Breast Cancer Treatment (PDQ®)–Health Professional Version

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Changes to This Summary (04/06/2018)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Early/Localized/Operable Breast Cancer

Added text to state that 5 years of adjuvant endocrine therapy has been shown to substantially reduce the risks of locoregional and distant recurrence, contralateral breast cancer, and death from breast cancer.

Added text to state that the optimal duration of endocrine therapy is unclear, although the preponderance of evidence supports at least 5 years of endocrine therapy. A meta-analysis of 88 clinical trials involving 62,923 women with hormone receptor–positive breast cancer who were disease free after 5 years of endocrine therapy showed a steady risk of late recurrence 5 to 20 years after diagnosis (cited Pan et al. as reference 129 and level of evidence 3iiiD). Added that the risk of distant recurrence correlated with the original tumor and node status, with risks ranging from 10% to 41%.

Added text to state that the optimal duration of aromatase inhibitor (AI) therapy is unclear, with the preponderance of evidence supporting at least 5 years of endocrine therapy. A meta-analysis of 88 clinical trials involving 62,923 women with hormone receptor–positive breast cancer who were disease free after 5 years of endocrine therapy showed a steady risk of late recurrence 5 to 20 years after diagnosis (cited Pan et al. as reference 129 and level of evidence 3iiiD).

Revised text to state that evidence regarding extension of endocrine therapy beyond 5 years of initial AI–based adjuvant therapy included a double-blind, randomized, phase III trial that assessed the effect of an additional 5 years of letrozole versus placebo in 1,918 women who had received 5 years of an AI.

Revised text to state that a randomized phase III study assessed the effect of an additional 2.5 years of letrozole versus 5 years of letrozole in 1,824 women who received 5 years of an AI (cited Blok et al. as reference 169 and level of evidence 1iiDiii). Also provided statistical data related to disease-free survival events, related distant metastasis-free interval data, details about a subgroup analysis, and a statement about the lack of evidence to show that 10 years of AI therapy was superior to 7.5 years of AI therapy.

Added text to state that the optimal duration of adjuvant AI therapy and whether it should be extended beyond a duration of 5 years remains unclear.

This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.

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