Impact of raloxifene or tamoxifen use on endometrial cancer risk

A population-based case-control study

Angela DeMichele, Andrea B. Troxel, Jesse A. Berlin, Anita L. Weber, Greta R. Bunin, Elene Turzo, Rita Schinnar, Desiree Burgh, Michelle Berlin, Stephen C. Rubin, Timothy R. Rebbeck, Brian L. Strom

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Purpose: Raloxifene reduces breast cancer risk in women with osteoporosis, and both tamoxifen and raloxifene prevent breast cancer in high-risk women. However, in vitro, raloxifene does not share the pro-estrogenic effects of tamoxifen on the endometrium. Randomized trials of these agents have provided limited information about endometrial cancer risk in the general population. We sought to compare endometrial cancer risks associated with raloxifene, tamoxifen, and nonusers of a selective estrogen receptor modulator (SERM) in the general population and characterize the endometrial tumors occurring in these groups. Methods: We performed a case-control study of white and African American women age 50 to 79 years in the Philadelphia area. Patients were diagnosed with endometrial cancer between July 1999 and June 2002. Controls were identified through random-digit dialing. Results: We analyzed 547 cases and 1,410 controls. Among cases, 3.3% had taken raloxifene; 6.2% had taken tamoxifen. Among controls, 6.6% had taken raloxifene; 2.4% had taken tamoxifen. After adjustment for other risk factors, the odds of endometrial cancer among raloxifene users was 50% that of nonusers (odds ratio [OR] = 0.50; 95% CI, 0.29 to 0.85), whereas tamoxifen users had three times the odds of developing endometrial cancer compared with raloxifene users (OR = 3.0; 95% CI, 1.3 to 6.9). Endometrial tumors in raloxifene users had a more favorable histologic profile and were predominantly International Federation of Gynecology and Obstetrics stage I and low grade. Conclusion: Raloxifene users had significantly lower odds of endometrial cancer compared with both tamoxifen users and SERM nonusers, suggesting a role for raloxifene in endometrial cancer prevention and individualization of SERM therapy.

Original languageEnglish (US)
Pages (from-to)4151-4159
Number of pages9
JournalJournal of Clinical Oncology
Volume26
Issue number25
DOIs
StatePublished - 2008
Externally publishedYes

Fingerprint

Tamoxifen
Endometrial Neoplasms
Case-Control Studies
Population
Selective Estrogen Receptor Modulators
Raloxifene Hydrochloride
Odds Ratio
Breast Neoplasms
Endometrium
Gynecology
African Americans
Osteoporosis
Obstetrics
Neoplasms
Estrogens

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

DeMichele, A., Troxel, A. B., Berlin, J. A., Weber, A. L., Bunin, G. R., Turzo, E., ... Strom, B. L. (2008). Impact of raloxifene or tamoxifen use on endometrial cancer risk: A population-based case-control study. Journal of Clinical Oncology, 26(25), 4151-4159. https://doi.org/10.1200/JCO.2007.14.0921

Impact of raloxifene or tamoxifen use on endometrial cancer risk : A population-based case-control study. / DeMichele, Angela; Troxel, Andrea B.; Berlin, Jesse A.; Weber, Anita L.; Bunin, Greta R.; Turzo, Elene; Schinnar, Rita; Burgh, Desiree; Berlin, Michelle; Rubin, Stephen C.; Rebbeck, Timothy R.; Strom, Brian L.

In: Journal of Clinical Oncology, Vol. 26, No. 25, 2008, p. 4151-4159.

Research output: Contribution to journalArticle

DeMichele, A, Troxel, AB, Berlin, JA, Weber, AL, Bunin, GR, Turzo, E, Schinnar, R, Burgh, D, Berlin, M, Rubin, SC, Rebbeck, TR & Strom, BL 2008, 'Impact of raloxifene or tamoxifen use on endometrial cancer risk: A population-based case-control study', Journal of Clinical Oncology, vol. 26, no. 25, pp. 4151-4159. https://doi.org/10.1200/JCO.2007.14.0921
DeMichele, Angela ; Troxel, Andrea B. ; Berlin, Jesse A. ; Weber, Anita L. ; Bunin, Greta R. ; Turzo, Elene ; Schinnar, Rita ; Burgh, Desiree ; Berlin, Michelle ; Rubin, Stephen C. ; Rebbeck, Timothy R. ; Strom, Brian L. / Impact of raloxifene or tamoxifen use on endometrial cancer risk : A population-based case-control study. In: Journal of Clinical Oncology. 2008 ; Vol. 26, No. 25. pp. 4151-4159.
@article{edf334be95f64556bb38697f304d6feb,
title = "Impact of raloxifene or tamoxifen use on endometrial cancer risk: A population-based case-control study",
abstract = "Purpose: Raloxifene reduces breast cancer risk in women with osteoporosis, and both tamoxifen and raloxifene prevent breast cancer in high-risk women. However, in vitro, raloxifene does not share the pro-estrogenic effects of tamoxifen on the endometrium. Randomized trials of these agents have provided limited information about endometrial cancer risk in the general population. We sought to compare endometrial cancer risks associated with raloxifene, tamoxifen, and nonusers of a selective estrogen receptor modulator (SERM) in the general population and characterize the endometrial tumors occurring in these groups. Methods: We performed a case-control study of white and African American women age 50 to 79 years in the Philadelphia area. Patients were diagnosed with endometrial cancer between July 1999 and June 2002. Controls were identified through random-digit dialing. Results: We analyzed 547 cases and 1,410 controls. Among cases, 3.3{\%} had taken raloxifene; 6.2{\%} had taken tamoxifen. Among controls, 6.6{\%} had taken raloxifene; 2.4{\%} had taken tamoxifen. After adjustment for other risk factors, the odds of endometrial cancer among raloxifene users was 50{\%} that of nonusers (odds ratio [OR] = 0.50; 95{\%} CI, 0.29 to 0.85), whereas tamoxifen users had three times the odds of developing endometrial cancer compared with raloxifene users (OR = 3.0; 95{\%} CI, 1.3 to 6.9). Endometrial tumors in raloxifene users had a more favorable histologic profile and were predominantly International Federation of Gynecology and Obstetrics stage I and low grade. Conclusion: Raloxifene users had significantly lower odds of endometrial cancer compared with both tamoxifen users and SERM nonusers, suggesting a role for raloxifene in endometrial cancer prevention and individualization of SERM therapy.",
author = "Angela DeMichele and Troxel, {Andrea B.} and Berlin, {Jesse A.} and Weber, {Anita L.} and Bunin, {Greta R.} and Elene Turzo and Rita Schinnar and Desiree Burgh and Michelle Berlin and Rubin, {Stephen C.} and Rebbeck, {Timothy R.} and Strom, {Brian L.}",
year = "2008",
doi = "10.1200/JCO.2007.14.0921",
language = "English (US)",
volume = "26",
pages = "4151--4159",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "25",

}

TY - JOUR

T1 - Impact of raloxifene or tamoxifen use on endometrial cancer risk

T2 - A population-based case-control study

AU - DeMichele, Angela

AU - Troxel, Andrea B.

AU - Berlin, Jesse A.

AU - Weber, Anita L.

AU - Bunin, Greta R.

AU - Turzo, Elene

AU - Schinnar, Rita

AU - Burgh, Desiree

AU - Berlin, Michelle

AU - Rubin, Stephen C.

AU - Rebbeck, Timothy R.

AU - Strom, Brian L.

PY - 2008

Y1 - 2008

N2 - Purpose: Raloxifene reduces breast cancer risk in women with osteoporosis, and both tamoxifen and raloxifene prevent breast cancer in high-risk women. However, in vitro, raloxifene does not share the pro-estrogenic effects of tamoxifen on the endometrium. Randomized trials of these agents have provided limited information about endometrial cancer risk in the general population. We sought to compare endometrial cancer risks associated with raloxifene, tamoxifen, and nonusers of a selective estrogen receptor modulator (SERM) in the general population and characterize the endometrial tumors occurring in these groups. Methods: We performed a case-control study of white and African American women age 50 to 79 years in the Philadelphia area. Patients were diagnosed with endometrial cancer between July 1999 and June 2002. Controls were identified through random-digit dialing. Results: We analyzed 547 cases and 1,410 controls. Among cases, 3.3% had taken raloxifene; 6.2% had taken tamoxifen. Among controls, 6.6% had taken raloxifene; 2.4% had taken tamoxifen. After adjustment for other risk factors, the odds of endometrial cancer among raloxifene users was 50% that of nonusers (odds ratio [OR] = 0.50; 95% CI, 0.29 to 0.85), whereas tamoxifen users had three times the odds of developing endometrial cancer compared with raloxifene users (OR = 3.0; 95% CI, 1.3 to 6.9). Endometrial tumors in raloxifene users had a more favorable histologic profile and were predominantly International Federation of Gynecology and Obstetrics stage I and low grade. Conclusion: Raloxifene users had significantly lower odds of endometrial cancer compared with both tamoxifen users and SERM nonusers, suggesting a role for raloxifene in endometrial cancer prevention and individualization of SERM therapy.

AB - Purpose: Raloxifene reduces breast cancer risk in women with osteoporosis, and both tamoxifen and raloxifene prevent breast cancer in high-risk women. However, in vitro, raloxifene does not share the pro-estrogenic effects of tamoxifen on the endometrium. Randomized trials of these agents have provided limited information about endometrial cancer risk in the general population. We sought to compare endometrial cancer risks associated with raloxifene, tamoxifen, and nonusers of a selective estrogen receptor modulator (SERM) in the general population and characterize the endometrial tumors occurring in these groups. Methods: We performed a case-control study of white and African American women age 50 to 79 years in the Philadelphia area. Patients were diagnosed with endometrial cancer between July 1999 and June 2002. Controls were identified through random-digit dialing. Results: We analyzed 547 cases and 1,410 controls. Among cases, 3.3% had taken raloxifene; 6.2% had taken tamoxifen. Among controls, 6.6% had taken raloxifene; 2.4% had taken tamoxifen. After adjustment for other risk factors, the odds of endometrial cancer among raloxifene users was 50% that of nonusers (odds ratio [OR] = 0.50; 95% CI, 0.29 to 0.85), whereas tamoxifen users had three times the odds of developing endometrial cancer compared with raloxifene users (OR = 3.0; 95% CI, 1.3 to 6.9). Endometrial tumors in raloxifene users had a more favorable histologic profile and were predominantly International Federation of Gynecology and Obstetrics stage I and low grade. Conclusion: Raloxifene users had significantly lower odds of endometrial cancer compared with both tamoxifen users and SERM nonusers, suggesting a role for raloxifene in endometrial cancer prevention and individualization of SERM therapy.

UR - http://www.scopus.com/inward/record.url?scp=51649084822&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=51649084822&partnerID=8YFLogxK

U2 - 10.1200/JCO.2007.14.0921

DO - 10.1200/JCO.2007.14.0921

M3 - Article

VL - 26

SP - 4151

EP - 4159

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 25

ER -