Dementia risk among post-menopausal women treated with endocrine therapy for early-stage breast cancer in Ontario, Canada.
Bibliographic record
Abstract
521 Background: The association between anti-estrogen therapy and risk of dementia remains controversial. We performed a population-based real-world study investigating the association between endocrine therapy use and dementia. Methods: We used health administrative data collected from post-menopausal women (aged ≥66 years) who were diagnosed with breast cancer and started on adjuvant endocrine therapy from 2005-2012. Patients were classified by use of either an aromatase inhibitor or tamoxifen and followed to measure an unadjusted cumulative incidence of developing dementia. A multivariable analysis adjusting for age, income quintile, medical comorbidities, and duration of endocrine therapy was completed using a Cox-proportional hazards model. Results: We identified 12,077 patients of whom 73% were treated with an aromatase inhibitor and 27% with tamoxifen. The median age was 73 years (IQR 69-78), 64% of patients were treated with lumpectomy, and 19% received adjuvant chemotherapy. The unadjusted event rate for developing dementia was Hazard Ratio (HR)= 0.70 (95% confidence interval (CI)=0.63-0.78, p-value<0.0001) among patients receiving an aromatase inhibitor versus tamoxifen and the 5-year dementia incidence rate was 7.4% versus 9.2% respectively. Our multivariable analysis showed a significant decrease in the rate of dementia in patients treated with an aromatase inhibitor compared to tamoxifen (HR=0.88, 95% CI 0.78-0.98, p-value=0.02) with a median of 5.9 years of follow-up. Factors associated with the development of dementia included older age, previous history of ischemic heart disease, diabetes, hypertension and stroke. Duration of endocrine therapy and previous use of adjuvant chemotherapy were not associated with dementia in our study. Conclusions: This investigation indicates that use of aromatase inhibitors compared to tamoxifen is associated with a lower risk of developing dementia among post-menopausal breast cancer patients. Further prospective studies investigating the neurocognitive effects of endocrine therapy are warranted.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".