How Many are doing 10 years on Aromatase Inhibitors
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Thanks Doxie. I don't think there is enough information on triple positives (luminal B, HER2+) at this time. Herceptin has only been approved for early stage breast cancer since 2006. We don't have 10 year of information on large groups of women yet. I know our prognosis has always been a little worse than those that aren't HER2+ but I think that is more for early recurrence.
aussieched I think what that might mean is lets say 20 women out of 100 recur before 10 years. 10 of them before 5 years and the other half ( other 10) between 5-10 years. I don't think it means that of 100 women who get hormone positive breast cancer, 50 will recur after 5 years. So nothing new here. I know when my onc gave me stats she gave me stats for the first 10 years not the first 5.
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My MO is starting me on Tamoxifen (if I decide to take any AH at all..still on the fence) evne though I am post-meno and feels that for DCIS, this is the only PROVEN drug and that AI's are still in clinical trials. She further went on to say that if I don't do well on Tamoxifen, that the only AI she feels would be most effective for DCIS is Aromasin (due to the steroidal component?) and that she would be comfortable giving me that one. I am at Yale which is an NCI certified breast center and my MO is cutting edge on everything so I trust her.
The thing is, the worry I have is the blood clots since I am a smoker (working on quitting as we speak) so I am nervous about the Tamox for that reason. There are some docs (Michael Lagios) who feels that tamox/AI's are not all that effective for DCIS patients and I am so conflicted about these powerful drugs. My inclination is to try the tamox and see how I do? But, if I throw a clot, there are no do-overs if it kills me...arghhhh!
Ten years is a long time but I understand that protection from recurrence is a huge deal! I also read that your chances actually increase a little after 5 years of being recurrence free (a small amount but there nonetheless) and I don't know why that is but the MMSK nomogram shows if I do rads and tamox for DCIS, my chance of recurrence (with my stats) are 2% over 5 years and 3% over ten years post diagnosis.
Anyone know why that is?
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ched....Thank you for sharing the information. I have read the article and other information regarding Dr. Sgroi and his Breast Cancer Index (BCI). I am providing a link of an article which I think is SLIGHTLY more understandable about the "50% of recurrences" that occur between 5 and 10 years. Hopefully, it will help resolve some of the confusion.
First off, one needs to know statistics to understand what they are saying!
Here's the statement that is confusing if you don't understand statistics:
"More than half of all recurrences of estrogen receptor–positive early-stage breast cancer take place after 5 years of adjuvant tamoxifen or aromatase inhibitor therapy."
This does NOT mean that half of ALL the patients WILL recur between years 5 and 10. It says "half of all RECURRENCES." But before we get carried away, let's understand what EXACTLY Dr. Sgroi is trying to do. Recall the recent results of the Atlas study that was presented at the San Antonio Breast Cancer Symposium. (Dr. Sgroi spoke about his BCI there as well). The headline was that 10 years of Tamoxifen trumped 5 years of Tamoxifen for premenopausal patients. If you read further into the study and looked at the comments, physicians applauded the study because they now felt they could offer patients, BASED ON THEIR RISK OF RECURRENCE, 5 more years of Tamoxifen therapy. This was GREAT NEWS for patients who had early stage ER positive breast cancer who had either positive nodes, or high grade, or large tumors. However, for patients who were at low risk of recurrence, the news was mixed. For them, the risk of taking the Tamoxifen, including QOL issues, might outweigh the benefit. But, for them, they now would have an option. The question that wasn't answered was EXACTLY which patients would benefit the most.
So, Dr. Sgroi's research tells us that comparing the OncotypeDX and IHC4 to his his BCI, his tool was better at figuring out which patients were at greater likelihood of having a recurrence between years 5-10. Now, if his research is well established, then one day, it might make it easier to determine who needs to take endocrine therapy longer. Wouldn't that be nice! Then we all wouldn't be having this conversation......
Okay...so let's get back to that statement about 50% of recurrences. Let's look further at what the study says:
"The baseline BCI score differentiated three risk groups over the course of 10 years of follow-up in TransATAC: 58% of women fell into the low-risk group with a 4.2% risk of distant recurrence within 10 years, 25% had an intermediate score with an 18% risk, and 17% had a high score with a 30% risk.
In the first 5 years of follow-up, patients with a low- or intermediate-risk BCI had a distant recurrence risk of 1.3% and 5.6%, respectively. Thus, the BCI identified 83% of study participants as having, on average, a 5-year distant recurrence risk of less than 5%. In contrast, women with a high BCI score had a 5-year recurrence risk of 18%.
Among patients who remained disease free at 5 years, the 61% with a low baseline BCI score had a 3.5% rate of distant recurrence during years 5-10. Those with an intermediate or high BCI had a 13.4% rate."
Reading the study we understand that using his tool for low risk and intermediate patients, their chances of distant recurrence at 5 years was less than 6%. At the 10 year mark, his tool further looked at the low and intermediate risk patients WHO WERE DISEASE FREE (Now understand...anyone who had a recurrence in the first five years were no longer part of the equation), and they were now at a 3.5% chance of recurrence, where as, the intermediate group were at a 13.4% chance of recurrence."
So, understand the pool of patients that are being studied drops in the 5 thru 10th year. None of the patients who recurred earlier were included. Some died of other causes. So, while there WERE recurrences during years 6-10, they weren't 50% of ALL of the patients. Nor were they 50% of the patients that were being studied. Instead, when recurrences occurred, besides the high risk patients, for those who were at low or intermediate risk based on his BCI score, the INDIVIDUAL likelihood of having a recurrence was as low as 3.5% or as high as 13.4%. So, while 50% of recurrences may be occurring in years 5-10, the actual number of INDIVIDUAL recurrences is small for low and intermediate risk patients. The bottom line is that you can't take one sentence out of context....
Maybe someone who is better at explaining statistics can explain what I'm trying to say better. Because for many people, statistics and EXPLAINING statistics may well be Greek or Latin!
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Lago....Yes. Your explanation is correct!
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Doxie....Dr. Sgroi is NOT making a sweeping statement. His statement was taken out of context and without understanding statistics and what he was trying to do, his statement got lost in translation.
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Thank you for that understandable breakdown of the study.
Here is something I found on the John Hopkins website. Here are some practical tips to help keep us on the good side of the statistics:
"Key factors are the type and location of the recurrence. The highest risk of recurrence for breast cancer patients is during the first two years following treatment...... Your risk of recurrence is never zero; however, as more time passes, your risk goes down. Read about the 10 lifestyle changes you can make to reduce your risk for breast cancer recurrence.
To help yourself better cope with the side effects of breast cancer treatment and to reduce your chances of breast cancer recurrence, try incorporating these healthy tips:
1) Take care of yourself emotionally
Put your needs first sometimes
Attend a support group or find a breast cancer survivor you can talk with
Stay informed about new breast cancer research
Consider psychotherapy and/or antidepressants if warranted; if you’re taking tamoxifen, check with your oncologist to ensure the prescribed antidepressant does not interfere with your endocrine treatment
Communicate with your doctor about fears or concerns
Volunteer or become a breast cancer advocate
2) Take care of yourself physically
Exercise regularly
Maintain a healthy weight
Reduce stress
Eat healthy
Limit alcohol consumption
Keep up with all scheduled screenings
Quit smoking
Report any physical changes to either your oncologist or primary care provider
Seek treatment for lymphedema if you experience signs
3) Eat healthy
Research has shown that a diet high in fat and calories increases circulating estrogen in the blood. Consuming a low fat and low calorie diet after breast cancer can improve your overall health and wellness. Here are some dietary suggestions:
Eat a diet rich in fruits and vegetables (at least five servings a day)
Choose organic foods whenever possible
Wash produce thoroughly to minimize pesticide exposure
Limit red meat intake
Consume 2-3 servings of fish weekly. Fish high in omega-3 fatty acids, such as salmon or sardines, are especially beneficial (try to consume freshwater wild salmon whenever possible)
Increase fiber intake
Avoid trans fat
4) Reduce stress
As a breast cancer survivor, your life has probably been filled with stress for some time now. The good news is that life will eventually calm down for you and your family. That does not mean the stress with coping with being a breast cancer survivor in combination with life’s everyday stress will not be a challenge. Finding ways to limit or cope with stress has been shown to improve overall survival. Just as every woman’s body is different, so is her ability to cope with stress. It is important that you find practical ways to cope with stress that work for you and your lifestyle.
Some helpful techniques for relieving stress include:
Exercise
Support groups
Acupuncture
Journaling
Mental health counseling
Exploring your creative abilities (such as painting, drawing or ceramics)
Gardening
Massage therapy
Energy healing (such as Reiki)
Yoga
Meditation and deep breathing exercises
Guided imagery
Take a cancer vacation to celebrate how far you have come
Discover new connections (such as religious/spiritual groups, reconnecting with friends, or new hobbies)
Be patient in finding your "new normal"
Reflect on the meaning of cancer and the experiences it has brought into your life—both good and bad
Find strength in your "wounds"
If stress or depression seems to be impacting your overall quality of life, speak to your doctor.
5) Limit alcohol
Research has shown a link between moderate and heavy drinking and breast cancer. High alcohol intake has also been shown to increase circulating estrogen levels in the body. Breast cancer survivors should limit their alcohol intake to a maximum of one drink a day to reduce the chance of a recurrence.
6) Exercise regularly
Exercising regularly improves fatigue symptoms, reduces stress, and impacts long-term overall health. The ten-year survival rate is higher in patients who exercise regularly than in patients who do not. We recommend that you engage in moderate exercise at least 3-5 hours per week.
7) Continue with regular health screenings
In addition to mammograms, you should stay up to date on flu shots and other vaccinations; screening colonoscopies; pap smears; bone density scans (if you’re over age 50 or no longer menstruating after chemotherapy); annual physicals by your primary care provider; dental cleanings; cholesterol, diabetes and blood pressure screening to monitor your risk for cardiovascular disease; and any other screenings your doctor recommends.
8) Maintain a healthy weight
Women who are overweight are more likely to have their breast cancer come back. Maintaining a healthy weight is something you can do to reduce your chance of a recurrence as well as optimize your overall health.
9) Have your vitamin D levels checked
The Nurses Health Study found a relationship between low levels of vitamin D and breast cancer incidence. It is not known yet if taking vitamin D supplements after breast cancer will reduce your chances of recurrences in the future. However, next time you have blood work performed you may want to ask your medical provider to check your vitamin D levels for general health reasons. Taking a supplement and/or spending 20 minutes outside in the sunshine every day will help increase your vitamin D3 levels. For women experiencing bone, joint or muscle pain on aromatase inhibitors, studies are being done to find out if vitamin D supplements at higher doses would be helpful. You should always speak with your doctor before starting higher doses of any vitamins or nutritional supplements, since most are not regulated by the U.S. Food and Drug Administration.
10) Take endocrine therapies as prescribed
It’s very important to take your endocrine therapy drug exactly as prescribed. Research has shown that many women do not—usually because of forgetfulness, cost or undesirable side effects.
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I will add that my onc asks how often I exercise every time I have a visit. It's that important! OK I'm out to do my power walk then finish with some upper body strength training. Did lower body yesterday. I have to say I feel so much better the days I exercise. I try not to miss it.
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Ruthbru, thanks so much for the very informative response above. I have heard all of this, but having it at a glance is great. I am going to print this for future reference. Thanks again!
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* I will add take a daily low dose aspirin to the John Hopkins list.
From what I've read, exercise is absolutely the biggest non-medicical thing we can do for ourselves to lower our chances of recurrence (plus then you can cheat on some of the food stuff
). If you want some exercise buddies here at BCO, check out the 'Lets Post Our Daily Exercise' thread on the Fitness Forum. A great, positive, encouraging group of ladies, in all stages of treatment and beyond. Doing everything from walking through the park, yoga, skiing, zumba, exercise DVDs (ie me) etc. to skiing and running half marathons...very cool!0 -
voraciousreader,
I've included "seems" in each of my first two sentences in my post. I actually understand the statistics. You are much, much better at taking the time to fully explain and back up your statements with documentation. I appreciate all the time you put into this. Too many 50-60 hr work weeks are zapping me of that kind of energy.
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Hi ladies- I just started Arimidex this weekend. My MO suggested 10 years on AI due to an intermediate score of 23 with the OncotypeDx genetic panel. My understanding was the 10 years on the AI recommendation was related to the 10 year projection of distant reoccurrence based on that Oncotype score.
I sort of assumed what a lot of you did about maybe knowing more after 5 years from now from the research being done. Maybe there will be more known, or maybe they will suggest we stay on these meds forever.
I found out I am osteopenic, so I am worried about what this will further do to my bones. But I am going to try to manage the later with improving my fitness and weight bearing exercise and suppliments for the time being.
These are hard choices, no one wants their bc to return nor do we want fractured hips either.
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Jazzygirl I was osteopenic before chemo and chemo-pause. So far my biggest loss was after chemo/chemo-pause. I re-read my reports and last year I lost very little after being on AL for almost 1.5 years. I'm now at the start of year 3. I do exercise, eat the right stuff, take my calcium and D as prescribed. I'm still osteopenic but not having huge drops. We sometimes forget that many of us would have osteoporosis regardless of AI. My mom had it and had reversed it on a small amount of hormone replacement. They won't let her take it anymore because of my diagnosis. I am the family history.
Mom is going to be 76.0 -
So with an oncotype of 38, I wonder what my doc will say. I am in month 8 of aromasin.Often wake up at night with body pains. OK during the day for the most part. I had no idea that recurrence was such a risk.
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Lisa there are other AIs that you can try if you are getting to many SE from this one.
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Interesting thread. I was dx in 2002, with 10 fully encased nodes but very small tumor In 2002 TAC was available as clinical trial Chemo which I participated. Started arimidex in 2002. My Onc said 5 years for sure and I could do more if i wanted. Had bones of 18 year old when I started (runner) but had major bone loss as I hit 5 years. I stayed on arimidex one more year and then decided to stop. (2008) All side effects went away, bones good , hair. Etc. However in aug of 2012 I was dx with met to my spine. The biopsy of the spinal met was exactly the same as my original cancer in 2002. Doc said I was in remission for 10 and half years. So now I am on letrozole and monthly zometa. I don't question if I would have stayed on arimidex for 10 years if I would have the met. I wanted to stop the arimidex when I did. Sigh. I am interested in research. Funny but in 2002 arimidex was a fairly new drug. Anyway. Keep on!
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Hope...According to the most recent 2013 NCCN breast cancer treatment guidelines, patients like yourself and I who have pure tubular or pure mucinous breast cancer...the guidelines say that for less than 1 cm and node negative, they don't recommend endocrine therapy. If your tumor is between 1 cm and 3 cm...they recommend that you CONSIDER endocrine therapy. Over 3 cm they RECOMMEND endocrine therapy.
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Hi ladies, I had my checkup today & visited with my onc. about the 10 year thing. You will know all this, but here is our conversation. He was more equivocal than his 'stop after 5 years' recommendation of last summer....but what he said was, there is no research completed that tells us what to do one way or the other for the Als. The research was on Tamoxifin; time may show that it holds true for Als as well, and it may not....sigh....he said that the thing he worries about prescribing 10 years of Arimidex is that it is so hard on the bones, and he is afraid of the irreparable damage that amount of time could do to them. We also reviewed my own personal stats (mildly positive, no nodes) and both agreed that staying off is the right thing for me to do. But, CRAP, I know he would have written me another prescription if I had wanted for it. Makes me mildly crazy!!!!
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Hi Ruthbru, Thanks so much for your response, as I originally started this post, so I do appreciate you taking the time to get back and update me with what the latest is from your Onc.
Hmm, I am still totally confused on what I should do. I was 80% er and 80% pr positive, and had 1 positive node. I reached the 5 years at the end of 2012, so my Onc really didn't suggest treatment either way. I was the one who said I would like to continue, and he basically said well we will continue for the time being and revisit it later this year.
The side affects are really affecting my quality of life, I can no longer go for walks because of the lower back and butt pain, and bone density has dropped dramatically in the last 18 months, so I am feeling really scared to continue, but also frightened, not to continue for fear of recurrence.
Does anyone know when we will have more results out on extended AI treatment?
thanks Ched
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Ched, there are other options. You can ask about bisphosphonates for your bones. Also switching to Tamoxifen like I did may provide bone benefits. There are some carryover effects from having taken 5 years of an AI so stopping for a period of time would help alleviate side effects until you can start again. In my book, quality of life counts, so if the meds are doing a number on yours, I would discuss the other options with your MO.
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Ched....Did you read the NCCN guidelines? Unfortunately, those endocrine studies are ongoing and the results will not be known for some time. I agree with Heidi....Have you looked into bone building meds? Before my diagnosis, I was very skeptical of using those drugs. I still am. However, I chose to do 6 infusions of Zometa due to some favorable research done by Dr. Michael Gnant.
Today, I am having my first bone density test done following my six Zometa treatments. I've always had issues with broken bones and I had mild osteopenia before I began this journey. I just finished 3 years of Tamoxifen and was told to get the bone density test. Once we get the results, I will decide if I will complete the 5 years of Tamoxifen or begin taking an AI going forward.....
When I broke my foot last year, I had already had 4 Zometa infusions. I asked my oncologist how I could still be breaking bones when I had the Zometa coating my bones and he said, "Well, when you fell, it could have been a lot worse had you not taken the Zometa. You could have broken your LEG too!" Hmmmmm......
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This is before the Tamoxifin study came out, but last year when I was talking to my GP (whom I love) about staying on/going off, he said that most of the ladies he's worked with who have tried to stay on finally say 'to hell with it' and quit after another year or so because the SEs keep adding up without a definite benefit.
I haven't looked this up (but I'll bet some of you good researchers have
), but even for the Tamoxifin ladies, what is the actual risk reduction? Is it huge, moderate or ?? I've found that most studies make a big splash, but don't turn out to be as clear-cut or earth shattering as the headlines suggest.0 -
ruthbru I don't remember the numbers but it did seem quite small. Thing is my risk at age of diagnosis with all the known risk factors was >2% of getting breast cancer in the first place. So I can understand why some would consider. Granted right now if I was told that staying on AIs would reduce my risk by 2% I'm not so sure I would given what it is doing to my bones and who knows what else.
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IF YOU LOG ON TO THE LANCET'S WEBSITE...YOU CAN ACCESS THE COMPLETE STUDY FOR FREE!!!!!!!!!!!!!!!!!The Lancet, Volume 381, Issue 9869, Pages 805 - 816, 9 March 2013doi:10.1016/S0140-6736(12)61963-1
Cite or Link Using DOIThis article can be found in the following collections: Oncology (Breast cancer)Published Online: 05 December 2012"Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial
Dr Christina Davies MBChB a
, Hongchao Pan PhD a, Jon Godwin DPhil b, Prof Richard Gray MSc a, Prof Rodrigo Arriagada MD c, Prof Vinod Raina MD d, Mirta Abraham MD e, Victor Hugo Medeiros Alencar MD f, Atef Badran PhD g, Xavier Bonfill MD h, Joan Bradbury i, Prof Michael Clarke DPhil j, Prof Rory Collins FMedSci a, Prof Susan R Davis MBBS i, Antonella Delmestri PhD a, Prof John F Forbes MD k, Prof Peiman Haddad MD l, Prof Ming-Feng Hou MD m, Prof Moshe Inbar MD n, Prof Hussein Khaled MD g, Joanna Kielanowska MD o, Wing-Hong Kwan MD p, Beela S Mathew MD q, Prof Indraneel Mittra PhD r, Bettina Müller MD s, Antonio Nicolucci MD t, Octavio Peralta MD s, Fany Pernas u, Prof Lubos Petruzelka MD v, Prof Tadeusz Pienkowski MD w, Ramachandran Radhika MD x, Balakrishnan Rajan MD y, Maryna T Rubach MD o, Sera Tort MD h, Gerard Urrútia MD h, Miriam Valentini MD t, Yaochen Wang MD a, Prof Richard Peto FRS a, for the Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) Collaborative Group†Summary
Background
For women with oestrogen receptor (ER)-positive early breast cancer, treatment with tamoxifen for 5 years substantially reduces the breast cancer mortality rate throughout the first 15 years after diagnosis. We aimed to assess the further effects of continuing tamoxifen to 10 years instead of stopping at 5 years.Methods
In the worldwide Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial, 12 894 women with early breast cancer who had completed 5 years of treatment with tamoxifen were randomly allocated to continue tamoxifen to 10 years or stop at 5 years (open control). Allocation (1:1) was by central computer, using minimisation. After entry (between 1996 and 2005), yearly follow-up forms recorded any recurrence, second cancer, hospital admission, or death. We report effects on breast cancer outcomes among the 6846 women with ER-positive disease, and side-effects among all women (with positive, negative, or unknown ER status). Long-term follow-up still continues. This study is registered, number ISRCTN19652633.Findings
Among women with ER-positive disease, allocation to continue tamoxifen reduced the risk of breast cancer recurrence (617 recurrences in 3428 women allocated to continue vs 711 in 3418 controls, p=0·002), reduced breast cancer mortality (331 deaths vs 397 deaths, p=0·01), and reduced overall mortality (639 deaths vs 722 deaths, p=0·01). The reductions in adverse breast cancer outcomes appeared to be less extreme before than after year 10 (recurrence rate ratio [RR] 0·90 [95% CI 0·79—1·02] during years 5—9 and 0·75 [0·62—0·90] in later years; breast cancer mortality RR 0·97 [0·79—1·18] during years 5—9 and 0·71 [0·58—0·88] in later years). The cumulative risk of recurrence during years 5—14 was 21·4% for women allocated to continue versus 25·1% for controls; breast cancer mortality during years 5—14 was 12·2% for women allocated to continue versus 15·0% for controls (absolute mortality reduction 2·8%). Treatment allocation seemed to have no effect on breast cancer outcome among 1248 women with ER-negative disease, and an intermediate effect among 4800 women with unknown ER status. Among all 12 894 women, mortality without recurrence from causes other than breast cancer was little affected (691 deaths without recurrence in 6454 women allocated to continue versus 679 deaths in 6440 controls; RR 0·99 [0·89—1·10]; p=0·84). For the incidence (hospitalisation or death) rates of specific diseases, RRs were as follows: pulmonary embolus 1·87 (95% CI 1·13—3·07, p=0·01 [including 0·2% mortality in both treatment groups]), stroke 1·06 (0·83—1·36), ischaemic heart disease 0·76 (0·60—0·95, p=0·02), and endometrial cancer 1·74 (1·30—2·34, p=0·0002). The cumulative risk of endometrial cancer during years 5—14 was 3·1% (mortality 0·4%) for women allocated to continue versus 1·6% (mortality 0·2%) for controls (absolute mortality increase 0·2%).Interpretation
For women with ER-positive disease, continuing tamoxifen to 10 years rather than stopping at 5 years produces a further reduction in recurrence and mortality, particularly after year 10. These results, taken together with results from previous trials of 5 years of tamoxifen treatment versus none, suggest that 10 years of tamoxifen treatment can approximately halve breast cancer mortality during the second decade after diagnosis.Funding
Cancer Research UK, UK Medical Research Council, AstraZeneca UK, US Army, EU-Biomed.Introduction
For women with oestrogen receptor (ER)-positive breast cancer, treatment for 5 years with adjuvant tamoxifen substantially reduces the rate of recurrence not only during the treatment period but throughout the first decade, and reduces breast cancer mortality by about a third throughout the first 15 years (including years 10—14), with little net effect on other mortality.1 Although 5 years of tamoxifen is more effective than is 1—2 years of treatment,1, 2 whether 10 years of treatment would have an even greater effect on breast cancer recurrence and mortality in ER-positive disease is not known.3, 4 Conversely, treatment with 5 years of tamoxifen can cause side-effects such as endometrial cancer and thromboembolic disease,1, 5 and continuing tamoxifen for an additional 5 years is likely to increase these side-effects.Early trials of continuing adjuvant tamoxifen to 10 years versus stopping tamoxifen at 5 years6—8 recruited relatively few patients. Although some of these studies had adverse early results,9 the small numbers of patients meant that these adverse results could have been due to the play of chance, so larger trials were needed.3, 4, 10Moreover, as 5 years of tamoxifen has a prolonged carryover effect after treatment ends, with a substantial reduction in mortality throughout the first 15 years, trials of continuing beyond 5 years of tamoxifen should eventually be followed up to beyond 15 years.4 The UK adjuvant Tamoxifen—To offer more? (aTTom) trial randomly allocated 7000 women, most with unknown ER status, to continue tamoxifen to 10 years or stop at 5 years, but has yet to report long-term findings.11—13 We report results from the global Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial, which randomly allocated 12 894 women to continue tamoxifen to 10 years or stop at 5 years. Our main analyses of breast cancer outcomes involve only the 6846 women with ER-positive disease (sensitivity analyses shown in the appendix include the other women); side-effect analyses include all 12 894 women, regardless of whether the ER status of their disease was positive, negative or unknown......"0 -
Iago, I was on Arimedex for 3 mos, so many aches and pains , off for 2 weeks and then put on Aromasin. Better at first but now after 5 mos seems similar, I'm more used to it. But the anxiety and depression SEs seem to be amping up. Reg doc prescribed Lexapro which I have been considering for a few months. Scared but hate how I feel now and I think the aromasin is contributing. /p>
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lisa I don't know your health history but there is also Tamoxifen if they can't find an AI that has fewer SE that you can life with. Before there was AIs everyone who was hormone positive got Tamoxifen regardless of menopausal state.
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I wish that our characteristics could be compiled and analyzed more carefully to provide more accurately designed treatments for each one of us in terms of dosages and length of time for taking the medications, instead of just generalizing the results of the trials and lumping us all together regardless of effectiveness.
A.A.
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I will be staying on Arimidex for 10 years. I finished 5 years in October 2012 then had a meeting with my onc (Vanderbilt Medical Center one of the best research hospitals in the US). My onc states that everyone should be offered the chance to continue if they wish after she attended the San Antonio meeting in December 2012. The 3% improvement for continuing is just as good as the 3% improvement with chemo that many women opt for. Everyone should be given the opportunity to continue. Chemo is rough, AIs are not as rough. Many women state I want to do everything including chemo when it only increases my chances by 3%. Why not do the AI for 10 years if it increases your chance by 3%?
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It is exactly the same question when it comes to choosing between recurrence vs maintaining proper weight. There is a tendency to think of chemo as being more effective, even though it actually is hit and miss. I've been through chemo once for 6 treatments, and it left me with a much harder job maintaining proper weight due to menopause -- but I have no intention of leaving protection up to doing chemo again...! I'd much rather eat less and exercise more.
But what is worse is not having any trial data to know who actually benefits from hormonal therapy vs something like supplementing with vitamin D. "What if" the benefit is equal? We just don't know, and no one does the homework to tell what works for sure.
A.A.
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I agree with AA. Aug24 your disease is a bit different than mine. You're a luminal A and I'm a luminal B. Do we know if our chances of distant recurrence is the same? AIs for me is a concern because of the bone issue having osteopenia, and osteoporosis family history. Adding a biophosphinate is something I would prefer to do later than sooner. I see my onc for my yearly check up next week. It will be interesting to see what she says. I know my NP hinted this fall about maybe 10 years.
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That is what is so frustrating.....were these women at their ideal weight? Did they exercise? Take vitamin D? Aspirin? Was there a difference depending on their stage? Their grade? Their age? How estrogen positive were they? Did PR levels make any difference? Did they do chemo? Radiation? Both? Neither? Luminal A? B? HER2 positive? Definitely too many varibles to fit all tamoxifin takers under one blanket statement....and really, for us AI girls...there is not even a blanket statement yet to analyze.
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