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Recommendations for Aromatase inhibitors as adjuvant endocrine therapy

Unanswered questions

Important unanswered questions about the use of aromatase inhibitors as adjuvant endocrine therapy for early breast cancer that are being addressed by ongoing trials include:

  • the optimal duration of aromatase inhibitor therapy
  • whether it is better to start adjuvant endocrine therapy with an aromatase inhibitor or to start with tamoxifen and switch to an aromatase inhibitor after 2–3 years, or vice versa
  • the relative benefits and harms of different aromatase inhibitors
  • the relative benefits and harms of aromatase inhibitors compared with tamoxifen in pre-menopausal women receiving ovarian suppression therapy, or in women rendered post-menopausal by chemotherapy
  • the effects of aromatase inhibitors on cognitive function
  • the management of bone mineral density reduction due to aromatase inhibitors.

The determination of menopausal status can be difficult, particularly in younger women who no longer have a uterus or who have become amenorrheic during chemotherapy.

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