Hi All,
Many thanks for reading my question. I am a concerned brother. My sister in in stage 4 of metastatic breast cancer. 

Just to point out that she lives in a third world developing country (Pakistan), therefore please bear in mind that the medical profession is not as closely regulated as one would ideally want (like here in the UK).

My sister (then 34 years old) underwent mastectomy 3 years ago (she was already in Stage 3/4 then). She was then put on Chemotherapy (which also resulted in Menopause since). She was also prescribed Nolvadex (Tamoxifen). After taking this med just for a few months she asked her doctors to find an alternative (due to the hot flashes and potential risk of secondary cancer developing due to Tamoxifen). Her doctor changed her medicine to Arimidex. She has taken Arimidex for last 2 years.
Since taking Arimidex her aches in her bones have increased. We took her for scans and found out that spots have spread throughout her bones all through these two years. My concern is that the doctor has NOT focused on the fine print that Arimidex is only applicable for post-menopause women OR perhaps the doctor is considering the chemo induced menopause as the same thing as natural menopause. Either way my suspicion is that Arimidex is NOT working on her.
I want to understand if I am thinking on the correct lines or not? If I am correct, should she not go back to either Nolvadex (Tamoxifen) or perhaps use the new anti-estrogen med called Faslodex?
Also what concerns me is that her doctor never asked her to do a blood test to check the levels of Estrogen to confirm if Estrogen levels are down. Is is normal to not ask for such a test?

Thanks in advance

Aamir.