Women who have early-stage breast cancer often undergo surgery, followed by chemotherapy, radiation therapy, and/or hormone therapy with tamoxifen. Many postmenopausal women with this type of disease receive tamoxifen in addition to any other therapies they undergo. One dilemma with which researchers have been grappling is, for how long should the hormone therapy be administered? Swedish researchers now report that receiving tamoxifen for at least 5 years is the most effective approach to preventing the recurrence (return) of breast cancer.

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.

Stage I breast cancer consists of the presence of cancer, not more than 2 cm, that is confined to the breast.

Stage II disease is characterized by the presence of cancer in the breast, with the tumor being either 5 cm or smaller

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with lymph node involvement (under the arm) or larger than 5 cm

without lymph node involvement. Usually, an important part of treatment for persons with this stage of breast cancer is surgery to remove the cancer and surrounding tissue (lumpectomy), or to remove the whole breast (mastectomy), as well as some of the lymph nodes under the arm. After surgery, radiation therapy to the breast area, chemotherapy, and/or hormone therapy with an agent called tamoxifen may also be given to help prevent a recurrence (return) of the disease and to improve the chance of survival. Tamoxifen is often used alone or in combination with other types of therapy. Over the last 2 decades or so, researchers have been trying to determine the optimal length of time to administer tamoxifen, to achieve the most benefit with the fewest possible side effects.

From 1983 to 1992, researchers in Sweden assigned 4587 postmenopausal women to receive either 2 years of tamoxifen therapy or 5 years of tamoxifen therapy after surgery for stage I or II breast cancer. Women who had lymph node involvement also underwent radiation therapy. Long-term followup revealed that the women who received 5 years of tamoxifen had fewer recurrences and a better survival rate than women who received only 2 years of tamoxifen. This finding was evident in those with and without lymph node involvement. The greatest benefit was found in women who had cancer cells that were hormone receptor-positive and who did not have cancer cells with an abnormality called her2neu.

The researchers concluded that all postmenopausal women with early-stage breast cancer should receive at least 5 years of tamoxifen therapy after surgery. Persons who have early-stage breast cancer may wish to talk with their doctor about the risks and benefits of receiving long-term tamoxifen or of participating in a clinical trial in which new treatments are being studied. Two sources of information on ongoing clinical trials include clinical trials listing services provided by the National Cancer Institute (cancer.gov) and eCancerTrials.com. eCancerTrials.com also performs personalized clinical trial searches on behalf of patients. (Proceedings of the American Society of Clinical Oncology, Vol 19, p72a, Abstract 276, 2000)

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