Extended adjuvant aromatase inhibition after 5 years of tamoxifen in women who were pre-menopausal at the time of diagnosis of early breast cancer. Real time experience data.
Session type: Poster / e-Poster / Silent Theatre session
In 2003 the MA17 study reported on the role of extended hormonal treatment in post-menopausal oestrogen receptor (ER) positive women with early breast cancer who had received 5 years of tamoxifen. Subsequent updates showed a prominent role in disease management, with a particular emphasis in those women who were premenopausal at the time of diagnosis[2–3]. Guidelines were developed for this patient group in 2009. We examined whether this practice was being adhered to.
Records were identified and data collated of all women who were pre/peri-menopausal at diagnosis with ER positive tumours between 2005 and 2007.Adjuvant-on-line was used to provide a level of risk of recurrence.
90 patients were identified as pre-/peri-menopausal at the time of diagnosis. 15 relapsed during follow-up (12 within the initial 5 years of tamoxifen), 1 declined adjuvant hormone therapy, 74 were suitable for consideration for further adjuvant therapy.
Only 20 patients were referred, 14 were confirmed postmenopausal and started extended hormone therapy. A further 17 patients of the 74 were identified as having a 5% or more reduction in risk of recurrence with additional treatment, 6 of whom had been discharged at 5 years.
Examination of the records of the patients not referred to the oncology service revealed that some clinicians reviewing patients in the follow-up setting were not aware of our current guidelines.
Referral for extended adjuvant endocrine therapy was not consistent. We need to improve awareness of the need to re-refer back to the oncology services at the end of 5 years in women who were premenopausal and ER positive at diagnosis for reassessment of menopausal status and to consider additional adjuvant hormone treatment.