Authors' recommendations: Breast cancer is the most common cancer affecting women, with > 200,000 newly identified cases every year in the United States. It is estimated in 2014 that 232,670 American women will be diagnosed with breast cancer and 40,000 will die of the disease. If identified while localized, treatment of breast cancer has a 98.5% survival rate; however, the rate drops to 84.6% once the cancer has spread to the lymph nodes, and drops further to 25.0% if the cancer has metastasized. Adjuvant chemotherapy is used in the treatment of many patients with a high risk of breast cancer recurrence to reduce the risk of recurrence following surgical resection. This has resulted in improvements in both disease-free survival (DFS) and overall survival (OS) of women with breast cancer. In addition, adjuvant endocrine therapy using tamoxifen and/or aromatase inhibitors (AI) such as anastrozole, letrozole, and exemestane are also associated with reduction in breast cancer recurrence and mortality when used for 5 years. Physicians and patients must balance the benefits and risks of adjuvant chemotherapy and endocrine therapy, however, since many women who receive these treatments will not benefit from them, but will be exposed to the associated toxicities. Common toxicities of breast cancer chemotherapies include nausea and vomiting, myelosuppression, hair loss, mucositis, and cognitive decline. Less common adverse effects include heart failure, thromboembolic events, premature menopause, and leukemia. Adjuvant endocrine therapy is also associated with significant toxicities, including endometrial cancer in postmenopausal women, deep vein thrombosis, and pulmonary embolism for tamoxifen or bone fractures for AIs. Given the need to balance the benefits and harms of adjuvant chemotherapy, it is generally offered on the basis of risk factors that have been shown to be associated with better disease-specific mortality or greater chance of distant recurrence (metastasis), such as patient age, menopause status, disease stage and location, histologic and nuclear tumor grade, hormonal receptor status (estrogen receptor [ER], progesterone receptor [PR], and v-erb-b2 avian erythroblastic leukemia viral oncogene homolog 2 [ERBB2, commonly referred to as HER2]), and measures of proliferation of the tumor. Several guidelines and prognostic models have also been developed to aid physicians and patients in making complex treatment decisions. Three of the most common guidelines are the National Comprehensive Cancer Network (NCCN) guidelines, the St. Gallen guidelines, and the National Institutes of Health (NIH) Consensus Conference Statement (2000) guidelines. In recent years, a number of molecular tests have been developed with the goal of identifying patients who have a higher risk of recurrence and are therefore more likely to benefit from adjuvant chemotherapy. The Breast Cancer Index (BCI) is a prognostic test.

Project Status: Completed

Year Published: 2014

URL for published report: The report may be purchased from: http://www.hayesinc.com/hayes/crd/?crd=17395

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: HAYES, Inc.

Contact Address: 157 S. Broad Street, Suite 200, Lansdale, PA 19446, USA. Tel: 215 855 0615; Fax: 215 855 5218

Contact Name: saleinfo@hayesinc.com

Contact Email: saleinfo@hayesinc.com

Copyright: 2014 Winifred S. Hayes, Inc