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Cancer-Free Five Years, Then What?

Posted by Jane Akre
Wednesday, August 13, 2008 2:21 PM EST
Category: Major Medical, Protecting Your Family
Tags: Breast Cancer, Tamoxifen, Women's Health, FDA and Prescription Drugs

The five year mark does not always mean you will remain cancer free.



IMAGE SOURCE: ©iStockphoto/ radiologist examines breast image/ author: Millanovic


Five years.  That has traditionally been considered the landmark date for cancer survival.  

A new study shatters that confidence and raises the question as to what therapies are appropriate after the five-year mark is reached.

Researchers at the University of Texas M.D. Anderson Cancer Center in Houston say a small risk for relapse exists, but it may depend on the type of cancer and when it was diagnosed.

Dr. Abenaa Brewster, a medical oncologist evaluated 2,838 breast cancer patients suffering from stage I through stage III cancers.  All had remained cancer-free for five years and all had received therapies such as surgery, chemotherapy, radiotherapy or endocrine therapy (tamoxifen, aromatase inhibitors and drug combinations) between the years 1985 and 2001.

The stage of cancer at diagnoses seemed to influence the relapse rates.

After ten years passed, 89 percent of the women were cancer-free, and after 15 years, 80 percent remained recurrence-free. 

Of the original 2,838 women, 216 developed cancer again. Dr. Brewster noted that those women who had been diagnosed at stage I had a seven percent chance of a relapse; at stage II, there was an 11 percent chance of relapse; and at stage III, there was a 13 percent relapse.

Other factors that influence the chance of a relapse were whether the rumor was ER-negative or positive.  ER refers to estrogen receptor status. ER-positive tumors seem to respond to the effects of estrogen.

“Women who had ER-positive cancer were more likely to have late recurrences than those with ER-negative,” according to Brewster. Among ER-negative women there were 34 relapses, while among ER-positive there were 149. 

No one was on the aromatase inhibitors for five years as they were not around in 1985, though they are now the standard of care for post-menopausal women.  The therapy involves three drugs that stop estrogen production in postmenopausal women -  letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin). They work by blocking an enzyme (aromatase) responsible for making small amounts of estrogen in postmenopausal women.

The study is published online in the Journal of the National Cancer Institute.

Dr. Len Lichtenfeld of the American Cancer Society tells the Washington Post, that “even though women may have gone through five years of hormonal therapy, they are still at risk of relapse,” he said, pointing out that ER-positive tumors seem to have a higher risk.

"Basically the jury is out on the potential value of additional treatment strategies once the five years is completed," Lichtenfeld said. "Based on this study, we need to be open to question whether other treatment programs may be appropriate in some of these women after the five-year period is completed."  #


Anonymous User
Posted by Joy Hawes
Wednesday, August 13, 2008 4:42 PM EST

After surgery and radiation in June 2000, I was on tamoxifen for five years and have been on Femara for three years. I would like to know how many years I can continue to use Femara.

Anonymous User
Posted by Dee
Wednesday, August 13, 2008 9:03 PM EST

I'm ending 5 years on Arimidex. While I understand we need to do more research as to who will benefit from ongoing treatment, frankly its unfair to deny a patient ongoing treatment until determined otherwise. Question to the professionals - if it were you would you take yourself off of any treatment and take a wait and see approach?

Comments for this article are closed.

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