Incidence and risk factors for non-alcoholic steatohepatitis in females treated with tamoxifen for breast cancer.

BACKGROUND AND STUDY AIMS Tamoxifen used in the treatment of breast cancer is reported to cause hepatic steatosis. This study aimed to assess the incidence and risk factors of the development of fatty liver disease, resulting from tamoxifen use, in females with breast cancer. PATIENTS AND METHODS Seventy females aged between 28 and 80years with breast cancer were recruited from Shahid Sadoughi Clinic, Yazd, Iran in 2006-2008. The patients underwent chemotherapy followed by 20mg tamoxifen daily as postoperative endocrine treatment. Only in patients with normal baseline liver function, negative test for hepatitis C virus (HCV) and hepatitis B surface antigen (HbsAg) and normal liver ultrasonography were included. The development of fatty changes over a 6-months period of treatment was the main outcome measurement assessed by ultrasonography. RESULTS Thirty-five of 70 patients developed fatty change during follow-up, in which nine were in grade one, 20 in grade two and six patients in grade three. Risk factors associated with the development of fatty change were elevation of triglycerides (2.4, 1.2-4.8), elevation of fasting blood sugar (FBS) and low high-density lipoprotein (HDL) (3.4, 1.4-7.8). No relation was found between the development of fatty change and age (1.3, 0.87-2.00), menopause (1.13, 0.69-1.9), previous history of diabetes (2.4, 0.7-8.4), previous chemotherapy regimen and receptors type (c-erbB2, P53, progesterone receptor (PR), oestrogen receptor (ER)) and stage of breast cancer. Further, there was no relation between the development of fatty change and hypercholesterolemia, low-density lipoprotein (LDL), arterial hypertension and body mass index (BMI). CONCLUSION Tamoxifen was associated with a high risk of development of non-alcoholic steatohepatitis in patients with higher triglycerides and FBS and lower HDL. However, no relationship was found with the level of BMI, LDL, hypertension, overweight and obesity.