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Using Aromatase Inhibitors in Early Stage Breast Cancer

Breast Cancer Breast Cancer Treatment

Preparing For Side Effects: What to Expect From Breast Cancer Therapies

Summary & Participants

A diagnosis of breast cancer usually leads to some form of surgery. Afterward, various therapies help guard against spread or recurrence of disease. Side effects are common, but many are more easily managed than just a few years ago. Listen as experts describe treatment options and explain what women can expect.

Medically Reviewed On: May 07, 2008

Webcast Transcript

Women who are pre-menopausal are treated with tamoxifen, which blocks the effect of estrogen on cancer cells.

WILLIAM GRADISHAR, MD: With tamoxifen, hot flashes are relatively common. Women can develop a vaginal discharge, vaginal bleeding and very infrequently, endometrial cancer or uterine cancer related to the drug's use. Extremely rarely, women can get cataracts or some visual disturbances. But again, these are side effects that are relatively uncommon.

ANNOUNCER: Women who are past menopause can be treated with tamoxifen or another class of hormonal agents called aromatase inhibitors, which reduce already-low levels of estrogen in the body.

Preliminary data from a clinical trail called ATAC shows one of these drugs, Arimidex, is effective, and produces fewer of the side effects associated with tamoxifen.

GENEROSA GRANA, MD: Arimidex appears to be superior to tamoxifen when it comes to a decrease in hot flashes and night sweats; a decrease in weight gain, although slight; a decrease in uterine cancer risk; vaginal bleeding and vaginal discharge; a decrease in clotting risk and that means both lower extremity clots, pulmonary emboli and stroke; and probably a decrease in cardiovascular events in general.

ANNOUNCER: But some side effects are more prevalent with aromatase inhibitors.

WILLIAM GRADISHAR, MD: The aromatase inhibitors are associated with musculoskeletal complaints. In all of the clinical trials, there seemed to be a slightly higher chance that women would complain of sort of aches and pains in their bones. That does not mean it's universal; in fact, it was infrequent, but nevertheless, more than what we saw with tamoxifen.

ANNOUNCER: Another side effect of aromatase inhibitors stems from the loss of the protection that estrogen normally provides against bone loss in older women.

AMAN BUDZDER, MD: You're taking a postmenopausal women and you're lowering the estrogen further. So there is an increased likelihood of developing osteoporosis or loss of calcium from the bones, and the woman may be a the increased risk of developing fracture.

ANNOUNCER: New scanning technology makes it possible for doctors to measure easily the strength of a woman's bone at the start of adjuvant therapy, and to monitor possible changes during treatment with hormonal agents.

GENEROSA GRANA, MD: In practice, what I tend to do is obtain bone mineral density assessment. If the woman has good bone mineral density, I feel comfortable. I will monitor that every two years.

On the other hand, if a woman is already beginning with less than ideal bone mineral density -- osteopenia -- again, there are medications that we can use, bisphosphonates, such as Actonel or Fosamax that can be added to the cocktail to protect bone.

ANNOUNCER: Cancer therapy often calls to mind images of discomfort and suffering.

But many women now undergo treatment with fewer and milder side effects, compared to just a few years ago.

And that means women have more choice among therapies, because so many are well tolerated, as well as effective.

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