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BMJ 2011; 343 doi: (Published 03 August 2011) Cite this as: BMJ 2011;343:d4930

Tamoxifen saves lives in the long term

Tamoxifen reduces recurrence and breast cancer mortality in women with early stage hormone sensitive breast cancer for up to 15 years. Beneficial effects of tamoxifen after surgery were also seen in women with weakly hormone sensitive breast cancer, defined as 10-19 fmol/mg of oestrogen receptor cytosol protein, but not in women with oestrogen receptor negative cancer.

Women with carcinoma in situ were excluded from this individual patient data meta-analysis of 20 trials, with more than 21 000 participating women. Comparison groups received observation or placebo. In most trials tamoxifen was given for five years, but this varied from two to 10 years across trials. Overall compliance was about 80%.

Improvements in survival were larger with longer treatment. The researchers have estimated that full compliance with five years of tamoxifen would reduce 15 year breast cancer mortality rates by at least a third, and probably more. This was largely independent of age, nodal status, tumour grade, tumour diameter, and chemotherapy use. Tamoxifen seemed safe in women younger than 55, but the risks of death from endometrial cancer or pulmonary embolus could be more than 1% in women over 55. In some trials tamoxifen showed the potential to reduce deaths from cardiovascular disease, but pooled analyses did not confirm this.

New and more sensitive assays for detecting low levels of oestrogen receptors would be useful, say the commentators (doi:10.1016/S0140-6736(11)61128-8), to identify more women who are candidates for treatment with tamoxifen but are currently being missed.

HLA desensitisation brings hope for some patients needing a kidney transplant

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About a third of patients waiting for a kidney transplant have donor specific anti-HLA antibodies, which have always been thought to be a contraindication to transplantation because of increased risk of severe organ rejection and high rates of organ loss. …

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