Diagnosis and Assessment Determining Menopausal Status
ÎEven among women who have not experienced menses for over one year, laboratory testing is inadequate as patients may recover ovarian function. This particularly applies to those patients who experience chemotherapy- or tamoxifen-induced amenorrhea.
ÎMultiple reports document late clinical recovery of ovarian function among women with treatment-induced amenorrhea, which could render AI therapy ineffective.
Postmenopausal Women
ÎAdjuvant therapy for postmenopausal women with hormone receptor- positive breast cancer should include an AI to lower the risk of tumor recurrence.
ÎIn comparison to 5 years of tamoxifen alone, use of an AI in either primary, sequential, or extended treatment has been found to improve disease- free survival, reducing the risk of breast cancer events including distant recurrence, locoregional recurrence, and contralateral breast cancer.
ÎTamoxifen and AI-based therapy are equivalent in terms of overall survival when used as either a primary or extended treatment strategy.
Premenopausal Women
ÎWomen who are pre- or perimenopausal at the time of breast cancer diagnosis should be treated with five years of tamoxifen.
ÎThere are no data at present to suggest that AI based therapy is superior to tamoxifen-based therapy in premenopausal women with ovarian suppression treatments.
ÎClinicians should use caution in evaluating the menopausal status of patients who were pre- or perimenopausal at diagnosis.
Comment: The Suppression of Ovarian Function Trial (SOFT) is comparing tamoxifen, tamoxifen plus ovarian suppression, and exemestane plus ovarian suppression. Findings from this trial will further define best practices for women who are premenopausal as well as those patients who experience treatment-induced menopause.
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