14 juli 2012: in tegenspraak met onderstaande blijkt uit een andere grote studie onder Indiase vrouwen dat Tamoxifen niet meer galstenen geeft: In our study we could not establish that an association existed between Tamoxifen use and gallstone formation in postmenopausal South Indian women.  Onderaan staat abstract van de studie.

Vijf jaar gebruik van tamoxifen bij borstkankerpatiënten veroorzaakt galstenen. Het verschil: 37,4 procent van de vrouwen die tamoxifen gebruiken kreeg binnen vijf jaar last van galstenen tegenover slechts 2 procent in de groep die geen tamoxifen gebruikte. (p<0.0001). Een hoog significant verschil dus. Dit is de uitkomst van een zevenjarige studie onder 703 vrouwen met borstkanker die overbleven van een groep van 3.165 vrouwen die aan de studie begonnen. Waarom er zoveel vrouwen - 2462 van de 3165 vrouwen - uitvielen wordt niet echt expliciet uitgelegd. De redenen worden omschreven als slechte follow-up, premenopausale status en andere redenen. Hoeveel van die vrouwen zijn overleden in de zeven jaar wordt er niet bij verteld wat ik wel opvallend vind. Hoe langer de vrouwen werden gevolgd hoe meer mensen galstenen rapporteerden, maar uit de studie lijkt na drie jaar gebruik van tamoxifen het ontstaan van galstenen groter en groter te worden. De studie gedaan aan de Gulhane Military Medical Academy in Istanbul, Turkije is gepubliceerd in de World Journal of Surgery 2003;27:395-399.

Bron: MEDSCAPE

Gallstones Linked to Tamoxifen Use

Laurie Barclay, MD

May 2, 2003 — A retrospective cohort study reported in the April issue of the World Journal of Surgery showed a significant association between gallstones and the use of tamoxifen. 

"Despite tamoxifen being an antiestrogen drug, it has estrogen-like activity in various tissues of some species," write Mehmet L. Akin, MD, from Gulhane Military Medical Academy in Istanbul, Turkey, and colleagues. "The relation between estrogen exposure and gallstone formation has been well known for a long time."

Of 3,165 patients treated for invasive breast cancer between 1990 and 1997 at four university hospitals, 2,462 were excluded from the study because of improper follow-up, premenopausal status, and other reasons. Of 703 subjects included in the study, 457 had received adjuvant therapy including tamoxifen and 246 had not. 

Both groups were similar in terms of age at breast cancer diagnosis, age at menopause, interval between onset of menopause and diagnosis of breast cancer, presence of diabetes, and body mass index. Mean follow-up period was 4.6 years (range, 1-7 years), during which patients received annual abdominal ultrasonography. 

After five years, the incidence of gallstone formation was 37.4% in tamoxifen-treated patients compared with 2.0% in patients who did not receive tamoxifen ( P < .0001). In 171 tamoxifen-treated patients, the cumulative incidence of gallstones was 0.4%, 3.7%, 24.4%, 33.1%, and 37.4% during the first, second, third, fourth, and fifth years, respectively. 

"Adjuvant tamoxifen therapy leads to gallstone formation in postmenopausal breast cancer patients and is most apparent after 3 years of treatment," the authors write. "The risk of gallstone formation increased with longer duration of hormone use for current postmenopausal patients and with higher doses of estrogen used [in another study]. The apparent increase in gallstone formation at the end of the third year of tamoxifen use underlines the fact that a minimum of 3 years is needed to see the estrogenic effects of tamoxifen."

World J Surg. 2003;27:395-399

Reviewed by Gary D. Vogin, MD



Tamoxifen use and gallstone formation in postmenopausal breast cancer patients in south Indian population

2009 Apr-Jun;46(2):151-4.

Tamoxifen use and gallstone formation in postmenopausal breast cancer patients in south Indian population.

Source

Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. asifpadiyath@gmail.com

Abstract

BACKGROUND:

Tamoxifen is being used in patients with estrogen receptor positive breast cancer as an adjuvant or palliative hormonal therapy. w0 estern studies have found a 30% incidence of gallstones in patients who are taking Tamoxifen and they have proved a significant association between the two.

OBJECTIVES:

The objective of the study was to find out the association of Tamoxifen use and gallstone formation in postmenopausal breast cancer patients in a South Indian population.

METHODS:

Ninety patients who had undergone surgery for invasive breast cancer in our institute, and were receiving adjuvant Tamoxifen, were recruited for the study. An equal number of age-matched postmenopausal women were taken as controls. All of them underwent an abdominal ultrasound screening test for gallstones. Presence or absence of gallstones was noted down from their ultrasound scan reports. Pretreatment status of the gall bladder was assessed from the preoperative scan reports.

RESULTS:

An odds ratio of 1 was derived when the case group was compared with the control group.

CONCLUSIONS:

In our study we could not establish that an association existed between Tamoxifen use and gallstone formation in postmenopausal South Indian women.


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