Primary endocrine therapy for the treatment of early breast cancer in older women

Abstract

The standard treatment for operable breast cancer is some form of surgery followed by a combination of adjuvant therapies, such as radiotherapy, endocrine therapy, chemotherapy, and Trastuzumab. Primary endocrine therapy (PET), by comparison, is the use of an antiestrogen as the sole method of treatment for early stage, operable, estrogen receptor (ER) positive breast cancer in women who may be less able to tolerate standard therapy. PET is widely used in the treatment of older, frailer women in the UK. It has much to recommend it from the perspective of both the patients and their health care professional. From the patients' point of view, it may allow the complete avoidance of surgery with all its physical and psychological morbidity. From the perspective of the health care professional, it may be as effective at systemic disease control, with no significant mortality disadvantage in women over the age of 75. It may also be less costly, though a formal health economic assessment has never been undertaken to compare PET with standard surgical care. Local disease control rates, however,are inferior as some women will develop endocrine resistant disease and require surgery at a later stage. © 2010 Springer-Verlag London.