Translating trial data into patients benefits: Making the right choice

Tamoxifen has been the standard first-line adjuvant treatment for postmenopausal women with early breast cancer for over 3 decades. Its use, however, is associated with a number of potentially life-threatening adverse events. As a result, the aromatase inhibitors (AIs), which are generally better tolerated and more efficacious, are now beginning to supersede tamoxifen as the treatment of choice in this setting. Nevertheless, some patients in clinical practice still start or remain on tamoxifen therapy instead of an AI. This review investigates our current understanding of AIs and tamoxifen in the adjuvant hormonal therapy of postmenopausal breast cancer in relation to efficacy, safety and patient benefits. Overall, it is concluded that the AIs show a significant advantage over tamoxifen, with the greatest difference observed at 1–2 years after initiation of treatment. Therefore, using an AI at the earliest opportunity provides patients with the best option to prevent the recurrence and excess adverse events associated with tamoxifen.