EFFECTS OF TAMOXIFEN ON LIPID PROFILE, SERUM CALCIUM AND GONADOTROPIN LEVELS IN CARCINOMA BREAST PATIENTS..

Corresponding Author:
Dr. Mallika Gopinath,
Subha, Mosque Lane,
Kumarapuram, Medical College PO,
Thiruvananthapuram-695011, Kerala.
E-mail: mallikagopinath@yahoo.co.in

ABSTRACT

BACKGROUND

Breast cancer is the second most common cancer in females in India. The regional cancer centre Thiruvananthapuram statistics show a steady increase in breast cancer every year. The anti-oestrogen Tamoxifen is used in long-term treatment of carcinoma breast and is also used as a chemo-preventive agent to subjects who are at high risk for carcinoma breast. Tamoxifen belongs to triphenyl ethylene group of oestrogen compounds. Pharmacological actions are both oestrogenic and anti-oestrogenic. In postmenopausal women, it is known to have oestrogen-like effects on bone density and on lipid metabolism. Anti-oestrogenic effects of tamoxifen may be exerted at hypothalamic or pituitary level. Drug opposes the negative feedback effect of oestrogen and blocks the inhibitory action of oestrogen on LH release.

MATERIALS AND METHODS

The study was a case control study. Hundred patients from Thiruvananthapuram Regional Cancer Centre, who were on treatment with tamoxifen for 1 to 4 years were taken as test group and fifty persons with carcinoma breast who were not taking Tamoxifen were taken as the control group. A proforma was given to assess the adverse effects of the drug like h/o profuse vaginal bleeding, nausea and vomiting or joint pains. The proforma also contained the risk factors of carcinoma breast like age at menarche, age of first child birth, premenopausal/postmenopausal and family h/o breast cancer.

Inclusion Criteria- 1. Carcinoma breast patients who were not on radiotherapy or chemotherapy at the time of study; 2. Patients who came for review in Regional Cancer Centre Radiotherapy Unit I, Trivandrum, who were on Tamoxifen.

Exclusion Criteria- 1. Carcinoma breast patients who were on radiotherapy or chemotherapy at the time of study; 2. Patients who were having terminal disease on palliative treatment; 3. Patients who were not willing for the study.

Parameters Taken- 1. Lipid Profile, A. HDL cholesterol, B. LDL cholesterol, C. Triglycerides; 2. Serum Calcium; 3. Total Proteins; 4. Luteinising Hormone.

As calcium is bound to total protein, it was also included. The study and control groups were further divided into premenopausal and postmenopausal groups. Post-menopausal group was mostly oestrogen receptor positive. Medical software was used for statistical analysis.

RESULTS

Comparison of total cholesterol and LDL cholesterol in test group and control group as a whole showed a reduction in test group, which was significant statistically. No statistically significant results were obtained on comparing serum calcium serum protein and LH in test and control group as a whole. Comparison of lipid profile in postmenopausal test group when compared to postmenopausal control group showed a reduction in total cholesterol, which was significant statistically. LDL cholesterol was reduced in the test group, which was statistically significant. Other parameters did not show statistically significant results.

CONCLUSION

From the questionnaire given in the proforma, it was concluded that Tamoxifen did not have any specific toxic adverse effect. It was more effective in postmenopausal patients, as they were oestrogen receptor positive. It had oestrogen like effects on lipid profile, which was favourable. There was no unfavourable effect on hypothalamo-pituitary axis, as it caused no variation in LH. So Tamoxifen can be used as a safe drug for long-term treatment of breast cancer preventing metastasis and contralateral breast cancer. It can also be used for chemoprophylaxis in healthy women who were at high risk for carcinoma breast.

KEYWORDS

Carcinoma Breast, Tamoxifen, Lipid Profile, Serum Calcium, Gonadotropins.