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Standard treatment of women who have breast cancer with involvement of the lymph nodes under the arm (stage II to III disease) includes surgery, followed by a combination of chemotherapy, radiation therapy, and/or hormone therapy. However, older women cannot always tolerate the side effects of chemotherapy. Researchers in Italy now say that, for women 65 years and older, the use of hormone therapy alone after surgery for this stage of breast cancer appears to afford the same survival time as hormone therapy combined with chemotherapy.

Breast cancer is characterized by the presence of cancer cells in the tissue or ducts of the breast. Depending on the stage of disease (extent of the cancer at diagnosis), treatment options may include surgery, chemotherapy, radiation therapy, and/or hormone therapy. Usually, an important part of treatment for persons with cancer that has spread to the lymph nodes under the arm, called locally advanced breast cancer, is surgery to remove the cancer and surrounding tissue (lumpectomy) or to remove the whole breast (mastectomy). After surgery, radiation therapy to the breast area, chemotherapy, and/or hormone therapy with an agent called

tamoxifen may also be given to prevent recurrence (return) of the disease and to prolong survival time. Because tamoxifen usually causes fewer side effects than chemotherapy, this is often a preferred option for older women. However, researchers continue to study new chemotherapy drugs and new treatment combinations to ensure that older women receive the most effective therapy with the most tolerable side effects.

Researchers in Italy treated postmenopausal women who had undergone either a lumpectomy or mastectomy for breast cancer that had spread to the lymph nodes under the arm. All patients had lymph nodes removed to test for the presence of cancer cells, and patients who had a lumpectomy also received radiation therapy. Three hundred six women were assigned to receive hormone therapy with tamoxifen for 5 years, while 302 women were assigned to receive the same hormone therapy plus 3 cycles of chemotherapy with cyclophosphamide, methotrexate, and fluorouracil (CMF). After 5 years the cancer had recurred in 39% of women 65 years and older who received tamoxifen alone and in 37% who received both chemotherapy and tamoxifen. The survival rates after 5 years was 80% if treated with tamoxifen alone and 77% in those receiving both chemotherapy and tamoxifen.

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The researchers concluded that the addition of CMF chemotherapy to hormone therapy appears to offer no advantage in survival time for women age 65 and older who undergo surgery for breast cancer with lymph node involvement. Persons age 65 years and older who have breast cancer may wish to talk with their doctor about the risks and benefits of receiving tamoxifen with or without chemotherapy or of participating in a clinical trial in which promising new chemotherapy drugs are being studied. Sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute ( and the Clinical Trials section and service offered by Cancer ( (Journal of Clinical Oncology, Vol 18, No 7, pp 1412-1422, 2000)

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