Risk of breast cancer’s return continues long after treatment ends

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Risk of breast cancer’s return continues long after treatment ends

Recurrence of breast cancer still looms, even after decades.
A recent analysis has found that even 20 years after receiving a diagnosis of estrogen receptor-positive breast cancer, the risk of the cancer’s return looms large. Should treatment be extended?

Estrogen receptor-positive (ER-positive) breast cancer is the most common breast cancer type, accounting for around 80 percent of all breast cancer cases.

In short, ER-positive breast cancer flourishes in response to estrogen. The standard treatments for this cancer type are tamoxifen, which blocks the effects of estrogen, or aromatase inhibitors, which stop the production of estrogen.

Even once the cancer has gone, these drugs are taken daily for 5 years. Tamoxifen reduces recurrence by half during treatment, and by almost a third in the 5 years following treatment.

Aromatase inhibitors, which will only work in women who are postmenopausal, are even better at reducing the risk of recurrence.

Should treatment be extended?

Over recent years, research has found that extending the length of time that these medications are taken could reduce risks further still. Some cancer researchers are asking whether they should be continued for 10 years.

But these drugs are not without disadvantages. Although side effects are rarely life-threatening, they can substantially impact a woman’s quality of life. Side effects often mimic menopause and include hot flashes, night sweats, mood changes, and vaginal dryness. Aromatase inhibitors also carry an increased risk of osteoporosis, among other conditions.

As the authors of the current study write, “[D]ecisions about extending adjuvant endocrine therapy after 5 years without any recurrence need to balance additional benefits against additional side effects.”

The analysis was carried out by researchers from the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). This group has been pooling research into a single dataset since the 1980s, looking at all aspects of breast cancer.

For this study, they took data from 88 clinical trials, including those of 62,923 women with ER-positive breast cancer. Their findings are published this week in the New England Journal of Medicine.

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