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Event-free survival following early endometrial events in breast cancer patients treated with anti-hormonal therapy: A nationwide claims data study

 Yura Lee  ;  Yu Rang Park  ;  Hae Reong Kim  ;  Jong Won Lee 
 MEDICINE, Vol.98(2) : 13976-13980, 2019 
Journal Title
Issue Date
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Antineoplastic Agents, Hormonal/administration & dosage ; Antineoplastic Agents, Hormonal/adverse effects ; Antineoplastic Agents, Hormonal/therapeutic use* ; Aromatase Inhibitors/administration & dosage ; Aromatase Inhibitors/adverse effects ; Aromatase Inhibitors/therapeutic use* ; Drug Therapy, Combination ; Endometrium/pathology* ; Female ; Humans ; Insurance Claim Review/statistics & numerical data ; Middle Aged ; Postmenopause ; Progression-Free Survival* ; Proportional Hazards Models ; Republic of Korea/epidemiology ; Retrospective Studies ; Tamoxifen/administration & dosage ; Tamoxifen/adverse effects ; Tamoxifen/therapeutic use* ; Young Adult
Tamoxifen, an anti-estrogen agent that can suppress breast cancer, has been reported to increase endometrium-related adverse events. There are no guidelines for screening tamoxifen-treated patients for endometrial disease. We analyzed nationwide claims data related to endometrial diseases to investigate patterns of endometrial disease in breast cancer patients who underwent hormonal treatment.We sourced claims data from the Health Insurance Review and Assessment Service in South Korea. Patients who made their first claim for an anti-hormonal agent between January 1, 2010 and December 31, 2012 were enrolled retrospectively. We analyzed patient characteristics and all claims related to endometrial disease, stratified by prescribed hormonal agents.Among a total of 32,496 enrolled patients, 19,603 used tamoxifen only and 10,101 were treated with an aromatase inhibitor (AI) alone. Endometrial events occurred in 15.4% (3028/19603) of the tamoxifen-only patients and 2.0% (201/10101) of the AI-only group. In patients diagnosed with breast cancer at the age of 50 or older, the hazard ratio (HR) of endometrial malignancy in the tamoxifen-only group compared to the AI-only group was 4.13 (95% CI 1.404-12.159, P = .010). The HR of curettage in the tamoxifen-only group was 31.0 (95% CI 19.668-48.831, P <.001).The occurrence of endometrial events among tamoxifen-treated breast cancer patients was higher than in patients treated with only AI, similar to previous studies. However, the HR of curettage was uniquely high, despite its invasiveness. Guidelines for screening endometrial disease and improvements of healthcare policy are required to appropriately manage high-risk patients.
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1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hae Reong(김혜령) ORCID logo https://orcid.org/0000-0002-2079-0498
Park, Yu Rang(박유랑) ORCID logo https://orcid.org/0000-0002-4210-2094
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