Node-Negative Breast Cancer
In previous years, the St. Gallen consensus has subdivided women with node-negative breast cancer according to menopausal status (pre vs post). This year, it was suggested that hormone responsiveness is probably an overriding factor and that all women with hormonally responsive tumors should be offered tamoxifen regardless of menopausal status. Low-risk patients (those with a 10% or lower risk of death at 10-20 years), who were defined by the presence of estrogen-receptor and/or progesterone-receptor positivity and all women with a tumor size of 2 cm or less and grade I or age 35 years or older, can be offered either tamoxifen or no treatment.
For premenopausal women at average to high risk, but whose tumors are hormonally responsive, ovarian ablation and tamoxifen, chemotherapy and tamoxifen, tamoxifen alone, or ovarian ablation alone can be considered standard therapy.
Node-negative and premenopausal women with hormone-unresponsive cancer should be offered chemotherapy with AC, CMF, or cyclophosphamide-adriamycin-fluorouracil (CAF).
In postmenopausal women, 5 years of tamoxifen should be standard for all hormonally responsive women. The addition of classic CMF, CAF, or AC should also be considered for women with average or high-risk hormone-responsive tumors, and as sole therapy in women with average or high-risk hormone-nonresponsive tumors.
Benefits might, however, decrease with age, and, in women with hormone-responsive tumors, the greatest benefit may be obtained with tamoxifen alone.
Presentation at 82 Meeting of
American Radium Society
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