Effect of low-dose tamoxifen after surgical excision of ductal intraepithelial neoplasia: results of a large retrospective monoinstitutional cohort study.

BACKGROUND: Postsurgical treatment of ductal intraepithelial neoplasia (DIN) with standard doses of tamoxifen has not reached a consensus yet. Given positive results of low-dose tamoxifen on breast cancer biomarkers modulation, we analyzed a large cohort of DIN patients treated with low-dose tamoxifen or no treatment as per institutional guidelines. PATIENTS AND METHODS: All consecutive women operated on at the European Institute of Oncology for estrogen receptor (ER)-positive DIN (474 treated with low-dose tamoxifen and 509 untreated patients) were followed up for a median of 7 years. RESULTS: Compared with untreated patients, a significant 30% reduction in breast cancer risk was observed on low-dose tamoxifen with an adjusted hazard ratio (HR) = 0.70 [95% confidence interval (CI) 0.51-0.94], with a greater benefit in postmenopausal (HR = 0.57; 95% CI 0.34-0.94) than in premenopausal women (HR = 0.79; 95% CI 0.54-1.17). Treated patients with ER and progesterone receptor (PgR) >50% DIN had a lower incidence of breast events than untreated ones (HR = 0.61; 95% CI 0.40-0.94), whereas no protective effect has been observed in patients with ER or PgR <50% DIN. Drug discontinuation resulted in a doubled risk of recurrence in premenopausal women only (HR = 1.95; 95% CI 0.98-3.89). No excess of endometrial cancer occurred. CONCLUSIONS: Low-dose tamoxifen is a promising and safe strategy for highly endocrine responsive DIN. Treatment adherence is crucial in premenopausal women. A definitive trial is ongoing.

[Alprazolam versus lorazepam in the treatment of anxiety: controlled clinical study]. / Alprazolam versus lorazepam nel trattamento dell'ansia: studio clinico controllato.

58 patients suffering from anxiety neurosis were divided into two groups, matched for age, sex, marital status and symptomatology. In a double-blind trial of 4 weeks' duration one group (28 patients) received alprazolam 0.75-3 mg/day and the other (30 patients) received lorazepam 3-12 mg/day. Both groups showed a steady and significant reduction in anxiety levels as measured by Hamilton Anxiety Rating Scale and Clinical Global Impression scores at 0, 1, 2 and 4 weeks. However, there was no significant difference in measured anxiety levels between the two groups at any stage. Fewer side effects were reported in the alprazolam treatment group, with the mental confusion symptom occurring significantly less often.