Perils of prolonged ovarian suppression and hypoestrogenism in the treatment of breast cancer: Is the risk of treatment worse than the risk of recurrence?

摘要: Premenopausal breast cancer is usually estrogen receptor positive, and hence, prolonged ovarian suppression by medical or surgical means to prevent recurrence has become standard of management improve disease-free survival. Ten-year adjuvant tamoxifen therapy associated with 3.5% fewer recurrences compared five years. The SOFT trial demonstrated small but statistically significant incremental improvements in long-term survival the addition gonadotropin-releasing hormone analog treatment (triptorelin) an aromatase inhibitor (exemestane). Profound hypoestrogenism premenopausal age group may not be well tolerated due a host bothersome side effects (primarily vasomotor symptoms, musculoskeletal complaints, genitourinary syndrome menopause, mood disorders). Prolonged younger women premature development cardiovascular disease, bone loss, cognitive decline, all-cause mortality. This paper explores multi-system consequences derived from studies without cancer. Pretreatment counseling positive should emphasize benefit on established risks lifelong quality life Future genomic research help identify best candidates for extended avoid treating many when only minority benefit.