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An article published in The Lancet Oncology reports
that postmenopausal women with breast cancer who ar on internal secretion
treatment ar likely to experience arthralgia and arthritis
(joint symptoms) if they previously let used internal secretion replacement
therapy (HRT), received a hormone-receptor positive tumor diagnosis,
undergone chemotherapy, standard treatment with anastrozole versus
tamoxifen, or been obese. Dr Ivana Sestak and Dr Jack Cuzick (Cancer
Research UK, London, UK) and colleagues talk over their results in a
retrospective explorative analysis of patients enrolled in the Arimidex
[anastrozole] Tamoxifen Alone or in Combination trial (ATAC).
In the ATAC trial, postmenopausal women with breast genus Cancer were
indiscriminately assigned to anastrozole (an aromatase inhibitor) or tamoxifen.
Sestak and colleagues set out to watch the importance of a range of
risk factors for joint symptoms and whether the importance of these
risk of exposure factors changed according to how these women were treated. The
study sample consisted of 5,433 women who reported no joint symptoms at
the beginning of the ATAC trial.
The researchers establish that articulation symptoms were reported by 777 of 1937
women (41.1%) who antecedently had used HRT and 1001 of 3496 women
(28.6%) who had not secondhand HRT. In addition:
Joint symptoms were reported by 1556 of 4596 (33.9%) with
hormone-receptor-positive tumors and in 124 of 448 (27.7%) with
hormone-receptor-negative tumors.
Joint symptoms were reported by 461 of 1176 (39.2%) world Health Organization
received premature chemotherapy and in 1317 of 4257 (30.9%) who have not.
Obesity as measured by body-mass index (BMI) besides correlated positively
with the onset of joint symptoms. About 37.2% with BMI greater than 30
kg/m�, 31.3% with BMI between 25 and 30 kg/m�, and 31.0% with
BMI <25 kg/m� reported symptoms. The researchers also noticed a
difference depending on which treatment a woman received. The
percentage reporting joint symptoms in the anastrozole was 35.2%
compared to 30.3% in the tamoxifen group.
Endocrine treatment reduces the concentration of estrogen in the
body, and estrogen deficiency has been linked to joint
symptoms in several different settings. Since the effects of the risk
factors can accumulate, they need to be taken into account when
aromatase inhibitors are being considered for women. "Awareness of risk
factors for joint symptoms will help both clinicians and patients to
anticipate and manage these symptoms and ensure optimum adherence to
endocrine treatment," conclude the authors.
Risk factors for joint symptoms in patients enrolled in the
ATAC trial: a retrospective, exploratory analysis
Ivana Sestak, Jack Cuzick, Francisco Sapunar, Richard
Eastell, John F Forbes, Angelo R Bianco, Aman U Buzdar, on behalf of
the ATAC Trialists' Group
The Lancet Oncology (2008).
DOI:10.1016/S1470-2045(08)70182-7
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Written by: Peter M Crosta
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