Women with hormone receptor-positive (HR+) breast cancer should be given the option to have adjuvant hormonal therapy for as long as 10 years, according to new guidelines issued today by the American Society of Clinical Oncology (ASCO).
The updated guidelines reflect results from several large studies that showed women who took tamoxifen for 10 years had a lower risk of recurrence and a “survival advantage,” compared to women who took the drug for only five years.
In a press release issued by ASCO, Harold J. Burstein, MD, PhD, a breast oncologist with the Susan F. Smith Center for Women’s Cancers at Dana-Farber, explained “tamoxifen taken for five years has been the standard adjuvant hormonal treatment for decades, but we now have evidence to recommend up to 10 years of tamoxifen for women with hormone receptor-positive breast cancer.” Burstein is co-chair of ASCO’s Expert Panel that wrote the guideline update.
The update applies to pre-/peri- and post-menopausal with HR+ breast cancer. However, the guidelines also state that post-menopausal women who have completed five years of tamoxifen should have the option to continue another five years of treatment with either tamoxifen or an aromatase inhibitor.
Before starting any treatment, Burstein notes that women should discuss with their physician the potential risks and benefits of adjuvant hormonal therapy for extended periods of time.
More details on the ASCO guidelines are available here. For more information on breast cancer treatment, visit the Susan F. Smith Center Breast Oncology Program website.
Does this recommendation apply to men who have he breast cancer and are taking Tamoxifin?
Dear Alan–
Thank you for your comment. This guideline only applies to women; men should take 5 years of tamoxifen.
Thank you again for connecting with us and reading Insight. Wishing you all the best.
What are the percentages of women who have a recurrence after five years of tamoxifen and after ten years of tamoxifen?
Dear Pam —
Thank you for your question and for reading Insight. Recurrence risk depends on the initial stage of the breast tumor. For women with stage I breast cancers, the average recurrence risk in years 5-10 is about 5 percent. For women with stage II or III breast cancers, the average recurrence risk in years 5-10 is about 10-15 percent.
I hope this is helpful. Wishing you all the best!
I was asking about those women who take tamoxifen. Does taking it for ten years offer a huge difference over taking it for five years? What are the numbers?
Dear Pam —
The information we left in the previous comment is referencing women who take tamoxifen. If you would like more information on this study and the recommendation, this page includes a detailed recommendation and supplemental materials available from ASCO. More details on the guidelines are also available here. I hope this is helpful! All the best.
If a patient with stage 1 HR+ breast cancer finished the 5 years of Aromasin 5 years ago, is it recommended that she go back on it now for another 5 years?
Dear Susan —
Thank you for your comment and for reading Insight. Unfortunately, we cannot give out medical advice on this blog, or over email. We recommend bringing your question to an oncologist or care team. If you are looking for more information on breast cancer treatment, research and clinical trials, you can visit our Breast Oncology Program website.
Wishing you all the best!
What about Femara which many women are advised to take for 5 years after the 5 years of Tamoxifen? Why didn’t you mention that? Is 10 years of Tamoxifen better than 5 years of Tamoxifen then 5 years of Femara?
You fail to mention the risk of taking Tamoxifen. My mother died after two breast cancer survivals from uterine cancer. She was on Tamoxifen for 5 years. My 55 year old sister-in-law one year after lumpectomy and radiation and the start of Tamoxifen therapy was diagnosed with uterine cancer. The uterine cancer killed my mother, thankfully after my sister-in-law had her hysterectomy there has been no recurrence. Sorry Doc, but I don’t trust Tamoxifen at all.
Dear Doctor,Do above recurrence rates apply in women who have had mastectomies?Thank you
Is this also indicated for DCIS?
Dear Kathy —
Thank you for your question and for reading Insight. This recommendation applies to use of adjuvant endocrine therapy for women with stages I-III hormone receptor positive breast cancer.
I had stage 0 DCIS. It was so small, it was called a biopsy instead of lumpectomy. It was hormone receptor positive. My sister had DCIS and mastectomies for both breasts, 5 years apart. My surgeon recommends Tamoxifen. Is it worth the risk?
Dear Pam —
Thank you for reaching out and for reading Insight. Unfortunately, we cannot offer medical advice over this blog or email. It is best to discuss any questions with your physician or care team.
If you are interested in a second opinion at Dana-Farber, the procedure is the same as for becoming a new patient. If you are able to come to Boston to meet with our treatment team, please call 877-442-DFCI (877-442-3324) or fill out this online appointment request form:
https://www.dana-farber.org/apps/request-an-appointment.aspx
If you are not able to travel to Boston, Dana-Farber offers a program called Online Specialty Consults, which allows patients and physicians to confer with our specialists online about second opinions, treatment options, or clinical trials.
These links provide an overview of the process:
http://www.dana-farber.org/Partners-Online-Specialty-Consultations.aspx
https://econsults.partners.org/v2/%28jwewk42ud2zpsevdo4p1l545%29/Tour/1.html
I hope this is helpful. Wishing you all the best!