Optimizing adjuvant endocrine therapy for early ER+ breast cancer: An update for surgeons

The optimal duration of adjuvant endocrine therapy in early ER + breast cancer has been controversial. This article aims to provide an overview of the evidence.

A search of the literature was conducted via MEDLINE using appropriate keywords. Eligible studies were screened and relevant articles were selected for this report.

Studies investigating the role of extended adjuvant tamoxifen beyond 5 years have revealed mixed results depending on the proportion of node positivity. In postmenopausal women, aromatase inhibitors (AIs) for 5 years are superior to tamoxifen. Extending the use of AIs beyond 5 years seem to reduce the risk of relapse in postmenopausal women with node positive disease. The addition of bisphosphonates to counteract AI-related osteopenia may further improve overall and disease-free survival. Women younger than 40 years seem to benefit from ovarian suppression combined with tamoxifen or exemestane.

An individualised approach is required for every patient. The adverse effects of endocrine therapy should be weighed against the potential benefits of extended therapy to better inform decision-making.