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EDITOR- In February 1996, Bulbrook's leading article on long term
adjuvant tamoxifen therapy for primary breast cancer (1) suggested that,
in the case of women whose primary breast cancers were small, node
negative or had favourable histology, surgery alone produced "equivalent
results, and such patients are probably not candidates for tamoxifen
treatment". Adjuvant therapy for more than five years was also described
as potentially "deleterious".
Following this article we audited the 24 patients in our semi-rural
practice of 9000, who receive repeat prescriptions for tamoxifen. Of
these, 14 (58%) had been on tamoxifen for greater than five years and 16
(67%) of the total were reported as being node negative. Repeating the
audit a year later, again found 24 patients (though not exactly the same
24) on tamoxifen. 12 (50%) of these had been on treatment for longer than
five years and 15 (63%) were node negative.
From our audit it became apparent that there was a reasonable number of
patients continuing therapy for longer than five years and a proportion
had node negative cancers diagnosed before treatment began. There were
also examples of patients who had reached the five years and then had
their therapy discontinued. Rea et al recently discussed the uncertainty
associated with how long adjuvant tamoxifen should be prescribed for and
the importance of the general practitioner in this debate (2).There are to
be two major trials (aTTom and ATLAS) endeavouring to answer
definitively the question on the duration of adjuvant tamoxifen therapy.
But what should we do in the interim period? Should we leave treatment
unchanged until the results of these trials are available? Should we stop
tamoxifen treatment after five years? Or should we be providing patients
with the available evidence and come to a decision based on the views of
the individual patient and doctor? If the first option is correct then we
need consistency. If one of the other options is thought to be correct,
then it is necessary to involve general practitioners, as a lot of women
receiving repeat prescriptions for tamoxifen will no longer be under
hospital follow up and may be unaware of these treatment options.
Philippa Claydon Medical Student
Department of General Practice,
Northern General Hospital,
Sheffield. S5 7AU
Repeat prescribing of adjuvant tamoxifen therapy
EDITOR- In February 1996, Bulbrook's leading article on long term
adjuvant tamoxifen therapy for primary breast cancer (1) suggested that,
in the case of women whose primary breast cancers were small, node
negative or had favourable histology, surgery alone produced "equivalent
results, and such patients are probably not candidates for tamoxifen
treatment". Adjuvant therapy for more than five years was also described
as potentially "deleterious".
Following this article we audited the 24 patients in our semi-rural
practice of 9000, who receive repeat prescriptions for tamoxifen. Of
these, 14 (58%) had been on tamoxifen for greater than five years and 16
(67%) of the total were reported as being node negative. Repeating the
audit a year later, again found 24 patients (though not exactly the same
24) on tamoxifen. 12 (50%) of these had been on treatment for longer than
five years and 15 (63%) were node negative.
From our audit it became apparent that there was a reasonable number of
patients continuing therapy for longer than five years and a proportion
had node negative cancers diagnosed before treatment began. There were
also examples of patients who had reached the five years and then had
their therapy discontinued. Rea et al recently discussed the uncertainty
associated with how long adjuvant tamoxifen should be prescribed for and
the importance of the general practitioner in this debate (2).There are to
be two major trials (aTTom and ATLAS) endeavouring to answer
definitively the question on the duration of adjuvant tamoxifen therapy.
But what should we do in the interim period? Should we leave treatment
unchanged until the results of these trials are available? Should we stop
tamoxifen treatment after five years? Or should we be providing patients
with the available evidence and come to a decision based on the views of
the individual patient and doctor? If the first option is correct then we
need consistency. If one of the other options is thought to be correct,
then it is necessary to involve general practitioners, as a lot of women
receiving repeat prescriptions for tamoxifen will no longer be under
hospital follow up and may be unaware of these treatment options.
Philippa Claydon Medical Student
Department of General Practice,
Northern General Hospital,
Sheffield. S5 7AU
Ralph Emmerson General Practitioner
8, Imperial Rd,
Matlock. DE4 3NL
ralph.emmerson@virgin.net
1 Bulbrook RD. Long term adjuvant therapy for primary breast cancer.
BMJ 1996;312:389-90.
2 Rea D, Poole C, Gray R. Adjuvant tamoxifen: how long before we
know how long? BMJ 1998;316:1518-9.
Competing interests: No competing interests