Management of advanced breast cancer with endocrine therapy: The role of the primary healthcare team

Abstract

Of the 25,000 new cases of breast cancer annually in the UK, at least half will develop metastases at some time. Approximately one-third of these will be hormone-sensitive and thus suitable for endocrine manipulation. Such patients may live for several years. Care should be patient-centred and evidence-based, with primary care playing an integral part in the multidisciplinary team. Quality of life is paramount, and largely determines decisions to change endocrine therapy. Tamoxifen remains the first choice treatment, but newer agents, in particular the oral aromatase inhibitors, have successfully extended the range of therapy available. Ovarian ablation can be effectively achieved using LHRH analogues, which have the advantage of being reversible if ineffective. In future, further improvements in outcome are likely with new pure antioestrogens and the possibility of sequential or combined use of existing drugs.