Cancer Chemotherapy and Pharmacology

, Volume 78, Issue 6, pp 1311–1315 | Cite as

Aromatase inhibitor-induced carpal tunnel syndrome: prevalence in daily practice

  • Labidi Soumaya
  • Mejri NesrineEmail author
  • El Benna Houda
  • Afrit Mehdi
  • Lakhdhar Sarra
  • Boussen Hamouda
Short Communication



We aim to evaluate prevalence and characteristics of CTS in routine daily practice over a 5-year period, with a review of the literature.


Patients treated with endocrine therapy (441) were retrospectively analyzed looking for CTS cases in aromatase inhibitors (219, 49.6%) and in tamoxifen (222, 50.3%) patients. We described patient’s characteristics and CTS management. We also reviewed the literature reporting CTS in aromatase inhibitors clinical trials.


Six cases of CTS were diagnosed, all in patients on aromatase inhibitors given in the adjuvant setting. Prevalence was 2.7%. Median age was 54 years. CTS occurred under anastrozole in four cases and letrozole in two cases. One patient had severe intensity presentation. Median time to symptoms onset was 14 months, and resolution was obtained within 4 months after a nonsurgical treatment.


Aromatase inhibitor-induced CTS is rare. It should be recognized and treated in order to avoid endocrine therapy discontinuation.


Aromatase inhibitors Breast cancer Carpal tunnel syndrome 


Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest to declare.


  1. 1.
    Middleton SD, Anawke RE (2014) Carpal tunnel syndrome. BMJ 349:g6437CrossRefGoogle Scholar
  2. 2.
    Geoghegan JM, Clark DI, Bainbridge LC, Smith C, Hubbard R (2004) Risk factors in carpal tunnel syndrome. J Hand Surg Br. 29:315–320CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Sestak I, Sapuner F, Cuzick J (2009) Aromatase inhibitors-induced carpal tunnel syndrome: results from the ATAC trial. JCO 27(30):4961–4965CrossRefGoogle Scholar
  4. 4.
    Forbes JF, Cuzick J, Buzdar A et al (2008) Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol 9:45–53CrossRefGoogle Scholar
  5. 5.
    Mieog JSD, Morden JP, Bliss JM, Coombes RC, van de Velde CJ (2012) Carpal tunnel syndrome and musculoskeletal symptoms in postmenopausal women with early breast cancer treated with exemestane or tamoxifen after 2–3 years of tamoxifen: a retrospective analysis of the Intergroup Exemestane Study. Lancet Oncol 13:420–432CrossRefPubMedGoogle Scholar
  6. 6.
    Bongers FJ, Schellevis FG, van den Bosch WJ, van der Zee J (2007) Carpal tunnel syndrome in general practice (1981 and 2001): incidence and role of occupational and non occupational factors. Br J Gen Pract 57:36–39PubMedPubMedCentralGoogle Scholar
  7. 7.
    Sestak I, Cuzick J, Sapunar F et al (2008) Risk factors for joint symptoms in patients enrolled in the ATAC trial: a retrospective, exploratory analysis. Lancet Oncol 9:866–872CrossRefPubMedGoogle Scholar
  8. 8.
    Colleoni M, Giobbie-Hurder A, Regan MM et al (2011) Analyses adjusting for selective crossover show improved overall survival with adjuvant letrozole compared with tamoxifen in the BIG 1-98 study. JCO 29:1117–1124CrossRefGoogle Scholar
  9. 9.
    Pascual E, Giner V, Arostegui A et al (1991) Higher incidence of carpal tunnel syndrome in oophorectomized women. Br J Rheumatol 30:60–62CrossRefPubMedGoogle Scholar
  10. 10.
    Toesca A, Pagnotta A, Zumbo A et al (2008) Estrogen and progesterone receptors in carpal tunnel syndrome. Cell Biol Int 32:75–79CrossRefPubMedGoogle Scholar
  11. 11.
    Liu M, Wang L, Bongartz T, Hawse JR et al (2012) Aromatase inhibitors, estrogens and musculoskeletal pain: estrogen-dependent T-cell leukemia 1A (TCL1A) gene-mediated regulation of cytokine expression. Breast Cancer Res 14(2):R41CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Morales L, Pans S, Verschueren K et al (2008) Prospective study to assess short-term intra-articular and tenosynovial changes in the aromatase inhibitor-associated arthralgia syndrome. JCO 26:3147–3152CrossRefGoogle Scholar
  13. 13.
    Lintermans A, Laenen A, Van Calster B et al (2013) Prospective study to assess fluid accumulation and tenosynovial changes in the aromatase inhibitor-induced musculoskeletal syndrome: 2-year follow-up data. Ann Oncol 24(2):350–355CrossRefPubMedGoogle Scholar
  14. 14.
    Spagnolo F, Sestak I, Howell A, Forbes JF, Cuzick J (2016) Anastrozole-induced carpal tunnel syndrome: results from the international breast cancer intervention study II prevention trial. JCO 34(2):139–143CrossRefGoogle Scholar
  15. 15.
    Fontein DB, Seynaeve C, Hadji P et al (2013) Specific adverse events predict survival benefit in patients treated with tamoxifen or aromatase inhibitors: an international tamoxifen exemestane adjuvant multinational trial analysis. J Clin Oncol 31:2257–2264CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Labidi Soumaya
    • 1
  • Mejri Nesrine
    • 1
    Email author
  • El Benna Houda
    • 1
  • Afrit Mehdi
    • 1
  • Lakhdhar Sarra
    • 1
  • Boussen Hamouda
    • 1
  1. 1.Medical Oncology DepartmentAbderrahmane Mami HospitalArianaTunisia

Personalised recommendations