The role of endocrine therapies in reducing risk of recurrence in postmenopausal women with hormone receptor-positive breast cancer.
Hormone receptor-positive breast cancer is increasingly considered a chronic disease, as there remains an ongoing risk of local and distant relapse for years after diagnosis. While early recurrence risk peaks 2-3 years post diagnosis, the majority of breast cancer recurrences and deaths occur following 5 years of adjuvant tamoxifen. Aromatase inhibitors have achieved greater relative reductions in recurrence risk than tamoxifen alone and are now widely recommended as adjuvant therapy for postmenopausal women with hormone-sensitive breast cancer. Although both anastrozole and letrozole have demonstrated superior disease-free survival compared with tamoxifen, letrozole to date offers the greatest significant reduction in the risk of distant metastases in patients with hormone-sensitive breast cancer. Anastrozole and exemestane also reduce local and distant recurrence risk in the "switch setting" following 2-3 years of tamoxifen. Extended adjuvant letrozole, given after 5 years of tamoxifen, significantly reduces local and distant recurrence as well as mortality in patients with node-positive disease. Specialist nurses and nurse practitioners facilitate informed choice for breast cancer patients through explaining treatment options and side effects; they thus need an understanding of which treatment strategies reduce recurrence risk, especially the risk of distant metastases.
Pennery
Emma
E
Breast Cancer Care, Kiln House, London SE1 0NS, UK. emmap@breastcancercare.org.uk
D000077384:Anastrozole; D000730:Androstadienes / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000451:nursing; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D000077289:Letrozole; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D009570:Nitriles / Q000627:therapeutic use; D009720:Nurse Clinicians / Q000458:organization & administration; D009722:Nurse Practitioners / Q000458:organization & administration; D024802:Nurse's Role; D009859:Oncology Nursing / Q000458:organization & administration; D010353:Patient Education as Topic; D018579:Patient Selection; D017698:Postmenopause / Q000187:drug effects; D011960:Receptors, Estrogen / Q000187:drug effects*; D012307:Risk Factors; D013629:Tamoxifen / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use
D000730:Androstadienes; D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D009570:Nitriles; D011960:Receptors, Estrogen; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole; D000077289:Letrozole; C056516:exemestane