Adjuvant endocrine therapy in premenopausal women with breast cancer

Abstract

Adjuvant endocrine therapy is indicated in almost all women whose tumors show evidence of endocrine responsiveness, defined as the presence of any detectable level of estrogen receptors (ER). Patients with tumors \1 cm in size, without axillary node involvement or other signs of metastatic potential might be spared from adjuvant endocrine therapy [1]. Nevertheless, young women with breast cancer represent a particular therapeutic challenge, among other reasons because breast tumors in young women tend to have higher tumor grade at diagnosis, higher mitotic rate and lymph node involvement, and less hormone receptor expression [2]. Furthermore, in some studies the role of adjuvant therapy is not clear due to the inclusion of patients with ER-negative disease [3]. This review will focus on endocrine therapy for patients younger than 40 years old. Patients between 40 and 50 years old are also a challenge because they may become amenorrheic with chemotherapy. In this specific subgroup of patients, several consensuses have been proposed. Figure 1 summarizes a consensus statement launched by a panel of experts in Spain [4].