Take anastrozole for the rest or your life?

Posted by sandyjr @sandyjr, Jul 28, 2023

My friend is 76. She has had BC twice…once in each breast. The last time was 4 years ago. Her oncologist told her she would have to take anastrozole for the rest of her life. Our cases are similar…different oncologists and I am 73…I was told I would finish after 5 years. Has anyone been told this or is currently taking it for the rest of their lives?

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@sequoia

@whr I’m lol as I was going to use ‘lab rats’ as that is how I feel. Changed to ‘test subjects’ which had a different connotation. August I’ll be 4 yrs out from my surgery. 🙏🏼💪🏼. Hugs right back at you.

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I'm not as polite as you are. 😊
I am 78 and hopeful, some days more so than others.

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I am 65. My breast cancer estrogen 100% and progesterone 90%. My oncologist recommends 10 years of anastrozole. While I would like to think I will live well in to my 90’s, 10 years could be considered “rest of my life”

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@whr

I'm not as polite as you are. 😊
I am 78 and hopeful, some days more so than others.

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@whr I definitely wasn’t saying you weren’t polite. Lol. Hugs

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To be clear, the Breast Cancer Index is only for those who have completed 5 years of meds and determines benefit of extending treatment. I was happy to do 5 years and had no doubts about the usefulness in preventing recurrence during those years.

I have read that 7 years may be as good as 10 - maybe our docs can expand on that.

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@windyshores

We were told that 10 years was optimal. Then I heard that 7 years was as good as 10. For someone who has had two cancers and is 76 perhaps "the rest of your life" is reasonable.

The thing is, you have to make sure it is doing something. When I finished 5 years I had a Breast Cancer Index test done. It showed no benefit from further treatment with an AI, High risk but no benefit. This was even with very high ER score of 95% and PR 80%.

Maybe your friend could do a BCI to make sure she is getting benefit from the meds. It is now in the NCCN guidelines but some docs don't know about it apparently.

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Is ER score of 95% and PR 80% a good thing or bad?

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@joannemm30809

Is ER score of 95% and PR 80% a good thing or bad?

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High ER (especially) suggests that the breast cancer cells are estrogen receptors. Therefore, limiting estrogen is a treatment for ER positive BC. Having a treatment is generally regarded as “ a good thing” as it may prevent recurrence.

Pre menopausal women still produce estrogen in ovaries ( which then needs to be shut down). Post menopausal women may have estrogen stored in adipose tissue “belly fat” as well as the ability to continue to produce estradiol (in adrenal glands) which converts to estrogen with the help of aromatase . Aromatase Inhibitors work to prevent the conversion thus cutting down availability to BC cells, which require it, to proliferate.

So if you are ER PR positive there is THIS ongoing potential treatment available. As AI’s lower circulating estrogen, side effects, related to this deficit, are felt. Most women find the side effects to be tolerable or can be mitigated. Some women find them to be intolerable. Oncologists may try taking a several week “vacation” then returning to the med or switching to another of the 3 to find a more comfortable match. This sometimes helps.

As it is a daily medication it can be stopped at any time if need be.

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@joannemm30809

Is ER score of 95% and PR 80% a good thing or bad?

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@joannemm34293 a high ER (and PR) means that aromatase inhibitors (or tamoxifen for pre-menopause) should have a high level of effectiveness. The scores make the cancer more treatable, in other words.

I asked the Breast Cancer Index people why extended treatment had no benefit for me, with those high ER and PR scores and a low Oncotype. They explained that the Oncotype looked at how many cars were in the road and they looked at the speed of the cars (or vice versa, I cannot remember).

I would think the BCI result would show that my cars were moving slowly but then I had a high risk of recurrence of 5.7% (they have since changed their labelling of risk).

It's hard to base our decisions on Oncotype, BCI and other testing but we don't have much choice. My bones needed attention or I might have continued another two years anyway. One oncologist said I could two more years anytime so once my bones are taken care of (almost done Tymlos) I might go back and ask about that. Letrozole would not be to treat but to prevent.

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@windyshores

@joannemm34293 a high ER (and PR) means that aromatase inhibitors (or tamoxifen for pre-menopause) should have a high level of effectiveness. The scores make the cancer more treatable, in other words.

I asked the Breast Cancer Index people why extended treatment had no benefit for me, with those high ER and PR scores and a low Oncotype. They explained that the Oncotype looked at how many cars were in the road and they looked at the speed of the cars (or vice versa, I cannot remember).

I would think the BCI result would show that my cars were moving slowly but then I had a high risk of recurrence of 5.7% (they have since changed their labelling of risk).

It's hard to base our decisions on Oncotype, BCI and other testing but we don't have much choice. My bones needed attention or I might have continued another two years anyway. One oncologist said I could two more years anytime so once my bones are taken care of (almost done Tymlos) I might go back and ask about that. Letrozole would not be to treat but to prevent.

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How are you doing with bone treatment?

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@anjalima

How are you doing with bone treatment?

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Tymlos returned me to spinal bone density that is better than when I started letrozole. I had a 20% gain in spine which is miraculous- from severe osteoporosis to borderline -2.5. Hip gain was 9% up to -2.9. However femur neck is still -3.6, up from -4.1. Tymlos is better with spine than hip. I was able to get on it by ramping up the dose: the pen comes with clicks that measure dose. Next step is Reclast but doc is infusing only a 20% dose to test my tolerance and kidneys
reaction. I am also working with a nephrologist.

Thanks for asking. My kids cannot get over how much strong I am and I walked 10 miles two days in a row with my daughter in Brooklyn!

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