After surgery, post-menopausal women with hormone-receptor-positive early breast cancer face the risk of the breast cancer coming back (recurrence). Recurrence can happen at any time. But the risk of recurrence is highest during the first 3 years after your initial diagnosis and treatment. Hormonal therapy medicine is usually prescribed for 5 years after initial treatment for women who had hormone-receptor-positive breast cancer to lower the risk of recurrence. Treatment that comes after surgery or another initial treatment is called adjuvant therapy.
For years, tamoxifen was the adjuvant hormonal medicine of choice for post-menopausal women with hormone-receptor-positive early breast cancer. But in the last few years, large clinical studies have shown that aromatase inhibitors work better than tamoxifen to reduce the risk of recurrence in these women. So aromatase inhibitors now are used more often. Arimidex, Aromasin and Femara are aromatase inhibitors. The study reviewed here was done when tamoxifen typically was used.
Hormonal therapy medicines can lower the risk of breast cancer recurrence. Still, many women stopped taking their hormonal therapy medicine before completing the full 5 years of treatment. In fact, more than 33% of the women in this study stopped taking their medicine only 3 1/2 years after they started. This is especially troubling because these women stopped taking their hormonal therapy medicine when their risk of recurrence is greatest. This isn't the first study to show that many women stop taking adjuvant therapy earlier than prescribed, which increases the risk of the cancer coming back.
Why would a woman do this? The answer is complicated and different for every woman. For some, it's because they need to put cancer behind them after the initial diagnosis and treatment. Lingering depression may also play a role. For others, the cost of the medication or unpleasant side effects may be the cause. And sometimes it's just that a woman doesn’t understand the importance of adjuvant therapy or doesn’t have good communication with the doctor who cares for her.
Still, all of these reasons are overshadowed by the reality that breast cancer can come back. And adjuvant hormonal therapy medicine can reduce that risk. Any woman who will be or has been prescribed adjuvant hormonal therapy must remember this. There are usually good ways to overcome any obstacles that might get in the way of doing all that you can to lower your risk of recurrence. You can start by visiting the Breastcancer.org Staying on Track with Treatment section. In this section, you can read about why it's so important to stick to your treatment plan and ways to handle possible difficulties in following radiation, chemotherapy, and hormonal therapy regimens. If you're taking adjuvant hormonal therapy medicine now, stick with it as prescribed. If you are thinking of stopping prematurely, talk to your doctor first and explore your options. Together, you can find a solution that is best for YOU.
NEW YORK (Reuters Health) - About one third of women with breast cancer who are prescribed tamoxifen stop taking the drug well before the end of the recommended 5 years of treatment, Irish researchers report. This is "likely to have a negative impact on the therapeutic success of tamoxifen," they warn.
The discontinuation rate of tamoxifen treatment in actual clinical practice is nearly twice that seen in clinical trials, Dr. Thomas I. Barron and his associates report in the medical journal Cancer. They point out that clinical trials do not reflect "real life" because patients tend to be carefully selected, highly motivated, and closely monitored.
Barron's team at the St. James' Hospital in Dublin evaluated adherence to tamoxifen using prescription refill data for 2816 women.
The investigators found that 22% of the women had stopped taking tamoxifen by 1 year, and 28% by 2 years. By 3.5 years, 35% of patients had stopped using tamoxifen without switching to an alternative hormonal treatment.
The youngest and oldest women were more likely to stop taking the drug, and so were patients with illness such as Parkinson's disease or dementia.
"This study demonstrates that persistence with tamoxifen cannot be assumed," Barron and his team conclude. Even though intervention efforts to improve adherence are costly and time-consuming, they say that "their use may be worthwhile in oncology patients."
SOURCE: Cancer, March 1, 2007.
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