title: Adjuvant Endocrine Therapy for Women With Hormone Receptor-Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update on Ovarian Suppression.
abstract: To update the ASCO adjuvant endocrine therapy guideline based on emerging data concerning the benefits and risks of ovarian suppression in addition to standard adjuvant therapy in premenopausal women with estrogen receptor-positive breast cancer.
  
  
  
  ASCO convened an Update Panel and conducted a systematic review of randomized clinical trials investigating ovarian suppression.
  
  
  
  Two trials investigating the addition of ovarian suppression to tamoxifen did not show an overall clinical benefit for ovarian suppression. Nonetheless, the addition of ovarian suppression to standard adjuvant therapy with tamoxifen or with an aromatase inhibitor improved disease-free survival and improved freedom from breast cancer and distant recurrence compared with tamoxifen alone among the subset of patients who were at sufficient risk for recurrence such that adjuvant chemotherapy was warranted. Compared with tamoxifen alone, ovarian suppression was associated with a substantial increase in menopausal symptoms, sexual dysfunction, and diminished quality of life.
  
  
  
  The Panel recommends that higher-risk patients should receive ovarian suppression in addition to adjuvant endocrine therapy, whereas lower-risk patients should not. Women with stage II or III breast cancers who would ordinarily be advised to receive adjuvant chemotherapy should receive ovarian suppression with endocrine therapy. The panel recommends that some women with stage I or II breast cancers at higher risk of recurrence who might consider chemotherapy may also be offered ovarian suppression with endocrine therapy. Women with stage I breast cancers not warranting chemotherapy should not receive ovarian suppression, nor should women with node-negative cancers 1 cm or less. Ovarian suppression may be administered with either tamoxifen or an aromatase inhibitor. Additional information is available at www.asco.org/guidelines/endocrinebreast and www.asco.org/guidelineswiki.
authors.affiliation: Harold J. Burstein and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Holly Anderson, Breast Cancer Coalition of Rochester, Rochester, NY; Thomas A. Buchholz and Sharon H. Giordano, The University of Texas MD Anderson Cancer Center, Houston, TX; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA; Karen E. Gelmon, British Columbia Cancer Agency, Vancouver, BC; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Alexander J. Solky, Interlakes Oncology and Hematology PC, Rochester, NY; Vered Stearns, Johns Hopkins, Baltimore, MD; and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI. guidelines@asco.org.
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Burstein
authors.affiliation: Harold J. Burstein and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Holly Anderson, Breast Cancer Coalition of Rochester, Rochester, NY; Thomas A. Buchholz and Sharon H. Giordano, The University of Texas MD Anderson Cancer Center, Houston, TX; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA; Karen E. Gelmon, British Columbia Cancer Agency, Vancouver, BC; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Alexander J. Solky, Interlakes Oncology and Hematology PC, Rochester, NY; Vered Stearns, Johns Hopkins, Baltimore, MD; and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI.
authors.forename: Christina
authors.initials: C
authors.lastname: Lacchetti
authors.affiliation: Harold J. Burstein and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Holly Anderson, Breast Cancer Coalition of Rochester, Rochester, NY; Thomas A. Buchholz and Sharon H. Giordano, The University of Texas MD Anderson Cancer Center, Houston, TX; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA; Karen E. Gelmon, British Columbia Cancer Agency, Vancouver, BC; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Alexander J. Solky, Interlakes Oncology and Hematology PC, Rochester, NY; Vered Stearns, Johns Hopkins, Baltimore, MD; and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI.
authors.forename: Holly
authors.initials: H
authors.lastname: Anderson
authors.affiliation: Harold J. Burstein and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Holly Anderson, Breast Cancer Coalition of Rochester, Rochester, NY; Thomas A. Buchholz and Sharon H. Giordano, The University of Texas MD Anderson Cancer Center, Houston, TX; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA; Karen E. Gelmon, British Columbia Cancer Agency, Vancouver, BC; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Alexander J. Solky, Interlakes Oncology and Hematology PC, Rochester, NY; Vered Stearns, Johns Hopkins, Baltimore, MD; and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.affiliation: Harold J. Burstein and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Holly Anderson, Breast Cancer Coalition of Rochester, Rochester, NY; Thomas A. Buchholz and Sharon H. Giordano, The University of Texas MD Anderson Cancer Center, Houston, TX; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA; Karen E. Gelmon, British Columbia Cancer Agency, Vancouver, BC; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Alexander J. Solky, Interlakes Oncology and Hematology PC, Rochester, NY; Vered Stearns, Johns Hopkins, Baltimore, MD; and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Davidson
authors.affiliation: Harold J. Burstein and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Holly Anderson, Breast Cancer Coalition of Rochester, Rochester, NY; Thomas A. Buchholz and Sharon H. Giordano, The University of Texas MD Anderson Cancer Center, Houston, TX; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA; Karen E. Gelmon, British Columbia Cancer Agency, Vancouver, BC; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Alexander J. Solky, Interlakes Oncology and Hematology PC, Rochester, NY; Vered Stearns, Johns Hopkins, Baltimore, MD; and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Gelmon
authors.affiliation: Harold J. Burstein and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Holly Anderson, Breast Cancer Coalition of Rochester, Rochester, NY; Thomas A. Buchholz and Sharon H. Giordano, The University of Texas MD Anderson Cancer Center, Houston, TX; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA; Karen E. Gelmon, British Columbia Cancer Agency, Vancouver, BC; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Alexander J. Solky, Interlakes Oncology and Hematology PC, Rochester, NY; Vered Stearns, Johns Hopkins, Baltimore, MD; and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
authors.affiliation: Harold J. Burstein and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Holly Anderson, Breast Cancer Coalition of Rochester, Rochester, NY; Thomas A. Buchholz and Sharon H. Giordano, The University of Texas MD Anderson Cancer Center, Houston, TX; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA; Karen E. Gelmon, British Columbia Cancer Agency, Vancouver, BC; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Alexander J. Solky, Interlakes Oncology and Hematology PC, Rochester, NY; Vered Stearns, Johns Hopkins, Baltimore, MD; and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI.
authors.forename: Clifford A
authors.initials: CA
authors.lastname: Hudis
authors.affiliation: Harold J. Burstein and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Holly Anderson, Breast Cancer Coalition of Rochester, Rochester, NY; Thomas A. Buchholz and Sharon H. Giordano, The University of Texas MD Anderson Cancer Center, Houston, TX; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA; Karen E. Gelmon, British Columbia Cancer Agency, Vancouver, BC; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Alexander J. Solky, Interlakes Oncology and Hematology PC, Rochester, NY; Vered Stearns, Johns Hopkins, Baltimore, MD; and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Solky
authors.affiliation: Harold J. Burstein and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Holly Anderson, Breast Cancer Coalition of Rochester, Rochester, NY; Thomas A. Buchholz and Sharon H. Giordano, The University of Texas MD Anderson Cancer Center, Houston, TX; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA; Karen E. Gelmon, British Columbia Cancer Agency, Vancouver, BC; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Alexander J. Solky, Interlakes Oncology and Hematology PC, Rochester, NY; Vered Stearns, Johns Hopkins, Baltimore, MD; and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI.
authors.forename: Vered
authors.initials: V
authors.lastname: Stearns
authors.affiliation: Harold J. Burstein and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Holly Anderson, Breast Cancer Coalition of Rochester, Rochester, NY; Thomas A. Buchholz and Sharon H. Giordano, The University of Texas MD Anderson Cancer Center, Houston, TX; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA; Karen E. Gelmon, British Columbia Cancer Agency, Vancouver, BC; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Alexander J. Solky, Interlakes Oncology and Hematology PC, Rochester, NY; Vered Stearns, Johns Hopkins, Baltimore, MD; and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.affiliation: Harold J. Burstein and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Holly Anderson, Breast Cancer Coalition of Rochester, Rochester, NY; Thomas A. Buchholz and Sharon H. Giordano, The University of Texas MD Anderson Cancer Center, Houston, TX; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA; Karen E. Gelmon, British Columbia Cancer Agency, Vancouver, BC; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Alexander J. Solky, Interlakes Oncology and Hematology PC, Rochester, NY; Vered Stearns, Johns Hopkins, Baltimore, MD; and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Griggs
mesh_terms: D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D010053:Ovary / Q000187:drug effects* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D013629:Tamoxifen / Q000627:therapeutic use
chemical_list: D047072:Aromatase Inhibitors; D013629:Tamoxifen