title: Is Endocrine Therapy Really Pleasant? Considerations about the Long-Term Use of Antihormonal Therapy and Its Benefit/Side Effect Ratio.
abstract: Endocrine therapy has become a key part in the adjuvant treatment of hormone responsive breast cancer. The positive effect on relapse risk reduction is well defined, but therapy is not free from bothersome side effects for which estrogen deprivation accounts to a great extent. Since endocrine therapy is usually prescribed for 5 years or longer to optimally display its protective effect, and because physical strain is missing, good tolerability and safety properties are important, particularly in low-risk patients. While tamoxifen has been the standard adjuvant endocrine treatment with well documented efficiency, it is increasingly replaced by third generation aromatase inhibitors due to their better effectiveness and tolerability. Because tamoxifen holds a risk for life-threatening adverse events such as endometrial cancer, pulmonary embolism, and stroke, its recommended duration of therapy is limited to 5 years, also because extension beyond that time did not produce a measurable advantage. While some side effects are present both with tamoxifen and aromatase inhibitors, differences in side effect profiles are well established. Although side effects of aromatase inhibitor-related therapy usually are mild and common to symptoms of menopause, misconception of the symptoms and their mechanism of action, as well as lack of knowledge about how to handle them, can easily lead to dangerous discontinuation of therapy.
authors.affiliation: Department of Surgery, Medical University of Vienna, Austria.
authors.forename: Peter
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authors.lastname: Blaha
authors.forename: Ruth
authors.initials: R
authors.lastname: Exner
authors.forename: Andrea Dal
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authors.lastname: Borgo
authors.forename: Sinda
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authors.lastname: Bigenzahn
authors.forename: Peter
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authors.lastname: Panhofer
authors.forename: Otto
authors.initials: O
authors.lastname: Riedl
authors.forename: Sebastian
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authors.lastname: Schoppmann
authors.forename: Thomas
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authors.lastname: Bachleitner-Hofmann
authors.forename: Emanuel
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authors.lastname: Sporn
authors.forename: Ursula
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authors.lastname: Pluschnig
authors.forename: Florian
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authors.lastname: Fitzal
authors.forename: Guenther
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authors.lastname: Steger
authors.forename: Raimund
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authors.lastname: Jakesz
authors.forename: Peter
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authors.lastname: Dubsky
authors.forename: Michael
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authors.lastname: Gnant