Ivana Sestak, PhD, and Jack Cuzick, PhD, Cancer Research UK, London, United Kingdom, and colleagues investigated the importance of a range of risk factors for joint symptoms in patients enrolled in the ATAC trial, in which postmenopausal women with breast cancer were randomly assigned to either an aromatase inhibitor or tamoxifen. The authors also examined whether the importance of these risk factors varied according to treatment. There were 5,433 women enrolled in the ATAC trial reporting no joint symptoms at entry.

Results demonstrated that 41.1% of women who had previously used HRT reported joint symptoms compared with 28.6% of women who had not used HRT. In women with hormone receptor-positive tumours, 33.9% reported joint symptoms compared with 27.7% who had hormone receptor-negative tumours. Women who received previous chemotherapy also reported significantly more joint symptoms than those who had not.

Obesity also had a role in the onset of joint symptoms, with significantly more joint symptoms being reported with increasing body mass index. Finally, when the number of joint symptoms was compared between the 2 treatment groups, patients assigned anastrozole reported a higher proportion compared with patients assigned tamoxifen.

These risk factors are all potentially linked with greater decreases in oestrogen concentration when patients start taking endocrine treatment. Oestrogen deficiency has been associated with joint symptoms in several different settings. The effects of these risk factors are additive, and therefore need to be taken into account when preparing women for the use of aromatase inhibitors. Dr. Sestak concludes, "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."

SOURCE: The Lancet

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