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Compare The Cost And Effectiveness of Tamoxifen and Aromatase Inhibitors

Hormone Therapies Prevent Breast Cancer Recurrence, Extend Life

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Updated June 10, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

After primary treatment for estrogen-receptor-positive breast cancer, most patients take two to five years of hormone therapy to help prevent a recurrence. The American Society of Clinical Oncology (ASCO) has guidelines for the use of hormone therapy, which has recommended tamoxifen as a standard drug for pre- and postmenopausal women. Now those guidelines have been updated to include aromatase inhibitors.

Two Ways to Keep Estrogen Low

Estrogen fuels 80% of all breast tumors, so taking medication to lower estrogen is key to extending your survival if you were diagnosed with a hormone-sensitive cancer.

Oncologists have two classes of hormone therapy drugs to offer patients - SERMS (Selective Estrogen Receptor Modulators) and AIs (Aromatase Inhibitors). Tamoxifen, a SERM, has been prescribed for young, premenopausal women, as well as women already in menopause. Arimidex (anastrazole) is one of the aromatase inhibitors that are usually prescribed for postmenopausal women.

ASCO Updates Guidelines on Hormone Therapy

The American Society of Clinical Oncology (ASCO) issued an update to their recommendations for hormone therapy for postmenopausal women. Instead of using tamoxifen alone for five years after primary cancer treatments, they now say that using aromatase inhibitors after, or instead of, tamoxifen is better for reducing the number of tumor recurrences.

That means that if you are a postmenopausal woman who was diagnosed with estrogen-receptor-positive breast cancer and have been taking tamoxifen, you could switch to aromatase inhibitors for the remainder of your five years of hormonal therapy. Or you could take an aromatase inhibitor such as Arimidex (anastrazole) for five years after finishing tamoxifen.

Trade-Offs For Using SERMs and AIs

Both types of hormone therapies will lower your levels of estrogen and help prevent a recurrence of breast cancer, but both types of medications come with some cost considerations and side effects. All types of hormone therapies can cause hot flashes and night sweats.

Tamoxifen is typically the least expensive of all the hormone therapies, but for some patients it may cause cataracts, endometrial thickening, blood clots, and stroke.

Arimidex (anastrozole), Femara (letrozole) and Aromasin (exemestane) are three aromatase inhibitors, all of which usually cost significantly more than tamoxifen. Aromatase inhibitors may cause headaches, joint pain, fatigue, and sleep disturbances.

Paying for Hormone Therapy

It is important not to skip hormone therapy if you were diagnosed with estrogen-receptor-positive breast cancer. After going through primary treatment, taking hormone therapy is like having an insurance policy against recurrence. Don't let the financial cost prevent you from getting the benefit of this therapy. There are ways to afford these drugs.

Essential Tips To Consider About Hormone Therapy

Do not skip taking hormone therapy after you have completed primary treatment (surgery, radiation, chemotherapy) for hormone-sensitive breast cancer. Ask your doctor to prescribe generic versions of hormone therapy so you can save money. If these medications are beyond your budget, seek help with expenses. When side effects become bothersome, tell your doctor and ask for ways to cope. Be glad that you have finished the most intense part of treatment, and are moving into life after breast cancer.

Cost Comparison of Tamoxifen and Aromatase Inhibitors

Let's compare prices for a 30-day supply or a year of these hormone therapies. You can see how big the savings are when you buy generic versions of these drugs. These costs are estimates based on national averages and are higher than your cost would be with health insurance.
Drug Dose 30 Days Annual Cost
Tamoxifen (Nolvadex) 20 mg $21.90 $262.80
Tamoxifen (generic) 20 mg $13.51 $164.37
Arimidex (anastrazole) 1 mg $379.80 $2,300.00
Arimidex (generic) 1 mg $25 - $79 $948.00
Femara (letrozole): 2.5 mg $441.76 $5,301.12
Aromasin (exemestane) 25 mg $377.12 $4,525.44

Sources:

American Society of Clinical Oncology Clinical Practice Guideline: Update on Adjuvant Endocrine Therapy for Women with Hormone Receptor-Positive Breast Cancer. Published ahead of print on 7/12/2010.

Experts Issue New Guidelines on Breast Cancer Drugs. www.womenshealth.gov. Accessed 8-7-2010.

State Pharmaceutical Assistance Programs 2010. National Conference of State Legislatures. Updated: April 1, 2010.

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