[Becky]

Dear Terri

Since the issue of Tamoxifen non-metabolizers is new, I am sure they did not take that into consideration at all. Especially since the ATAC trial (Arimidex or Tamoxifen or both) just published the 100 month followup.

The key trial though is the Femara one - taking Femara after 5 years of Tamoxifen and the fact that the women who took Femara did better so when the trial was over, they offered the Femara to the women who were controls. Those that opted to take Femara - even years and years after they completed the Tamoxifen still did better than those who only took the 5 yrs of Tamoxifen. And with those women - many had to be metabolizers since they remained NED up to 7 years AFTER ending Tamoxifen (Tam does provide long-ongoing protection as do ai's after the initial treatment is over).

However, your question is valid on how much better is an AI over Tamoxifen if you are a metabolizer. I do not remember the % of women who are not (to do some worst case scenario math. I say worst case because all you can assume is that all non-metabolizers would recur but that is not a true statement. And you also cannot say that all metabolizers would also not recur (at least during the time of treatment)).