"Aromatase Inhibitors More Effective than Tamoxifen"

Here's an article that just gets me.  The more I read stuff like this the less I beleive in statistics, studies, risks or numbers.

From the San Antonio Breast Cancer Symposium - courtesy of CURE publication.

"Aromatase Inhibitors More Effictive than Tamoxifen"

"On the 1st day of the meeting, a morning seeion on adjuvant hormonal therapy offered a repetitive theme: Aromatase Inhibitors WORK BETTER than Tamoxifen.

According to new data from the BIG 1-98 trial, 5 years of the aromatase inhibitor Femara (letrozole) reduced the risk of death by about 1/5th when compared with Tamoxifen.  Some patients on the Tamoxifen arm crossed over to receive Femara, and the reduced risk of death in these patients was 13% compared with patients who only received Tamoxifen.

To determine the most effective approach for minimizing the risk of recurrence, the BIG 1-98 trial compared 3 arms: 5 years of Femara, 2 years of Femara followed by 3 years of Tamoxifen, and 2 years of Tamoxifen followed by 3 years of Femara.  There was no evidence that sequential treatments imporved disease-free survival compared with Femara alone.  However, after 2 years of initial treatment with Femara, the patients who switched to Tamoxifen did as well as patients treated with Femara for the entire study period, indicating that patients can switch to Tamoxifen if needed, said investigators.

The TEAM trial asked whether 5 years of of Aromasin (exemestane) or Tamoxifen works better as single agent therapy after surgery.  The first analysis of this largest-ever trial of an Aromatase Inhibitor compared with Tamoxifen included data from nearly 10,000 women.  The trial found a significant advantage for Aromasin over Tamoxifen after 3 years of follow up."

Ok, here's why I have problems with studies like this: first and foremost I was on Femara for 3 years when I found out I had a recurrence - plain and simple, Femara failed to work properly for me.  It did not stop my estrogen from binding with my cancer cells, therefore allowing it to grow over time.  If my plastic surgeon hadn't actually seen this suspicious looking tissue it would have gone unnoticed till who knows when cause my cancer markers were all within range.  Secondly, the data on AI's is reletively new compared to the research on Tamoxifen.  Tamoxifen was the original standard in adjuvant hormonal therapy, it's been used successfully for over 30 years.  Femara and other Aromatase Inhibitors have only been around since the late 90's.  Sure both drugs carry risks of side effects, all medicine does.  My point is how can you compare 10 -15 years of data to something that's been used for 30+ years?

I will most likely start taking Tamoxifen shortly if my PET scan comes back clean, therefore allowing me to skip chemotherapy.  Even after reading this article I can't say that I'm even slightly hesitant about taking Tamoxifen.  I know I will be monitored with quarterly blood tests and yearly scans and should things appear to change, then I am confident my doctor will make the appropriate changes to my treatment - but I do have to ask, if AI's are better at treating breast cancer than Tamoxifen is, and AI's don't work for you, then where do you go from there if Tamoxifen doesn't work?  Sounds like a question for my doctor on Monday!