''Aromatase inhibitors are being given routinely to many [breast cancer] patients," he said. And not everyone gets the same benefit, he said, so treatment should be based not just on breast cancer risk, but on the patient's cardiovascular profile and other health risks, he said.
"If you have heart disease, perhaps you want to avoid aromatase inhibitors," Amir said.
Another option would be to switch from one drug to the other, to avoid staying on aromatase inhibitors long-term, he said.
When he compared women who used aromatase inhibitors first to those who used tamoxifen first, the risk for serious adverse effects was similar. But there was a hint that switching drugs reduced the risk of death from other causes.
Because this study was presented at a medical meeting, the findings should be viewed as preliminary until they are published in a peer-reviewed journal.
Still, the findings are no surprise, said Dr. Julie Gralow, director of breast medical oncology at Seattle Cancer Care Alliance, who reviewed the study results but was not involved in it.
Aromatase inhibitors aren't perfect, she said. Neither is tamoxifen, which has been linked with blood clots, stroke and cataracts.
"For some women maybe tamoxifen is better," said Gralow, who is careful to follow her patients closely and monitor them for any suggestion of heart disease.
As with much of medical practice, decisions must be made on a case-by-case basis, she said.
To learn more about aromatase inhibitors, visit the U.S. National Cancer Institute.
SOURCES: Eitan Amir, M.D., seni
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