Quick Answer
Anacan — Anastrozole 1 mg (Natco Pharma). Aromatase inhibitor for hormone-receptor-positive (HR+) breast cancer in post-menopausal women — adjuvant, extended adjuvant, and metastatic settings. Once-daily oral.
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⚠️ Specialist-supervised cancer therapy — this medication is started, monitored, and stopped by an oncologist or haematologist. Dosing depends on tumour type, stage, body surface area, organ function, and concomitant therapy. Self-treatment is not appropriate; the information below is educational and supports informed conversations with your specialist.
AIs are NOT effective in pre-menopausal women — without ovarian suppression, ovaries override AI inhibition. Pre-menopausal HR+ breast cancer requires tamoxifen ± ovarian suppression (LHRH agonist) or AI WITH ovarian suppression as a specialist-supervised regimen.
AIs accelerate bone density loss and fracture risk. Baseline DEXA is recommended; consider bisphosphonate (zoledronic acid, ibandronate) or denosumab in osteopenia/osteoporosis. AIs may modestly raise lipid levels and cardiovascular events vs tamoxifen. Monitor lipids and cardiovascular risk factors annually.
Frequently Asked Questions
AI vs tamoxifen — which is better?
In post-menopausal HR+ breast cancer, AIs (anastrozole, letrozole, exemestane) give modestly higher disease-free survival than tamoxifen (ATAC, BIG 1-98, MA.17). AIs are preferred adjuvant in most post-menopausal women; tamoxifen remains preferred in pre-menopausal disease and in patients with severe AI side effects.
How long is treatment?
Adjuvant therapy is typically 5 years; some women benefit from extended adjuvant (5-10 years total) based on ATLAS/MA.17 data. Specialist decides extended therapy based on recurrence risk.
Common side effects?
Hot flushes, joint and muscle pain (arthralgia/myalgia — affects 30-50%, often improves with continued therapy), fatigue, vaginal dryness, mood changes, accelerated bone loss.
Joint pain — is it serious?
AI-related arthralgia is the most common reason for non-adherence. Often improves over 3-6 months; symptomatic relief with NSAIDs, exercise, occasionally switching between AIs (anastrozole ↔ letrozole ↔ exemestane). Vitamin D + calcium adequacy helps.
What if I’m pre-menopausal?
AIs alone do not work — ovaries override. Discuss tamoxifen, or AI + ovarian suppression, with your specialist.
Bone density?
Mandatory baseline DEXA. Repeat every 1-2 years. Add a bisphosphonate or denosumab if osteopenia or osteoporosis develops, or in high baseline-risk patients prophylactically.
Side effects vs exemestane?
Anastrozole and letrozole are non-steroidal AIs (reversible). Exemestane is a steroidal AI (irreversible inactivator). Side-effect profiles broadly similar; some women prefer one over another. Switching is reasonable for tolerability.
Vaginal dryness?
Common. Topical vaginal moisturisers and water-based lubricants help. Topical oestrogen (very low dose, vaginal) is generally avoided in HR+ breast cancer; if symptoms severe, discuss with oncologist — vaginal DHEA, ospemifene, or specialist menopause review may be options.
Drug interactions?
Few major. CYP-modulators have minimal effect on AIs. Tamoxifen and AIs should NOT be combined (no benefit). Always disclose all medications.
What if I miss a dose?
Take when you remember if same day; otherwise skip. Do not double up. Consistent daily dosing maximises effect.
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