Imagine being diagnosed with breast cancer, going through the treatment and hearing that you are cancer-free, only to receive another related cancer diagnosis 10 or 15 years later.
That happens to many women with estrogen receptor positive (ER-positive) breast cancer, which is fueled by their estrogen levels, says Dr. Sapna Khubchandani, an oncologist and breast health specialist with Hartford HealthCare Medical Group Oncology and Hematology in Waterford.
A possible solution, she notes, can be found in recent research published in the New England Journal of Medicine that suggests extending the course of hormone treatment with tamoxifen from the current standard of five years to 10 years.
“We know endocrine treatment decreases the risk of recurrence but the duration of hormonal treatment is still under debate,” says Dr. Khubchandani. “This is the latest research suggesting that longer treatment could eliminate the risk this type of breast cancer will recur.”
Tamoxifen is an endocrine-based pill patients take daily with a near-perfect success rate of eliminating ER-positive breast cancer. The NEJM publication featured an evaluation of 88 clinical trials involving 62,923 women with ER-positive breast cancer who received five years of endocrine therapy that left them free from cancer.
Many of the women, however, experienced a cancer recurrence up to 20 years after their initial diagnosis. The risk of having the disease return elsewhere in the body – generally in the bone, liver or lung – remained constant for these women, the study reports.
Dr. Khubchandani references two landmark trials – ATLAS in the United States in 2012 and Attom in Europe – as specific evidence that doubling the course of tamoxifen to 10 years could decrease the risk of cancer recurrence and reduce a woman’s mortality from breast cancer, particularly after 10 years. She suggested an even longer course might be warranted.
“I think we need to see what giving the treatment for 15 years would do,” Dr. Khubchandani offers. “Taken together, the results suggest that 10 years of tamoxifen can halve breast cancer mortality during the second decade from diagnosis.”
She does caution that extending the treatment can slightly worsen such side effects as endometrial hyperplasia and pulmonary embolus, especially in post-menopausal women. For younger women, the benefit of extended protection against the cancer would outweigh the risks.
“Premenopausal women, especially those who are not expected to reach menopause within five years, will benefit most from extending tamoxifen treatment to curb the chance of breast cancer recurrence,” Dr. Khubchandani says.
Dr. Sapna Khubchandani, an oncologist and breast health specialist with Hartford HealthCare Medical Group Oncology and Hematology in Waterford, is accepting new-patient referrals at 860.443.4455.