Arimidex (aromatase inhibitors) for women over 60

SpecialK · April 2015

jane - yes, aromatase inhibitors are hormonal therapy. They are generally offered for post-menopausal women, or pre-menopausal women who simultaneously undergo ovarian suppression with another drug. Tamoxifen is prescribed to pre-menopausal women, but also to post-menopausal women who cannot tolerate aromatase inhibitors because of co-morbidities or side effects. The Oncotype Dx test is for a chemo decision, it is not intended to tell you whether to do hormonal therapy - the assumption that you will is factored into the score. The information it can provide if you decline hormonal therapy is that I believe your recurrence score roughly doubles.

BrooksideVT · April 2015

Yes, Jane, you are correct that tamoxofen (or an aromatase inhibitor) is also expected.

As for your other question, well, yes and no:

YES: If your doctor has already decided that she will not offer chemo, then what that tells you is that she is planning to treat you based on what she already knows about your tumor, that she does not wish to gather more information about your tumor, and that whatever the oncotype might reveal would not change her position, or inform or impact her treatment decisions, not only now, but in the years to come.

NO: Many tumors smaller than yours, and with a lower grade, can, when their individual genes are tested through the oncotype, still turn out to be at high risk for recurrence. This is the specific-to-the-individual information that can affect treatment choices. it is because of this individual variation that the oncotype sometimes indicates that chemo is called for, despite small size and low or moderate grade. Remember, only early tumors are eligible for the test--those that are sizeable, and/or that are already known to be aggressive clearly need chemo. As the purpose of the oncotype is to gather information that helps make the chemo decision, those are the cases that automatically do not receive the test.

I was the same age as you, with a smaller, grade 1 tumor, and my onc strongly recommended the test, because sometimes it catches a nasty wolf of a cancer hiding in sheep's clothing. I am very, very happy that he and I have the results, and that those results confirmed that I did not need chemo.

It does seem that your onc is somewhat unusual in that she is disinterested it the results. It would be an excellent idea to set up a second opinion with another medical oncologist

ruthbru · April 2015

Anti-hormonals are prescribed for women in menopause because they greatly reduce chance of recurrence. The chemo (which I did) reduced my recurrence risk by 20%. Arimidex reduced it 40%. Huge in my case! Since we have had estrogen positive breast cancer once, we unfortunately know that we have enough estrogen circulating around in our systems so that it might contribute to a recurrence down the road.

JaneQPoppy · April 2015

Thanks for this very helpful answers. I think I will ask her to do the test.

doxie · April 2015

I've understood that it is more important for Grade 2 rumors to be tested than Grade 1 or 3.

Generally Grade 1 does not respond well to chemo and grade 3 tumors are more aggressive and respond much more to chemo. So if an MO saw a patient with grade 1 high ER and high PR and low Ki67, it would be very likely that this tumor would not react to chemo. With ER, middle to no PR, and high Ki67 grade 3 tumor, chemo should be very effective. Generally the Onco DX correlates with these. With grade 2 in the gray area of chemo, this is the tumor that needs to be tested. Unfortunately often the Onco score is often equally gray.

My grade 2 tumor tested higher than many Onco DX scores for grade 3 ladies, indicating that chemo was indicated. High ER, very low PR and very high Ki67. From my reading I knew I probably needed chemo.

I would demand the test by phone and not wait for your next MO appointment. Unless your ER and PR are a very high % and your Ki67 is well < 20%, you need this test. Any grade 2 deviating from these good stats really needs the Onco DX to help determine chemo. Do you know your ER, PR, and Ki67 percentages?

JaneQPoppy · April 2015

Doxie said: "I would demand the test by phone and not wait for your next MO appointment. Unless your ER and PR are a very high % and your Ki67 is well < 20%, you need this test. Any grade 2 deviating from these good stats really needs the Onco DX to help determine chemo. Do you know your ER, PR, and Ki67 percentages? "

Hell, the next MO appointment isn't for THREE MONTHS from now. I'll be through with radiation by then. After my first visit to the MO, the next visit was supposed to be SIX MONTHS later, and when I freaked out, they changed it to three months.

Anyway, My numbers:

IDC, -1.1 cm, Stage 1, Grade 2, 0/5 nodes, ER+ 95%/PR+ 95% HER2 negative

I see Ki67 on this report in a table but the "interpretation" column is grayed out for it. Maybe they didn't do the test.

doxie · April 2015

Not every MO tests for Ki67, but it is helpful when there is no Oncotype done and one is HER2- and ER +. My guess is that your MO sees the 95% ER and PR + as a very positive sign that your cancer is slow growing thus not receptive to chemo. She may be right.

If you've not started rads, there is still time to get a 2nd opinion and have the tumor sent for the test. But if the score falls in the gray zone, you'll have a difficult decision to make. A quicker option is to request a test for Ki67. That should not take long for results and a low % could give you peace of mind.

Nash54 · April 2015

JaneQPoppy....I know all this BC stuff can be so confusing. The Onco test is used to determine if you would benefit from Chemo. The test assumes you will be taking an AI (which is the same as hormone therapy). I was DX at age 59. I was postmenapausal 16 years. However, I had been on Hormone Replacement Therapy for about 11 years and off for 5. I have never been overweight so I was surprised to learn that my tumor was er/pr +. I assumed I had very little estrogen left in my body. It was recommended that I take Femara 5-10 years. So far no problems.

BrooksideVT · April 2015

Jane, if you did have the Ki-67 test, that would explain why your onc does not feel the oncotype to be important, as both produce similar information. Although the oncotype is considered more accurate, and has replaced the older test in many areas, it is not necessary for both test to be performed. I would suggest a phone call to clarify whether the Ki-67 test was done. If so, and if the results indicate that you have a low chance of recurrence, I think you can relax. If the test was not done, you'll want to ask for the oncotype now, as that test takes a few weeks, and chemo (unlikely as it might be for you) normally starts before rads. Either way, that phone call should settle the issue.

Yes, Nash. We postmenopausal gals all assume we have only miniscule amounts of estrogen in our bodies, but, from the point of view of an ER+ bc, there is a veritable buffet of goodies just sitting around, waiting to be gobbled up. The evidence, of course, is the information that an aromatase inhibitor can cut our chance of recurrence in half. Glad the femara is treating you well. Wish my arimidex would treat me a bit more kindly.

loxie · July 2015

What about Arimidex if you have osteopaenia, do not have two parathyroid glands, have had tooth extraction problems while on Fosomax and have to have 4 dental implants? I also have arthritis in my neck, spine, hands, feet, knees and jaw joints and was told I need TMJ replacements. I will be 70 next week and had a lumpectomy for Stage 1, Grade 2 IDC with mucinous edges and went through brachyradiation therapy. My Oncotype is 1 with a 3 % recurrence rate (with tamoxifin). I am terrified to go on Arimidex as prescribed by the oncologist. Any thoughts on this from your knowledge or experience? I have also had thyroid and kidney cancer.

JaneQPoppy · July 2015

. Loxie, I have a friend who had a bilateral radical mastectomy. I don't know any of the details of her cancer, except that it was DCIS, and she opted for The Full Monty. No chemo, no radiation.She has osteoporosis and her doctor will not put her on Arimidex.

Anyone else know anything?

You have a lot on your plate. Hope there's also some cake on that plate next week. Hugs.

windingshores · March 2016

This is an old thread but I just wanted to comment, because some of the info differs from what I learned.

Genomic Health, who makes the Oncotype test, told me that 30% of grade 3 cancers have low Oncotype scores, and some grade 1's have high Oncotypes. Oncotypes do not always correlate with pathology results.

The ki67 may not predict Oncotype either. I had a high ki67 and grade 3 tumor but my Oncotype was 8, letting me out of chemo.

Ki67 is a proliferative rate but not the only one that Genomic Health uses, and it does vary a lot, which is one reason some docs don't use it. (In my case it is possible that tissus healing from the biopsy threw it off since healing tissues are proliferating.)

There is some info on the Internet that suggests a cost effective way to determine treatment without an Oncotype is to use pathology results (grade, ki67, stage etc.) but this is not a reliable way to go for many of us. The Oncotype gives information not available with traditional pathology and is a key part of the NCCN guidelines used by oncologists.

lindab142 · March 2016

I'm 61, got done with radiation for a small lumpectomy - last radiation was 1/22/16.

I tried anastrozole and had horrible side effects and had to quit after a week. I have a chemical imbalance and it interfered with my medication, sleeping and eating habits. I can't function with side effects like that.

nurse88 · May 2016

I have been taking Arimidex for 8 months no problems. I am 62 and had mucious carinmona in Aug 2015. Had radiation twice a day for five days now it's back going to surgery soon for another lumpectomy.

dtad · May 2016

Hi everyone. Im 63 and was prescribed Arimidex. So far I have refused and decided to lower my estrogen levels naturally. I take DIM as well as other supplements. Ive also eliminated sugar and have lost 22 pounds since my diagnosis. I have a debilitating autoimmune disease so Im just not willing to take something that could affect my QOL even more. Good luck to all....

darby1419 · July 2016

I have been taking armidex for almost 12 years. My Dr. Did no suggest that I discontinue the armidex. I now have a new dr. (Recommended by my retired dr.) My new dr. Gave me the 0 opinion of going off the drug. She said that there is no evidence that there was a benif it of taking the drug longer than 10 years

As I have 20% loss of bone density. Infusion could destroy my teeth. I decided to discontinue the drug.

My question is do I have an increase of getting cancer again by discontinuing the drug.

Thanks I'm rwally stressed.

Arimidex (aromatase inhibitors) for women over 60

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