"Carcinogenicity
Tamoxifen is reported to be carcinogenic in animals. The carcinogenic potential of tamoxifen in humans should be considered.
Uterine Cancer.
In athymic mice, tamoxifen has stimulated the growth of certain endometrial tumors. An increased incidence of endometrial changes, including hyperplasia, polyps, and endometrial cancer, has been reported in women receiving tamoxifen. The incidenceand pattern of this increase is related to the estrogenic activity of tamoxifen. Some evidence suggests that prior exposure to hormone replacement therapy may contribute to the development of endometrial cancer and may be a confounding factor in determining the effect of tamoxifen therapy on the uterus.
Current evidence indicates that long-term (i.e., exceeding 2 years) tamoxifen therapy is associated with an increased risk (2.5—7.5 times that in untreated women) of developing endometrial cancer. In a large controlled study of adjuvant tamoxifen therapy (40 mg daily for 2—5 years) in women with early breast carcinoma, the relative risk of developing endometrial cancers associated with tamoxifen therapy was 5.6 times that of the control group (23 of 1372 tamoxifen-treated women and 4 of 1357 women in the control group developed cancers of the uterus). After approximately 6.8 years of follow-up in the National Surgical Adjuvant Breast and Bowel Project (NSABP B-14) study, 15 of 1419 women randomized to receive tamoxifen 20 mg daily for 5 years developed uterine cancer; 2 of 1424 women who were receiving placebo initially, but who subsequently received tamoxifen for recurrent breast carcinoma, also developed uterine cancer. The relative risk of endometrial cancer in the tamoxifen-treated women was 7.5; most of the uterine cancers in tamoxifen-treated patients with breast cancer were diagnosed at an early stage, but deaths resulting from uterine cancer associated with tamoxifen therapy for the treatment of breast cancer have been reported.
Women receiving tamoxifen for the prevention of breast cancer in the BCPT had an approximately 2.5 times greater risk of developing an invasive endometrial cancer (36 versus 15 cases according to data available as of March 31, 1998) than women receiving placebo. The increased risk of developing endometrial cancer in women receiving tamoxifen for the prevention of breast cancer occurred predominantly in women aged 50 years or older at the time of randomization (relative risk of 4.5 according to data available as of January 31, 1998; relative risk of 4.01 according to data available as of March 31, 1998). According to age at the time of diagnosis of endometrial cancer, increase in risk of endometrial cancer was similar for women 49 years of age or younger (relative risk of 2.21) and women 50 years of age or older (relative risk of 2.5), although fewer cases of endometrial cancer occurred in younger women. Among women receiving tamoxifen in the BCPT, endometrial cancer was diagnosed on average at 32 months (range: 1—61 months) following initiation of therapy with the drug.
All but one of the women in the BCPT who developed endometrial cancer (a study participant receiving placebo who subsequently died of endometrial cancer) had early-stage disease that can be treated effectively with surgery (i.e., hysterectomy) with or without postoperative radiation therapy. The distribution according to stage of endometrial cancer (according to FIGO) was similar among women receiving tamoxifen or placebo.
Approximately 37% of the participants receiving tamoxifen or placebo in the BCPT had undergone a hysterectomy prior to enrollment in the study and therefore were not at risk for the development of endometrial cancer. For women in the BCPT who had anintact uterus, endometrial sampling (i.e., examination of cells from the lining of the uterus) did not alter the rate of detection of endometrial cancer; currently, no data suggest that routine endometrial sampling in asymptomatic women receiving tamoxifen to reduce the incidence of breast cancer would be beneficial. Endometrial cancer often is associated with clinical manifestations, such as abnormal vaginal bleeding or pelvic pain. About 88% of cases of endometrial cancer diagnosed in tamoxifen-treated women in the BCPT were associated with symptoms.
Endometrial hyperplasia can be a premalignant change. In one study of postmenopausal women receiving tamoxifen for the prevention of breast cancer, 16% developed atypical hyperplasia while no cases occurred in those receiving placebo; 8% of women receiving tamoxifen had an endometrial polyp compared with 2% of those receiving placebo. These findings were based on screening of a randomized cohort of women from the study who had not been screened before the initiation of therapy, and some of the women also were receiving hormone replacement therapy as permitted by the study protocol. Optimal management of women who develop endometrial changes during tamoxifen therapy remains to be elucidated; the value of progestins in reversing such hyperplasia is not established nor are their effects on breast cancer in tamoxifen-treated women adequately studied. Screening and management of women who develop endometrial hyperplasia during tamoxifen therapy should be individualized, weighing the risks and benefits of continued therapy with the drug.
Endometriosis also has been reported. In addition, variations in the karyopyknotic index on vaginal smears and varying degrees of estrogenic effects on the Papanicolaou test also have been reported in postmenopausal women receiving the drug. The manufacturer states that patients receiving or having previously received tamoxifen should undergo routine gynecologic examinations, and they should be advised to report promptly any menstrual irregularities, abnormal vaginal bleeding, change in vaginal discharge, or pelvic pain/pressure to their clinician; the cause of such effects should be evaluated promptly.
Liver Cancer.
In rats given 5, 20, or 35 mg/kg of tamoxifen daily for up to 2 years, hepatocellular carcinoma occurred at all dosages. The incidence of this carcinoma in rats receiving 20 or 35 mg/kg daily (69%) was substantially greater than that in those given 5 mg/kg daily (14%), and the incidence in rats given 5 mg/kg daily was substantially greater than that in controls. In addition, limited data from other studies in rats revealed hepatic tumors that were malignant in one of the studies.
In a study of women with breast cancer receiving tamoxifen (40 mg daily) or no adjuvant endocrine therapy for 2—5 years, 3 cases of liver cancer were reported in women receiving tamoxifen versus 1 case in the control group. No cases of liver cancer currently have been reported (at a median follow-up of 4.6 years) among women receiving either tamoxifen or placebo in the BCPT."
Stew, i got it from medscape under drug profiles.
Now i dont think that Nolva causing cancer is something to worry about, but it will still be in the back of my mind.
I am scared shitless of cancer (saw my dad die of pancreatic cancer, fucking horrific) so anything that has that potential to cause cancer scares me. Every time there is something wrong with me, i think its cancer! Im paranoid beyond belief, but i cant help it. I need a pscyh. Again i didnt mean to cause any alarm by posting that nolva can cause cancer.