The large study reviewed here offers some excellent news. Older women with hormone-receptor-positive early breast cancer who had surgery (and possibly radiation and chemotherapy) and then took tamoxifen for 5 years were more likely to die from something OTHER THAN breast cancer (heart disease, for example). The women were followed for about 4 years after they stopped taking tamoxifen.
About 70% of the women in the study who were older than 70 died because of a reason other than breast cancer. Of the younger women in the study who died, about 52% died from breast cancer.
In post-menopausal women diagnosed with hormone-receptor-positive early breast cancer, hormonal therapy, such as tamoxifen, is given after surgery and any other initial treatments (radiation therapy, chemotherapy) to lower the risk of the cancer coming back (recurrence). When this study started, tamoxifen was the hormonal therapy of choice. Today, aromatase inhibitors, which lower the risk of the cancer coming back more effectively than tamoxifen, are the hormonal therapy standard. Arimidex (chemical name: anastrozole), Aromasin (chemical name: exemestane), and Femara (chemical name: letrozole) are all aromatase inhibitors.
This research was part of a study looking at whether Femara can further reduce the risk of breast cancer coming back when taken for 5 years AFTER 5 years of tamoxifen. Taking hormonal therapy medicine for more than the usual 5 years is called extended adjuvant treatment. While not discussed in this story, the research found that extended adjuvant hormonal therapy offered some some benefits.
This study reinforces two important points:
Visit the breastcancer.org Staying on Track with Hormonal Therapy page to learn more about ways to make sure you stick with your treatment for the prescribed time.
NEW YORK (Reuters Health) - Older women treated for a common type of breast cancer and who survive past the five-year mark will probably not die from the disease, a new study shows.
"For those ladies that fall into that category, it's wonderful news," Dr. Judith-Anne W. Chapman, the study's lead author, told Reuters Health. "They are essentially, most of them, surviving their breast cancer and having very low toxicity" from cancer treatment, she added.
Understanding mortality due to other causes among breast cancer patients is becoming increasingly important as survival improves, Chapman, with the National Institute of Canada Clinical Trials Group at Queen's University in Toronto, and her team point out in the Journal of the National Cancer Institute.
"Usually the perception has been up until now that if you had breast cancer ultimately you would die of breast cancer," Chapman said. "More and more reports are coming out now that if you are older, you have a better chance of dying of something else."
To investigate causes of death in these patients, the researchers followed 5,170 women 32 to 94 years old who had been diagnosed with hormone receptor-positive breast cancer, meaning their tumors carried receptors for estrogen or progesterone and were susceptible to anti-hormone therapy.
All the women had been disease-free after five years on tamoxifen, and were randomly assigned to receive letrozole -- another estrogen-blocking drug used to treat breast cancer -- or a placebo.
During the follow-up, which averaged about four years, 256 of the women died. Overall, 60% of the deaths were not due to breast cancer.
Among women 70 and older, 72% of deaths were not breast cancer-related, while 48% of deaths among younger women weren't related to breast cancer.
Women who had heart disease at the study's outset were more likely to die of causes other than breast cancer, while having osteoporosis increased the likelihood of dying from some other type of cancer. Women whose cancer had spread to their lymph nodes were more likely to die of breast cancer.
The researchers also found that women who had heart disease at the beginning of the study and were taking letrozole were more likely to die of heart disease than those who were on placebo. This finding, Chapman said, requires further investigation.
Breast cancer survivors should make sure they are paying attention to their overall health, including their risk of cardiovascular disease, she added.
Chapman also emphasized the importance for all women of getting regular mammography screening exams. "The earlier you can get the cancer, and if you can get it in the non-invasive phase, the better the chances of survival and the better the treatment options."
SOURCE: Journal of the National Cancer Institute, February 20, 2008.
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