Boost Survival After Breast Cancer Without Busting Your Wallet

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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You’ve survived cancer, now how much will it cost to keep it that way? Breast cancer survival for women with hormone receptor positive cancer has improved because of two classes of medications. This is awesome news for women, though just when you think you are all done with surgery and chemotherapy, you may then be told to take another medication for 5 to 10 years. These medications are now available as generics but they can still put quite a dent in women’s wallets. What you need to know is that these medications prevent estrogen responsive cells from growing, thereby improving survival and decreasing breast cancer recurrence in women who have estrogen receptor positive cancers.

First, you may start with tamoxifen, which blocks certain estrogen receptors. How much will tamoxifen help you? For postmenopausal women with estrogen receptor (ER) positive breast cancer, five years of tamoxifen reduces the 15-year risk of breast cancer recurrence by 40 percent and breast cancer mortality by 35 percent. Tamoxifen 20 mg a day will be taken for 5 years. Because it’s generic, this shouldn’t be too painful at the pharmacy.

The next medication your doctor may have you take is one of the three aromatase inhibitors. Thankfully these are also now available as generics which will save you hundreds. Arimidex (anastrozole), Femara (letrozole) and Aromasin (exemestane) block cells from making estrogen. Arimidex and Femara are structurally similar so if you have side effects from one (joint pain, etc.) you will have side effects to the other. Aromasin (exemestane) is slightly different and may be an option if you can’t tolerate the other two, though it costs a little more.

Doctors will differ in the exact regimen they give you. Arimidex should be continued for five years when used as initial therapy. For postmenopausal women who started with five years of tamoxifen, an additional five years of Arimidex may be suggested.

Generic versions of these medications have transformed access to the additional survival benefit they provide. When these were brand named drugs only, women were paying hundreds a month to receive them. It’s a new day.

Dr O.

Tamoxifen, anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) should all be considered Tier 1 medications by most insurance plans, meaning you will pay only your lowest copay. Tamoxifen 20mg is included in many pharmacies’ discount generic programs, and can be found for $25 for 90 tablets. Anastrozole is slightly more, at around $25 for 30 tablets, while letrozole can be found for as little as $25 for 30 tablets online, up to about $500 at some local and chain pharmacies. Exemestane is a more expensive option when paying cash, at about $300 for 30 tablets.

Drugs featured in this story

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