AI- more than 10 years

Julie,

We are pretty much in the same boat here. I am osteopenic too. With the exception I have been on the AI's much less time then you have. It will be interesting to see how opinions differ from UK to USA.

Any more on bisphosphonates? I'm really surprised they're not recommending.

July marks the end of five years on letrozole for me, and I'm hoping my onc doesn't want to discontinue it. My DEXA scans have been OK, but I convinced her to put me on Prolia for recurrence prevention. Any weapon in the arsenal is welcome.

DON'T YOU JUST HATE ALL THE AMBIGUITY!!!? I've been through 3 oncologists in the past 6 months, and their advice was as follows: "get off it", "take a 6-month break from it", & "continue taking if it eases your anxiety but there's no proof it's doing any good".

Meanwhile in addition to osteopenia, I've now developed an abnormality in my latest EKG which led to a nuclear stress test last Friday (should get results next week). Who knows what havoc Arimidex has been quietly wreaking on my insides, under the guise of protecting me from estrogen!

It's all such a crap shoot, isn't it? My best to all of us as we struggle to make impossible decisions...

Julie

I am a worrywart too. What do you mean the potential for eye problems

American Academy of Ophthalmology, March 2003:

Aromatase Inhibitors

In recent years, aromatase inhibitors (AIs) such as anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) have been increasingly prescribed to postmenopausal breast cancer patients as adjuvant endocrine therapy, sometimes after two to three years of tamoxifen treatment. The short-term ocular side effects of AIs often seem to be mild, at least according to the limited cross-sectional studies that have looked at this question, Dr. Eisner said, although "There is theoretical potential for AI-induced estrogen depletion to increase the long-term risk of serious eye disease."

Although AIs work by inhibiting estrogen synthesis rather than by occupying estrogen receptors as tamoxifen does, some of the AI side effects are similar to those of tamoxifen, according to Dr. Eisner. The estrogen suppression that occurs with AIs might be regarded as causing an accelerated female aging that resembles an exaggerated menopause.

A study by Dr. Eisner and colleagues suggests that anastrozole can cause small retinal hemorrhages in some patients.4 He said that his research indicates that breast cancer patients who take anastrozole are more likely to have retinal hemorrhages than tamoxifen users. These hemorrhages may be the result of excessive traction on the retina, caused by estrogen depletion.5Related effects, such as posterior vitreous detachments, may occur during the natural menopausal transition, he said. Dr. Eisner noted that it's possible to assess the tractional effects of AIs through the use of OCT. Other possible effects of AIs include photopsia and increased incidence of floaters, as well as dry eye.

Dr. Eisner pointed to the need for more studies of the effects of AIs, particularly longitudinal studies to better document and help clarify their ocular effects.

"As many as 40 percent of women completely abandon their use of AIs before the prescribed time because they can't tolerate the side effects. Although the ocular side effects may be less important or less compelling than well-known side effects such as arthralgia or hot flashes, they nevertheless may provide the straw that breaks the camel's back for breast cancer patients on these drugs," said Dr. Eisner.

I already have distorted vision- i have floaters (a lot) caused by Posterior Vitreous Detachment in both eyes and an ERM, I think that is a wrinkling of the retina, in one eye. A friend sent me another version of Dr. Eisner's study. I took it to my MO and my opthamologist. I was hoping that there might be more studies and more recent information concerning the eyes when I asked the question. My opthamologist said that Letrozole can cause swelling at the back of the eyes. He says I don't have swelling (yet) and I have another appointment in six months. I already have hazing/or cloudiness in both eyes due to the floaters from the PVD. There is a topic here called AIs and blurred vision, has anyone seen it. Since my vision in the last six months has deteriorated. I'm thinking I have to abandon AI. I also have pretty severe arthralgia recently. That might have been caused by having to switch from Roxane to Brec (Breckenridge) mfrs. If anyone has other studies they can post I would appreciate it. The doctors might take me more seriously if there was. After cataract surgery my eyes were great! Unfortunately that only lasted 4 years.

Is there anyone in Ontario who has continued AI treatment beyond 10 years

Update-My oncologist agreed to keep me on Letrozole for now.  I believe I will soon be starting Prolia for bone loss.

Thanks Stephincanada. Although I have the aches, not enough to outweigh continuing to take an AI. But I do understand that the side effects can adversely effect some people’s quality of life. Tough decisions.