Adjuvant hormonal therapy in early breast cancer

For many years, tamoxifen has been the gold standard adjuvant hormonal therapy with the greatest impact in early breast cancer for both pre- and postmenopausal women. Tamoxifen-based adjuvant endocrine therapy and chemotherapy have together contributed substantially to the reduction in breast cancer mortality that has occurred in recent years. Over the past few years, the role of aromatase inhibitors has grown in prominence and they are now on the threshold of supplanting tamoxifen as the new gold standard adjuvant therapy for postmenopausal women with estrogen-receptor-positive disease. With extended use of oral antihormones such as tamoxifen, the role of ovarian suppression on the other hand has become less clear in the adjuvant setting. This article reviews the most important data regarding the various adjuvant hormonal treatments in the management of early breast cancer and will also give a brief overview of the role of these agents in the neoadjuvant setting.