Iatrogenic Induction of Menopause as Adjuvant Therapy for Premenopausal Women With Early Breast Cancer

43 Vol. 10 No. 1, January-March 2008 Introduction Breast cancer is the most common cancer diagnosed in women in North America and 25 % of them are premenopausal (1). The young pre-menopausal and perimenopausal women constitute a significant group of patients with breast cancer and their specific treatment requires careful consideration. Approximately 60% of tumors in pre-menopausal women are hormone sensitive, and are potentially suitable for endocrine treatment (2,3). Systemic therapy which includes endocrine therapy and chemotherapy are used to reduce the likelihood of recurrence in early breast cancer (EBC) and to treat more advanced disease with or without distant metastases. Such therapy in the adjuvant setting in EBC will on average reduce the risk of recurrence by 20-35% and the odds of death by 15-30%. The adjuvant therapy decisions are guided by numerous factors like tumor size, lymph node status, hormone receptor status, HER2-neu over expression, grade of the tumor, DNA synthesis rate, gene profiling assay and host related factors like physiological age of the patient, menopausal status and presence of co morbid conditions. Endocrine therapy: The presence of endogenous estradiol plays a significant role in the progression of disease and its impact is dependant on the hormone receptor status of the tumor. Thus, removal of the some of endogenous estrogen in pre-menopausal patients is likely to prevent growth of tumors that are sensitive to circulating estrogens. Hormonal manipulation has been used for more than 100 years to treat young women with advanced cancer, but there is still no complete consensus about how to translate this into the management of EBC. Tamoxifen, a selective estrogen receptor modulator (SERM), is an effective agent for pre-menopausal women Iatrogenic Induction of Menopause as Adjuvant Therapy for Premenopausal Women With Early Breast Cancer