Looking for research re: taking AI drugs vs not taking them

Posted by celestebradham @celestebradham, Jan 4 10:38am

I am currently taking Exemestane. I’m 61. Took a while but I’m doing well on it (doing yoga, pranayama and acupuncture). I now have osteopenia after taking it six months. I’m trying to find research on taking AIs vs not taking. What I’m finding there is not much difference between taking and not taking. But more likely to get arthritis and osteoporosis.
Can anyone post links. .

Interested in more discussions like this? Go to the Breast Cancer Support Group.

there is a current clinical trial for early stage bc in which the AI is only taken for 2 yrs, will be interesting to find out if 2 yrs is equal to 5 yrs

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Good to know. Who’s doing it ?

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@celestebradham

Good to know. Who’s doing it ?

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In Canada, ‘la least’ trial, in Quebec and also in Vancouver, BC i believe

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@bloncape

I think the 53% of reduction, to which this article refers, is prevention in women who are at risk for developing breast due to genetic factors or family history, for example, not for women who already have breast cancer. I have read that the risk reduction benefit from taking an aromatase inhibitor (AI) for 5 - 10 years after being diagnosed with ER+ breast cancer and after having had surgery and possibly radiation is 40% to 60%.
I was told that my chance of recurrence was 12% without taking an AI.
If I took an AI for at least 5 years, my risk would be between 7.2% and 4.8%. I had MANY side effects from anastrozole, the worst being severe depression and an overall poor quality of life. I was encouraged to try exemestane, but I declined. The hope of potentially reducing my risk of recurrence by less than 5%, was not worth feeling so awful for 5 -10 years, so I decided to stop taking anastrozole after 2 1/2 months. That was 4 years ago. I will be 75 in May. So far, I am doing well. I walk every day and eat a good diet.
I am not suggesting that anyone stop taking these drugs. It's a difficult, personal decision. Just know that it is your decision to make based on your situation and how you feel. I wish you all well. Try to be at peace with whatever decision you make. Sending hugs.

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Yes, great factual response. We have to understand the statistics as they pertain to us, individually. I refused AI treatment after Stage1 treatment including surgery and short term radiation. Factored in: stage, age, Onco Typing, current bone density, all factors being weighed. Risks and side effects outweighed benefits. AI treatment has multiple side effects. Do loads of research as it pertains to You. God Bless😘

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You are so right! I went to two other reputable organizations, Dana Farber in Boston and Sloan Kettering and they told me the same thing. these two other oncologists were women. They all agree that there are no studies for women over 55 years old and that is the problem itself. No studies and fear of suits. It is up to us to research and choose the path we instinctually think is best.

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Hi
For myself I did the research and decided not to do any of the hormone blockers. I already have osteoporosis in my spine with a compression fracture.
I guess you have to weigh the odds.It's a personal decision. I did not want to take a medication.That made me take three other medications to cope with one medication. It's bad enough not being able to take hormones anymore and having all those side effects.

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I totally agree. I had a lumpectomy. Stage 1 estrogen driven. I took radiation and have been taking Temoxifan. I started with three of the others before switching to Temoxifan and tolerated it better. However I took a break from it in November and decided to discontinue it. I am finally feeling so much better. I stayed on the drugs for three years and decided I would rather feel good with whatever time God gives me. I just turned 70. I exercise and try to eat healthy. It's definitely a personal decision. I have no regrets!

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@kcalhoun

Hi All,
New member here and breast cancer patient (post-meno, E+P+, PT2, PN1a, Grade 2, surgery, chemo, radiation, AIs, OncoDX 25).
I'm a researcher for a living, so I'm one of those irritating patients that researches everything to death to make sure I'm well-informed. 😀 This is offered in NO WAY as a replacement for medical advice, just to share what I've learned in my travels. As always, your mileage may vary. 🙂
I too have been struggling with the issue of AIs, and have researched the pros and cons of each (already been through Anastrozole and Letrozole, and supposed to start Exemestane next). A couple things in case they're useful:
1. Whether or not an AI is worth the tradeoff of side-effects/potential damage vs. recurrence risk is a VERY important decision for you. One tool mentioned here is the (very well researched) Predict Breast cancer tool (be SURE you're using the latest version (v3) as they update their models based on new data). It allows you to provide details on your cancer type, then lets you turn treatments on or off to see how they could impact your outcomes. In my case, the difference taking AIs would make to my risk reduction is 1% difference at year 5, 2% at 10, and 3% at year 15. For someone who's not tolerating them well and scared of damage, this'll be critical to know.
2. There are outstanding oncologists everywhere, and hopefully you have one. But be aware that in some systems, that onco has been told that the protocol is "AI or Die" and they have to relentlessly stick to that script regardless of the actual relevant data for you. For them, it protects from liability if they don't offer it, but be aware, that may not always be the final answer. (At the risk of offense, I'm so tired of videos of old, white drs. telling women to stop the complaints and just "suck it up and take the medicine." Let's see you do it.) :-Z
3. Many people (and drs.) will mention that figure of AI "reducing your risk by 53%." If that no.'s accurate, be aware of this. That's 53% of your RISK of recurrence, NOT a 53% chance you'll get cancer again. Often misunderstood (and good to scare you into AIs). So for example, if your survival odds are 97%, the AI's impact is 1.59% (53% of 3%). Of course, if you have a scary-high risk of recurrence, you may well calculate that every bit of additional help is worth the price you may need to pay. But again, just be sure you're an informed patient.
4. Finally, there's a LOT of legit research going on around other natural forms of aromatase inhibition (the function that makes estrogen in your body). Some foods (top are button mushrooms, cruciferous veggies (ex., broccoli), fermented foods, MANY more easily found online) in addition to the impact of a high fiber diet and exercise to inhibit aromatase production. Actual research you can look up to help women who can't (or don't want to) tolerate AIs. Is it the same as an AI med? Likely not, but you can sure have a big impact if you decide not to go the AI path.
I hope this is useful for anyone here. Appreciate everybody in the conversation. Kelly

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Hello Kelly and all, I'm new to this forum. I'm 60, had lumpectomy surgeries for Stage 1, Grade 2, HR+, Her2-, IDC + DCIS, and doing radiation now (4 wks). Having a serious dilemma about whether to take hormone therapy or not. Fearful of SERMs (I have PCOS, and my risk of uterine cancer is already higher than general population; plus heart, eye health risks, etc.), and regarding AI's, I already have osteopenia (serious level on lumbar spine).
Trying to better understand the Predict model, which if I understand correctly, predicts survivorship, not recurrence. I can't understand from this model how many of these patients may have had a recurrence, and then may have needed further surgery (lumpectomy, or mastectomy), radiation, hormone therapy, etc. but survived. Running my stats in Predict looks very good regarding survival, but it doesn't seem to be telling me about my odds for recurrence? Please correct me if I am wrong.
I was informed by my oncologist that if I took an AI (Arimidex), I should also take Zometa to combat bone loss. Has anyone followed this route and had success or issues with it?
Ideally, like anyone, I'd like to avoid hormone therapy altogether, due to my personal risks vs. benefits given my decent chances of survival, but I don't fully understand recurrence odds without hormone therapy. Is there a valid tool or study for recurrence, or am I missing something in the Predict model? Thank you for all input. LJ

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@lj22

Hello Kelly and all, I'm new to this forum. I'm 60, had lumpectomy surgeries for Stage 1, Grade 2, HR+, Her2-, IDC + DCIS, and doing radiation now (4 wks). Having a serious dilemma about whether to take hormone therapy or not. Fearful of SERMs (I have PCOS, and my risk of uterine cancer is already higher than general population; plus heart, eye health risks, etc.), and regarding AI's, I already have osteopenia (serious level on lumbar spine).
Trying to better understand the Predict model, which if I understand correctly, predicts survivorship, not recurrence. I can't understand from this model how many of these patients may have had a recurrence, and then may have needed further surgery (lumpectomy, or mastectomy), radiation, hormone therapy, etc. but survived. Running my stats in Predict looks very good regarding survival, but it doesn't seem to be telling me about my odds for recurrence? Please correct me if I am wrong.
I was informed by my oncologist that if I took an AI (Arimidex), I should also take Zometa to combat bone loss. Has anyone followed this route and had success or issues with it?
Ideally, like anyone, I'd like to avoid hormone therapy altogether, due to my personal risks vs. benefits given my decent chances of survival, but I don't fully understand recurrence odds without hormone therapy. Is there a valid tool or study for recurrence, or am I missing something in the Predict model? Thank you for all input. LJ

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Im in the same boat. I have decided not to take estrogen blockers due to almost your same issues. My radiation oncologist felt i do not need them because of my age, 72, and my tumor was small was removed and with radiation he felt my reoccurencr was less than 5%. I also went go oncologist and she thinks i should take 20 mg of tamoxifen but with all the side effects, depression etc. Im not going to. They seem to tell everyone the same thing. I have also read studies where 10 mg of tamoxifen is just as effective with lower side effects. I know its confusing and these are hard decisions to make.

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Thank you for sharing, Irene. Hard decisions, indeed. Best of luck to you.

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