Use residual disease tests to decide who needs ten years of hormone therapy
Many women take hormone-blocking tablets for a decade with real side-effects. A sensitive blood test could show who can safely stop at five years.
Extended adjuvant endocrine therapy prevents late recurrence in a minority while imposing joint pain, bone loss and sexual side-effects on everyone. Sensitive MRD testing at year five, repeated annually, could identify the persistently negative majority in whom continuation adds little, while intensifying treatment for the positive minority. This inverts the usual escalation-only use of MRD.
- Dormant cells and minimal residual disease · After a 'successful' treatment, cells can sleep for years then relapse. We can barely detect them and cannot target them.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.
- Survivorship and late effects are neglected · Tens of millions of people live after cancer with heart damage, infertility, second cancers and fear, and few services.
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