Science

Kefah Mokbel: Five or Ten Years of Adjuvant Endocrine Therapy for Breast Cancer?

Kefah Mokbel/LinkedIn

Aug 11, 2025, 08:20

Kefah Mokbel: Five or Ten Years of Adjuvant Endocrine Therapy for Breast Cancer?

Kefah Mokbel, Chair of Breast Cancer Surgery at The London Breast Institute, shared a post on LinkedIn:

“5 or 10 years of adjuvant endocrine therapy for breast cancer?

This meta-analysis has demonstrated that allocation to further 5 years of aromatase inhibitor treatment reduces the absolute risk of distant recurrence by 2% (from 8.6% to 6.6%) while increasing bone fracture risk by 1.2%. (from 3.4% to 4.6%).

The risk-benefit balance favored node-positive patients more than node-negative patients. There was no significant reduction in overall mortality. The analysis did not assess the adverse impact on quality of life.

Personally, I am less enthusiastic than the authors about recommending extended treatment, especially in patients with node-negative disease.

Women should feel empowered to make informed decisions about their hormonal therapy after five years—especially if their disease was node-negative, received an aromatase inhibitor in the first 5 years and they’ve experienced adverse effects impacting their quality of life. They should not feel held hostage by fear of cancer recurrence.

Relative risk reductions can be misleading and may unnecessarily alarm patients because they often exaggerate the perceived benefit. Absolute risk reductions, which show the actual change in a patient’s chance of an event, provide clearer, more meaningful information.

Using absolute risks helps patients make informed decisions grounded in realistic expectations rather than fear.”

Title: Extending the duration of endocrine treatment for early breast cancer: patient-level meta-analysis of 12 randomised trials of aromatase inhibitors in 22 031 postmenopausal women already treated with at least 5 years of endocrine therapy

Read The Full Article at The Lancet.

Kefah Mokbel: Five or Ten Years of Adjuvant Endocrine Therapy for Breast Cancer?