Wearing a red headscarf, Kylie Minogue looked fetching in a recently released photograph. Headscarfs of the type she sported could be the hallmark of religious views, an indication that she has become as shy as Greta Garbo, or a sign that she is having chemotherapy and for a short time will be having trouble with her hair.

Never has the outlook in breast cancer been so good. During the summer, Roche introduced Herceptin, a new anti-cancer agent that shows a highly significant 46 per cent reduction in the number of women suffering recurrence of breast cancer. This improvement in outcome was only of help to the 20 to 25 per cent of women, many of them younger women with an above average malignant tumour, whose cancer expressed (secreted) a greater than normal amount of the protein HER2.

There is good news also for the 75 per cent of post-menopausal women whose cancers are oestrogen receptor positive. Tamoxifen has been a lifesaver for many of these patients for years but now the aromatase inhibitors are set to rival its efficiency. Trials are under way to decide whether it is better to give aromatase inhibitors with Tamoxifen or sequentially.

Professor Ian Smith, head of the breast unit at the Royal Marsden Hospital, said recently that in his opinion the introduction of aromatase inhibitors would be as revolutionary to the treatment of breast cancer as statins had been to cardiovascular disease, or antibiotics to infections. Professor Smith suggested that aromatase inhibitors were not only a revolutionary treatment for these cancers but also had hitherto unrecorded physiological effects on women.

Aromatase inhibitors induce a unique biological phenomenon: an oestrogen-free mammal. Both women and men produce oestrogen and it is still manufactured by the female body after the menopause, but in much smaller quantities. The aromatase inhibitors are a dramatic step forward in treatment. Tamoxifen prevented the body utilising oestrogen, but the aromatase inhibitors Arimidex (anastrozole), Aromasin (exemestane) and Femara (letrozole) prevent any oestrogen being produced.

Nobody can be certain what will be the other effects of having no oestrogen. There was an obvious anxiety that osteoporosis could have been a problem in post-menopausal women deprived of oestrogen, but the improvement in bisphosphonates, the anti-osteoporosis drugs, removes this concern. Some bisphosphonates also have an anti-cancerous effect in their own right.

The 75 per cent of women with post-menopausal breast cancer who have oestrogen positive receptor tumours and are taking aramatose inhibitors can expect a much better outcome, but may have difficulty in keeping their genitalia youthful. Treatments are available for these problems. The effects of the aromatase inhibitors on mood and temperament will also need assessing, but there are grounds for believing that these will not necessarily be negative.

The advantages of aromatase inhibitors over Tamoxifen are already understood. As well as better survival rates, the inhibitors are known to be less likely to cause problems with blood clotting and hence strokes, pulmonary emboli and heart attacks. They have no tendency to induce cancer of the body of the womb.

Professor Smith says that he would bet that the UK’s 25,000 post-menopausal women who have an oestrogen receptor positive breast cancer will take an aromatase inhibitor at some time of their life. If theirs is an advanced or unusually aggressive tumour, or if there is a bad family history, there is a reasonable chance that they will start on one straight away.

Other women with one of these cancers are likely to begin by taking Tamoxifen for a couple of years, and then to be switched to an aromatase inhibitor. Trials have been set up to compare this switch treatment with that of combined therapy but, one way or another, aromatase inhibitors are here to stay and there is a good chance that some, even possibly most, women will stay on them for the rest of their lives.

There are two problems. Will the Treasury pay for the Herceptin for those younger women with HER2positive tumours? Will they agree that the days when Tamoxifen was the sole treatment for hormone receptor positive post-menopausal cancers are over? If they do, the risk of a recurrence of breast cancer for 25,000 women will be reduced each year by 26per cent. There will be a 53 per cent reduction in the risk of cancer returning to the opposite breast and a 16 per cent reduction in its returning elsewhere in the body.

Screen saver

Forty thousand UK women develop breast cancer every year; 13,000 eventually die.

Treatment should enable almost 100 per cent of those whose cancer is confined to the breast to survive five years.

If the UK adopted the American Cancer Society's mammography screening programme, more than 90 per cent of all women with breast cancer should achieve long-term survival, virtually a cure.