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Editorial
March 2017

Vaginal Estrogens and Aromatase Inhibitors: How Safe Is Safe Enough?

Author Affiliations
  • 1University of North Carolina at Chapel Hill, School of Medicine, Division of Hematology/Oncology, Chapel Hill
  • 2University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill
JAMA Oncol. 2017;3(3):305-306. doi:10.1001/jamaoncol.2016.3934

Adjuvant endocrine therapy with tamoxifen, and now in postmenopausal women with aromatase inhibitors (AIs), has been a major factor in improving survival for women with early-stage, hormone receptor (estrogen and/or progesterone receptor)-positive breast cancer. In postmenopausal women, 5 years of AI therapy reduces breast cancer recurrence by about 30% and breast cancer mortality by 15% when compared with 5 years of tamoxifen,1 making it the clear therapy of choice for most women in this age group. The average age of patients with breast cancer at diagnosis in the United States is now 62 years2 and most of these women have hormone receptor–positive tumors and are candidates for adjuvant endocrine therapy. Current guidelines suggest that postmenopausal women with hormone receptor–positive tumors who are candidates for adjuvant endocrine therapy, which includes all except some with tumors less than 1 cm or with short life expectancy, receive an AI as part of their adjuvant treatment.3 Aromatase inhibitor therapy was previously recommended for 5 years, but recent data show that extending AI therapy for 10 years results in further improvement in relapse-free survival.4 These data indicate that for women who take AI therapy, adverse effects may be present for long periods of time and may result in decreased adherence to treatment.

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