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.


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MH Ruhe Chowdhury1, Amanda Shewbridge1, Ines Sandri1, Sivanadiyan Kabilan1, Janine Mansi1
1Guy's and St Thomas' Hospital, London, UK

Background

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[1]. 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.

Method

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.

Results

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.

Conclusion

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.