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The effect of adjuvant chemotherapy in young patients with breast cancer in relation to hormone receptor status This study is of interest since it demonstrates that the prognosis of young breast cancer patients is significantly improved by adjuvant chemotherapy in hormone receptor negative tumors but not in young breast cancer patients that have hormone receptor positive tumors. This study is unique in that its results were not influenced by the effects of endocrine therapy, which was not administered to these women. The fact is that estrogen-receptor positive breast cancers in young women are relatively insensitive to adjuvant chemotherapy therapeutic strategies and estrogen-receptor negative breast cancers are not. This may partly be due to the fact that chemotherapy in young women regularly does not induce an irreversible suppression of the ovary function as compared to older premenopausal breast cancer patients. This results in a temporal menopausal status. When ovarian function returns estrogen-receptor positive breast cancer cells, which are left in the body, may be stimulated again to proliferate and transform into metastases. Therefore, in young women with estrogen-receptor positive breast cancer, adjuvant chemotherapy without endocrine therapy with or without ovarian function suppression is inadequate treatment. Current prospective trials concerning this subject are studying whether or not adjuvant treatment strategies consisting of endocrine therapy with ovarian function suppression but without chemotherapy yield similar or even better results in terms of survival compared to treatment strategies with chemotherapy. Currently, we are finalizing a study in very young breast cancer patients in which we have tried to identify good-prognosis profiles. At present, all very young breast cancer patients are advised to receive adjuvant chemotherapy regardless of other tumor characteristics. These so-called "good-prognosis profile very young breast cancer patients" might not need to receive adjuvant chemotherapy.
Bibliographic reference:
Jos van der Hage Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
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