What is the optimal endocrine therapy for postmenopausal women with hormone receptor-positive early breast cancer?
A 56-year-old postmenopausal woman with a recent diagnosis of breast cancer was referred to discuss adjuvant therapy. Annual screening mammogram demonstrated a suspicious mass in the left breast. Ultrasound-guided core needle biopsy revealed an infiltrating ductal carcinoma that was estrogen receptor (ER) positive and progesterone receptor (PR) negative and lacked amplification of human epidermal growth factor receptor 2 (HER2; ie, HER2 negative). She underwent excision and sentinel node evaluation. Pathology demonstrated a 1.9-cm grade 2 invasive cancer without lymphatic vascular invasion; clean margins were obtained, and both sentinel nodes were free of cancer. The 21-gene recurrence score was 16. She has a body mass index (BMI) of 28.5 but is otherwise healthy; levothyroxine is the only prescription medication she takes. She experienced vaginal spotting 2 years earlier because of an endometrial polyp, which was resected. She exercises regularly and takes a calcium supplement with vitamin D. Bone density study performed 6 months earlier was normal other than mild osteopenia in the femoral neck (T score, -1.3). Radiation therapy is planned.
Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. ntung@bidmc.harvard.edu
Nadine
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Tung
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* / Q000378:metabolism / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D006801:Humans; D000077289:Letrozole; D008875:Middle Aged; D009570:Nitriles / Q000627:therapeutic use; D017698:Postmenopause; D017410:Practice Guidelines as Topic; D011960:Receptors, Estrogen / Q000378:metabolism*; D013629:Tamoxifen / Q000627:therapeutic use; D013997:Time Factors; 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