Risk Assessment; D020845:Selective Estrogen Receptor Modulators / Q000008:administration & dosage; D013629:Tamoxifen / Q000008:administration & dosage* / Q000009:adverse effects; D014481:United States
chemical_list: D018931:Antineoplastic Agents, Hormonal; D004965:Estrogen Antagonists; D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen; D020849:Raloxifene Hydrochloride