In recent years, breast cancer treatment has witnessed significant advancements, particularly in the realm of hormone-based therapies. Among women diagnosed with early stage breast cancer—specifically those with tumors that depend on estrogen or progesterone for growth—endocrine therapy has been a cornerstone treatment to reduce the risk of cancer recurrence. Traditionally, this therapy, which includes drugs such as tamoxifen and aromatase inhibitors, has been prescribed for five years following initial treatment. However, emerging clinical evidence advocates for an extended duration of up to ten years for certain patients, creating a pivotal question: are women actually opting to continue their hormone therapy beyond five years?
A groundbreaking study spearheaded by researchers at the University of Michigan Rogel Cancer Center in collaboration with Stanford Medicine provides critical insights into this question. By surveying 591 women with early stage breast cancer who had completed at least five years of endocrine therapy, scientists gleaned that less than half—47 percent—decided to proceed with continuing the treatment. Notably, this decision was strongly influenced by the stage of the cancer at diagnosis. While 62 percent of patients with stage 2 disease opted to extend their therapy, only 39 percent of those with stage 1 breast cancer chose to do so, underscoring the nuanced benefit-risk calculus that patients face.
Endocrine therapy functions by interrupting estrogen signaling pathways, a pivotal driver in many breast cancers. Tamoxifen, a selective estrogen receptor modulator, and aromatase inhibitors, which disrupt estrogen production, are administered orally on a daily basis. The choice to extend therapy involves weighing the incremental benefits—particularly in reducing recurrence risk—against the cumulative side effects and the psychological toll of prolonged treatment. Although extended therapy is less invasive compared to surgery or chemotherapy, its chronic nature presents unique adherence challenges.
Researchers leveraged the iCanCare study, a comprehensive longitudinal survey capturing both patient experiences and physician perspectives, to investigate the decision-making landscape. Participants included women approximately six years post-diagnosis, ideally timed when patients have just completed or nearly completed the conventional five-year endocrine therapy. Out of the women contacted for this follow-up survey, an impressive 557 responded, providing a robust data set that enriches the understanding of patient choices in real-world settings.
The analysis revealed several psychosocial and clinical determinants influencing decisions to persist with endocrine therapy. Younger patients and those who had undergone chemotherapy were more predisposed to continue treatment beyond five years. Intriguingly, the involvement of the primary care physician in discussing the decision significantly increased the likelihood of extension, demonstrating the critical role of ongoing patient-provider communication across specialties, not solely within oncology.
Central to the patients’ decision-making were their oncologist’s recommendations, their personal anxiety about cancer recurrence, and their desire to pursue the most comprehensive treatment approach available. These factors highlight the complex interaction between medical advice, individual risk perception, and treatment preferences. The decision is seldom straightforward, embodying a deeply personal calculation of quality of life versus survival benefit.
Current clinical guidelines around endocrine therapy are evolving in response to accumulating evidence. Patients with higher-risk characteristics, such as stage 2 breast cancer, derive a more pronounced benefit from extended therapy compared to those with low-risk stage 1 tumors. This stratified approach emphasizes personalized medicine, encouraging treatment plans tailored to the biological aggressiveness of the tumor and patients’ tolerance of therapy.
Dr. Allison W. Kurian of Stanford Medicine, lead author of the study, remarked that the additional estimated benefit varies across patients but often holds greater significance for those facing higher recurrence risks. Extending endocrine therapy represents an actionable step patients can endorse to mitigate this risk, a prospect that empowers many but also requires careful consideration of potential adverse effects. These may include bone density loss, cardiovascular risks, and quality of life impairments that accumulate over time.
The study further accentuates the indispensable role of coordinated care among oncologists and primary care physicians. Continuous collaboration is vital to reassess evolving treatment risks and benefits, ensuring decisions reflect up-to-date clinical evidence and align with the patient’s evolving health status and personal values. This integrated approach supports what is increasingly recognized as shared decision-making—a dynamic dialogue that accommodates changing circumstances and advances in medical understanding.
According to Dr. Lauren Wallner, co-senior author and associate professor at the University of Michigan, the less intensive nature of endocrine therapy, juxtaposed with its protracted duration, presents unique challenges for patients. Encouragingly, more than half of higher-risk patients demonstrated willingness to continue therapy, indicating that many perceive the long-term benefits as outweighing the hurdles. This finding underscores the importance of tailored patient education and supportive care strategies to enhance adherence and address barriers.
The implications of these findings extend beyond breast cancer to broader oncology and chronic disease management realms. They emphasize that treatment efficacy is not solely a function of pharmacology but is inextricably linked with patient preferences, communication quality, and ongoing re-evaluation. As cancer care continues to pivot toward lifelong management in some contexts, understanding patients’ perspectives on prolonged therapies becomes increasingly critical.
Support for this research was provided by the American Cancer Society and grants from the National Cancer Institute, reflecting a commitment to bridging clinical research and patient-centered outcomes. The Rogel Cancer Center’s Cancer Data Science Shared Resources also contributed to sophisticated data analysis and interpretation efforts. Importantly, the authors disclosed no conflicts of interest relevant to this work, underscoring the independent nature of the findings.
In summary, this pivotal study documents a nuanced and evolving landscape of patient decision-making regarding extended endocrine therapy for early stage breast cancer. By revealing significant variation tied to disease stage, patient demographics, and provider engagement, it provides essential guidance for clinicians aiming to support patients through complex treatment choices. The pressing future challenge lies in developing decision aids and communication frameworks that further empower women to make informed choices that best align with their risk profile and quality of life expectations.
Subject of Research: People
Article Title: “Extended endocrine therapy use and decision-making after breast cancer diagnosis”
News Publication Date: 31-Mar-2025
Web References:
References:
Kurian AW, Wallner L, Furgal AKC, et al. Extended endocrine therapy use and decision-making after breast cancer diagnosis. Journal of the National Cancer Institute. 2025. DOI: 10.1093/jnci/djaf076
Keywords: Breast cancer, Cancer, Hormone therapy, Cancer medication, Cancer treatments, Decision making
