Reducing The Risk Of Breast Cancer Recurrence After Surgery With Endocrine Therapy
More than 215,000 women are diagnosed with breast cancer every year. For many of them, surgery to remove the tumor is just the first step in the battle against the disease, and may be followed by radiation, chemotherapy, or endocrine therapy, which are all “adjuvant therapies”. After surgery, women will decide along with their doctors, which adjuvant therapies are right for them, to help prevent their cancer from coming back.
When a woman’s breast cancer does come back or spreads to other parts of the body, she may be at greater risk of dying from the disease. Women whose breast cancer is detected in the lymph nodes at diagnosis requiring chemotherapy before or after surgery are considered to be at the greatest risk for breast cancer recurrence.
Women whose breast cancer is hormone-sensitive (estrogen or progesterone receptor positive) have an option to take endocrine medication (also called anti-estrogen or hormone therapy) following surgery. The U.S. Food and Drug Administration has approved a number of medications called selective estrogen receptor modulators (SERM) for pre- and postmenopausal women and aromatase inhibitors (AI) for postmenopausal women for this use. A panel from the American Society of Clinical Oncology, the country’s leading group of oncologists, recommends endocrine therapy as part of the optimal adjuvant treatment for this group of women.
“One of the greatest fears confronted by women who have been treated for early breast cancer is that their cancer will come back. With Femara, we now have an option that can help address that fear early on, even in patients who we know face the greatest risk of recurrence,” said Matthew Ellis, MD, PhD, FRCP, director of the Breast Cancer Program at Washington University in St. Louis, when Femara (letrozole, an AI) was introduced.
In a large clinical study of post-surgery breast cancer treatment, researchers compared the effectiveness of Femara and Tamoxifen (a SERM), another drug prescribed after surgery, in postmenopausal women. An analysis performed after 26 months showed that Femara reduced the risk of breast cancer coming back by 21% over the reduction offered by Tamoxifen. Patients taking Femara also showed a 27 percent reduction in the risk of the cancer spreading to distant parts of the body.
In this study, women at increased risk of recurrence experienced the greatest benefit from Femara. Femara lowered this risk by 29 percent in women whose breast cancer had already spread to the lymph nodes at the time of diagnosis and by 30 percent in women who had prior chemotherapy. The results also showed that in these high-risk women, Femara reduced the risk of cancer spreading to distant parts of the body by 33 percent and 31 percent, respectively.
In this study, Femara was generally well tolerated with the most common side effects including hot flashes, joint pain, night sweats, weight gain and nausea.
Tips for Living Healthy
Discuss postsurgery treatment options with your oncologist. Whether you’re one, five or ten years beyond your diagnosis, taking care of your overall health and well-being can also reduce your risk of cancer coming back and give you the energy to do the things in life that you love.
• Practice good nutrition
• Exercise regularly
• Tap into a support network
• Take time out for yourself
Editors Note: Important safety information
Aromatase Inhibitors are approved for the adjuvant (following surgery) treatment of postmenopausal women with hormone receptor−positive breast cancer.
You should not take AIs or SERMs if you are pregnant as it may cause fetal harm. You must be postmenopausal to take AIs. Until you know how it affects you, use caution before driving or operating machinery. There is an increase in cholesterol in patients on AIs versus Tamoxifen (5.4% vs. 1.2%).
In the adjuvant setting, commonly reported side effects were generally mild to moderate. Side effects seen in AIs versus Tamoxifen included hot flashes (33.7% vs. 38%), joint pain (21.2% vs. 13.5%), night sweats (14.1% vs. 13.5%), weight gain (10.7% vs. 12.9%) and nausea (9.5% vs. 10.4%). Other side effects seen were bone fractures and osteoporosis. Your prescribing doctor will monitor your health while taking these medications.
