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Adjuvant Therapy of Breast Cancer
Adjuvant chemotherapy is offered to patients with stage I, II and III breast cancer after surgical removal of the tumor. In stage I breast cancer the decision to give chemotherapy is based on the tumor size, hormone receptor status, and menopausal status of the patient. In stage I breast cancer, if the tumor size is less than 1 cm (about half an inch) chemotherapy is not generally recommended, however your physician may sometimes recommend adjuvant chemotherapy even if the tumor was less than 1 cm based on some other poor outcome factors. Women with hormone receptor positive tumor are mostly recommended to take adjuvant Hormonal therapy. This adjuvant hormonal therapy is not effective in patients who have hormone receptor negative tumors. Pre-menopausal women are usually given tamoxifen for 5 years. Tamoxifen is appropriate for post-menopausal women as well. There is another hormonal drug option available for postmenopausal women. This is a drug from the class of aromatase inhibitors and is called anastrozole (Arimidex) and has been shown to be superior to tamoxifen in the breast cancer treatment. Some of the side effects of tamoxifen like the risk of uterus cancer and blood clots are much less with the use of anastrozole. The risk of osteoporosis and fracture are however higher with anastrozole compared to tamoxifen. Removal of all the post-menopausal estrogen may be responsible for the increased risk of osteoporosis and fracture. The experience with tamoxifen however spans to the last twenty years, whereas our experience with anastrozole is limited to the last few years. These are some of the factors we should consider before choosing between tamoxifen and anastrozole as the choice of adjuvant therapy. One new study has suggested that, at the end of five years of tamoxifen if another hormonal agent namely letrozole is given for another 5 years, that would further decrease the risk of breast cancer from coming back. Also one new study has suggested that if at the end of 2 to 3 years, if tamoxifen is switched to another hormonal agent namely exemestane, patient may get more benefit, Like anastrazole and letrozole, this drug is also a member of the aromatase inhibitors group. Other options include surgical removal of the ovaries or chemical suppression of ovarian hormone production. Most commonly used adjuvant chemotherapy regimens include n a combination of cyclophosphamide with doxorubicin or epirubicin with or without fluorouracil.
Breast cancer resources