The world's largest drug maker -- Pfizer Inc. -- announced Monday it will cut 10,000 jobs and close at least five facilities due to fierce competition from generic drug makers. The goal, says Pfizer spokespeople, is to whittle away annual costs by $2 billion by the end of the year -- to combat the prediction that the company will lose 41 percent of its sales to generic drugs between 2010 and 2012.

Pfizer's other obstacles include expiring drug patents -- costing Pfizer about $14 billion in revenues between 2005 and 2007 -- as well as demands for lower prices by insurers and large purchasers, and repeated requests for evidence of products' worth.

The 10,000 layoffs amount to 10 percent of the company's global workforce and will take jobs from 2,200 United States employees. The company will cut 20 percent of its European sales force, will close three research sites in Michigan and two manufacturing plants in New York and Nebraska, and is considering selling a manufacturing site in Germany and closing two research sites in Japan and France. In the midst of all of this, the company will focus its efforts on transforming the way they do business.

"I believe we must transform the way we've done business in the past in order to be more successful in the future," said Jeffrey Kindler, CEO and chairman of Pfizer. " Incremental evolution is not enough. Fundamental change is imperative -- and it must happen now."

Pfizer's Monday announcement is the second declaration of budget cuts. A previous announcement has the company -- the maker of cancer drugs Aromasin, Ellence, Camptosar, and Sutent -- slashing costs by $4 billion a year until 2008.

One in five postmenopausal women with estrogen-positive breast cancer do not take the newer chemoprevention hormone therapy aromatase inhibitor drugs to prevent recurrence as prescribed, according Dana-Farber Cancer Institute and AstraZeneca Pharmaceuticals researchers who conducted a study to determine drug usage.

Aromatase inhibitors, such as Anastrozole, have been shown to be an effective means of blocking estrogen that fuels cancer for women diagnosed with estrogen-positive breast cancer, and Dana Farber's Dr. Ann Partridge warns that, "Women may be compromising their care, and ultimately their survival, if they do not take these medications as recommended."

Despite warnings, a significant number of women are choosing to discontinue use and the researchers of this survey can only speculate as to the reasons why. Some of the reasons they believe play a role in the women's decision not to comply with recommended treatment are: fear of side effects, actual experience of side effects, cost of treatment, and negative health beliefs that treatment will not help.

From a personal insight, the most common reason I know of as to why women are not taking this medication, or discontinue usage, is the fact that these drugs do not have a long history of use, and one can only guess what the possible, and presently unknown, long-term side effects will end up being. While Dr. Partridge states without a shadow of a doubt that these new aromatase inhibitor drugs are effective in breast cancer recurrence, only time itself will remedy the hesitation and non-compliance.

Some of the aromatase inhibitors include Anastrozole (Arimidex), Letrozole (Femara), Exemestane (Aromasin) and Formestane (Lentaron). To learn more about aromatase inhibitors, visit the National Cancer Institute's aromatase inhibitors digest.