Roy Moore, Louis CK and Tamoxifen.

They’re all having to come to terms with things that happened decades ago. The EBCTCG published in NEJM last week a meta-analysis of 20-year outcomes after 5 years of endocrine therapy for early stage breast cancer with hopes of identifying a cohort who could safely forego those additional years on the pill. The results are pretty sobering, particularly the magnitude of distant failures and subsequent breast cancer related death across the entire population. T-stage and N-stage dominated prognosis. Among N0 patients, distant recurrence ranged from 13% for T1 to 19% for T2. For node positive patients, 20-year distant recurrence was 31% with 1-3 nodes and 52% with 4-9 nodes. Notably, these risks started rising significantly as soon as endocrine therapy was stopped at 5 years. However, it’s hard to say to what extent other therapies such chemo and nodal radiation (or lack thereof) influenced outcomes. It will take comparative analyses with maturing results of long-term endocrine therapy to determine if longer treatment is 1) tolerable and 2) effective in continually reducing the risk of distant recurrence over decades. So for now the question remains for very early stage breast cancer patients on endocrine therapy...and for Alabamians: is Moore really the better option?