Rahman et al developed the Tamoxifen Indication Score (TIS) to help identify women with breast cancer who should or should not be treated with tamoxifen. The authors are from Umass Memorial Health Care in Worcester, Massachusetts.
NOTE: The information here is based on a poster description.
Absolute contraindications to tamoxifen:
(1) deep vein thrombosis
(2) pulmonary embolism
Parameters for TIS:
(1) probability of developing breast cancer from Gail risk score
(2) age of patient in years
(3) surgical history
(4) significant comorbidities (ischemic heart disease, stroke)
|
Parameter |
Finding |
Points |
|
probability from Gail risk score |
<= 2% |
1 |
|
|
2.01 - 2.99% |
2 |
|
|
>= 3% |
3 |
|
age of the patient |
<= 50 years |
3 |
|
|
51 - 59 years |
2 |
|
|
>= 60 years |
1 |
|
surgical history |
bilateral oophorectomy |
-2 |
|
|
hysterectomy |
3 |
|
|
none |
0 |
|
significant comorbidities |
absent |
0 |
|
|
present |
-2 |
where:
• An alternative would be to treat a hysterectomy and bilateral oophorectomy as +1 (3 - 2). A single oophorectomy would not remove the hormonal source.
• I am assuming that significant comorbidities are scored as present or absent, rather than for each significant comorbidity.
TIS score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: -2
• maximum score: 9
|
TIS |
Decision |
|
<= 4 |
do not give tamoxifen |
|
5 |
proceed with caution |
|
>= 6 |
treat with tamoxifen |
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
