Breast cancer paper named among 2005's hottest

Citations are a key marker of a paper's influence within its discipline. The top-cited cancer paper was the ATAC study into breast cancer, published in 'The Lancet' 365(9453): 60-2, 1 January 2005. It was in tenth place overall for the whole of medical science. The trial was originated and designed by UCL academics Professor Michael Baum (UCL Surgery), Senior Lecturer Ms Joan Houghton (UCL Surgery) and Jeffrey Tobias, Professor of Cancer Medicine. Mr Richard Sainsbury (UCL Surgery) also sits on the trial's steering committee.  The study examined 9,366 breast cancer patients over their five-year course of drug treatment.

Breast cancer is by far the most common female cancer, and women in the UK have a one in nine lifetime risk of developing the disease. Due to earlier detection and improved treatment, the breast cancer death rate has fallen by a fifth in the UK over the last ten years. However, the disease is still responsible for eight per cent of all cancer deaths annually.

For the past two decades, tamoxifen has been the gold standard adjuvant drug for breast cancer for patients with hormone-responsive disease, used across the globe in millions of breast cancer patients. The UCL academics and their international collaborators tested tamoxifen against another drug called anastrozole, and the combination of tamoxifen and anastrozole.

The study found that anastrozole is more effective than either tamoxifen or the combination of the two and, what's more, has fewer side effects, explained Professor Tobias: "The ATAC study is a randomised, double-blind controlled trial, and by far the biggest of its kind. Our results now show that there is an absolute difference of almost four per cent between the five-year recurrence rates of breast cancer after tamoxifen and after anastrozole ­ highly significant, since it is recurrent breast cancer that tends to kill these patients. Except for a small increased risk of osteoporosis (occasionally complicated by fracture) in the anastrozole group, our study shows that anastrozole is also a safer treatment than tamoxifen."

Tamoxifen has probably been the world's most widely prescribed anti-cancer drug, but the evidence from this 2005 paper looks set to change practice.