Efficacy and safety of aromatase inhibitors in early breast cancer

Background: Third-generation aromatase inhibitors (Als) are surfacing as the standard adjuvant treatment for postmenopausal women with hormone receptor positive breast cancer over tamoxifen but their long-term effects are still under investigation. Objective: in the light of current information, what factors should health practitioners take into consideration when prescribing Als to patients? Methods: Results of several randomized controlled adjuvant clinical trials were reviewed to assess the efficacy of treatment and their subprotocols focusing on quality of life and skeletal health to highlight the safety concerns. Conclusion: To prevent early recurrences, Als should be considered as the upfront hormonal treatment of choice. They are also recommended for use as a switching strategy after 2 - 3 years of tamoxifen and as extended adjuvant treatment after 5 years of tamoxifen. The adverse events experienced are manageable and overall quality of life is not compromised; however, bone density must be monitored for patients at risk and appropriate bone-protection supplements need to be taken.