In the ATAC trial comparing anastrozole versus tamoxifen as adjuvant therapy in postmenopausal early breast cancer, which of the following was a key finding that changed clinical practice?

• A Anastrozole significantly improved overall survival at 5 years
• B Anastrozole caused more endometrial cancers than tamoxifen
• C Both drugs had identical efficacy but tamoxifen had fewer side effects
• D Anastrozole demonstrated superior disease-free survival with fewer thromboembolic events but increased bone fractures ✓

Explanation

The ATAC trial showed anastrozole (an aromatase inhibitor) had superior disease-free survival compared to tamoxifen in postmenopausal HR-positive early breast cancer, with fewer thromboembolic events and endometrial cancers. However, the critical trade-off was increased bone mineral density loss and fracture risk with anastrozole, necessitating baseline DEXA scanning. This trial established aromatase inhibitors as preferred adjuvant endocrine therapy in postmenopausal women.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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