Treatment
➤ Women with Stage II or Stage III breast cancers who would ordinarily
be advised to receive adjuvant chemotherapy should receive ovarian
suppression in addition to endocrine therapy.
➤ Women with Stage I or II breast cancers at higher risk of recurrence, who
might consider chemotherapy, may also be offered ovarian suppression
in addition to endocrine therapy.
➤ Women with Stage I breast cancers not warranting chemotherapy should
receive endocrine therapy but not receive ovarian suppression.
➤ Women with node-negative cancers 1 centimeter or less (T1a, T1b)
should receive endocrine therapy but not receive ovarian suppression.
Qualifying Statements:
The standard duration of ovarian suppression in the included trials was 5 years. With no
comparative data available on alternative durations, the Panel supports ovarian suppression
for 5 years.
To date there is no adequate evidence for assessing the benefit of adjuvant ovarian
suppression in women at sufficient risk to warrant chemotherapy compared with 10 years of
tamoxifen.
There is no current role for ovarian suppression as adjuvant therapy in ER-negative breast
cancers.
There are substantial side effects to ovarian suppression. Clinicians and patients should
consider the tradeoffs of side effects when choosing ovarian suppression.
The long term effects of ovarian suppression on breast cancer risk and survival are not yet
established.
➤ Ovarian suppression may be administered with either tamoxifen or an
aromatase inhibitor.
Qualifying Statements:
Tamoxifen and AI therapy differ in their side effect profiles, which may affect patient
preferences.
Clinicians should be alert to the possibility of incomplete ovarian suppression with GnRH
agonist therapy and evaluate patients in whom there is concern for residual ovarian
function.
