Hi Stretton,

I am replying to you, as I know that the nurses are not here over the weekend. However I must state that I am not a nurse, just someone else who has had a couple of bouts of breast cancer. 

I am sorry to hear that you have had 2 bouts of breast cancer and understand why you want to continue taking Anastrozole. I looked into extending the time that I took Letrozole for, when I finished taking it after 6½ years. I discovered that there was about a 4% chance of preventing reoccurrence, but that it didn't translate into living longer. Consultants do sometimes prescribe taking the tablets for 10  years, but this is usually only with high risk node-negative patients, or people with lymph node involvement at initial diagnosis. It is not recommended for low-risk node-negative  patients, as there is little benefit and extended therapy may not justify ongoing toxicity.

Extended use of Letrozole significantly increases bone related effects, fractures, new-onset Osteoporosis, cardiovascular events and can worsen quality of life by reducing mobility. Guidelines advise never to extend the use of this therapy for more than 10 years, as toxicity accumulates and there is no evidence to support benefit beyond this duration.

If you do decide to continue taking Anastrozole, you should do this in consultation with your care team, as you will need regular bone health monitoring in the form of bone density scans and/or the consideration of taking Biphosphonates.

I see that you have had no lymph node involvement and am shocked that you were dismissed over the phone without any discussion about the benefits and side-effects of continuing this therapy. It is clear that guidelines for extending this therapy include carefully accessing the occurrence risk, using lymph node status, tumour grade and age. I don't know what type of breast cancer you had, but the fact that your lymph nodes were clear and that you have already had 10 years of endocrine therapy, suggests that this may be why you received such a definite NO!

I hope that this gives you some explanation as to why you may have been refused, but don't hesitate to speak to your breast care nurse, as she will be better able to explain it all to you than I am.

Please let us know what you decide. We are always here for you.

Kind regards,

Jolamine xx