Not every patient with hormone sensitive breast cancer requires 10 years of anti-hormonal therapy
In a new research article, published in the current issue of the American Journal of Surgery by Professor Kefah Mokbel and his team from the London Breast Institute, the authors conclude that extending anti-hormonal therapy after surgery for early breast cancer beyond five years should be tailored to the individual patient according to the future risk of relapse and the potential adverse effects of this form of treatment on the quality of life. Unfortunately, too many women are being over treated with anti-hormonal therapy including drugs like tamoxifen, letrozole and anastrozole. This trend, which started in the last two years, was based on two studies which showed additional benefit from 10 years of tamoxifen compared with five years. However, Professor Mokbel highlighted that these studies included primarily post-menopausal women who had breast cancer that had spread to the lymph nodes. Therefore, the patients who had an additional benefit from extended treatment had high-risk disease. However, most women have localised breast cancer that has not spread to the lymph nodes and many of these women can be treated with five years of anti-hormonal therapy. The molecular signature of the cancer can be used to determine the future risk of recurrence and guide the selection of the treatment duration. The team at The Princess Grace Hospital uses molecular scores to individualise treatment selection. Endocrine therapy can be associated with significant adverse effects and can compromise the quality of life and therefore extended duration of treatment should be limited to those at high risk. The authors constructed an algorithm to guide doctors to determine the optimal duration of treatment for individual patients.