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.