Bone Modifier Use as Adjuvant Therapy for Early Breast Cancer

Abstract

Many studies have examined the effects of adjuvant bisphosphonates on long-term breast cancer outcomes. However, results have been inconsistent. Here, we review the evidence for their role in early breast cancer. In a recent meta-analysis, no significant decreases in recurrence or breast cancer mortality were observed in the overall population. In postmenopausal women, statistically significant, but modest, reductions in distant recurrence were observed, driven by decreased bone recurrence. This translated to decreased breast cancer mortality. While most individual studies were not performed exclusively in postmenopausal patients and were not adequately powered to detect subgroup effects based on menopausal status, observed effects were highly consistent. Adjuvant bisphosphonates in postmenopausal women should be considered in individual cases of high-risk patients, where the absolute benefit justifies associated risks. There is no evidence supporting their routine use in premenopausal women except in selected patients receiving ovarian function suppression.