Surgical oophorectomy or GnRH plus tamoxifen adjuvant therapy for breast cancer in low-risk premenopausal women: comparative benefits and risks

Abstract

Background: While the combination of ovarian suppression or ablation treatment and tamoxifen or an aromatase inhibitor has been demonstrated to provide better outcomes as adjuvant therapies in premenopausal women with hormone receptor positive breast cancer, than treatment with tamoxifen alone, the details of applying these results in clinical practice, and the risks and benefits of the different ovarian treatments, particularly in women at lower risk for disease recurrence and death, have received limited attention. Methods: Details of clinical trials investigating combination hormonal adjuvant therapies, particularly with tamoxifen, were reviewed focusing on issues pertinent to assessment of risks and benefits in clinical practice. Results: Equivalent survival outcomes from surgical oophorectomy (SO) or GnRH agonist treatment plus tamoxifen, for which there are the most data at present, make the major decision issues for individual patients in choosing between these treatments: interest in future pregnancy, availability of data on secondary biological effects, capacity to adhere to a GnRH injection program for 5years, and ability to optimize dental hygiene (for taking bisphosphonate additional treatment). Other considerations applicable in individual patients include comparative secondary treatment effects, financial costs, and psychological impacts. Conclusion: If a patient with low-risk for recurrence breast cancer has interest in a future pregnancy, GnRH treatment is clearly appropriate. Otherwise, all major and minor risks of GnRH treatment are greater than those for SO treatment, when combined hormonal treatment with tamoxifen is taken.