Does anyone know whether use of aromatase inhibitors has made a difference to recurrence rates

Life after a breast cancer diagnosis Living with breast cancer
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I have just been reading an article by an American oncologist. I had grade 1 breast cancer in 2003 with no lymph node involvement. It was oestrogen positive. In 2022 I had a new primary cancer diagnosed, grade 2 with one lymph node involved, rest had been removed in previous surgery. It was not the same kind of cancer it was of no special type, but it is still oestrogen positive. The first time I had a rarer kind but still oestrogen plus.

I am wondering if and when I am going to get another recurrence…secondary or a new primary in the right breast or the remains of my old one. I am now 67 so quite a few years for something to happen. The  info below is a breast cancer Doctor from the USA talking about recurrence of hormone positive breast cancer….

Mark Pegram, MD: Let’s talk about late recurrence. This is the bane of our existence with hormone receptor [HR]–positive disease. Triple-negative and HER2 [human epidermal growth factor receptor 2]–positive tend to recur early if they do relapse, usually in the first 2 to 3 years. But ER [estrogen receptor]–positive disease can recur 10, 15, or 20 years after the fact. There’s a stubborn 1% or 2% risk of relapse per year for about 20 years. How do we identify those patients?

 

Lee Schwartzberg, MD, FACP: That’s a great question. We’re still struggling in some cases to identify them. It’s well established that over half of the recurrences occur after year 5. Our traditional thinking, and what’s out there in popular culture, that you’re home free if you’re disease-free at 5 years, unfortunately isn’t true for HR+ disease. That’s a difficult discussion that I have with our patients all the time, that we have to continue to monitor these patients, particularly if they’re at higher risk. It was very sobering a few years ago when the Early Breast Cancer Trialists’ Collaborative Group looked at the recurrence rate for up to 20 years, even in patients who had T1N0 tumors. It continues up through 20 years. Of course, the larger the tumor in terms of T size or the more nodes that are involved, the curves shifted upward as well. This is a substantial problem going out to 20 years.

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Yes AI’s have made a difference in recurrence rates. Here’s an article talking about it - onclive.com/view/aromatase-inhibitors-significantly-reduce-recurrence-in-premenopausal-er-breast-cancer

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I think the stats say it does, but little is made to the quality of life experienced by women taking Ai’s-there are such a list of side effects which most women suffer to one level of another. Age at onset has to be taken into account surely-if a young woman has a HR cancer, then Ai’s are a must to help prevent recurrence, but if an older lady-including myself in that-surely it’s the quality of life at that stage which is more relevant. That’s what I think anyway!

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I would agree! I would always recommend trying endocrine therapy with the attitude that you will figure it out. It most certainly does reduce recurrence rates and most people do figure out eventually how to deal with it to the point that they have a good quality of life. But if no matter what you do, your life sucks and you’re older then I can easily say chuck the whole thing. It’s risk versus reward for everything. A few more years of life might not matter as much to an older person if those years are horrible.

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