Low-Dose Tamoxifen in Noninvasive Breast Neoplasia: Long-Term Results From an Individual-Participant Data Pooled Analysis

Abstract

PURPOSE Tamoxifen 20 mg once-daily reduces the risk of breast cancer recurrence after ductal carcinoma in situ (DCIS), but its use is limited by adverse effects. Lower doses may be effective, but benefit durability and differences according to menopausal status and site of recurrence remain uncertain. METHODS We conducted an individual-participant pooled analysis of three clinical studies involving women with estrogen receptor–positive or unknown DCIS, microinvasive carcinoma, or high-risk breast lesions. Participants received low-dose tamoxifen (5 mg once daily or 10 mg once-every other day for 2-5 years) or a control intervention. The primary end point was breast cancer–free interval, defined as the first occurrence of any ipsilateral or contralateral invasive breast cancer, DCIS, regional recurrence, or distant recurrence. Hazard ratios (HRs) were estimated with mixed-effects Cox models accounting for between-study variability. RESULTS Among 1,545 women included with a median follow-up of 9.4 years, low-dose tamoxifen reduced breast cancer events overall, with evidence of treatment heterogeneity according to menopausal status ( P = .01). In postmenopausal women, breast cancer events occurred in 40 of 335 receiving low-dose tamoxifen versus 93 of 401 controls (HR, 0.51 [95% CI, 0.35 to 0.73]), with a 10-year absolute reduction of 11.2%. Among premenopausal women, no significant reduction was observed (HR, 0.90 [95% CI, 0.70 to 1.17]), although contralateral breast cancer was reduced (HR, 0.45 [95% CI, 0.26 to 0.76]). Serious adverse events were infrequent and similar between groups. CONCLUSION Low-dose tamoxifen was associated with a sustained reduction in breast cancer events, with differences by menopausal status and site of event. These findings support endocrine dose de-escalation to improve the benefit-risk profile of preventive therapy in DCIS and high-risk lesions.