The Breast Cancer Survival Manual by John Link M.D

Author:John Link, M.D.
Language: eng
Format: epub
Publisher: Henry Holt and Co.

Preoperative Hormonal Treatment

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There has been a movement to treat breast cancer patients who have high-grade (fast-growing) cancers with chemotherapy before surgery. These are not Luminal A cancers but high-grade Luminal B, HER2-positive, and triple-negative breast cancers. We will discuss this thoroughly in the following chapters. But the same principles that apply to treating Luminal A and some Luminal B breast cancers with estrogen-targeted therapy before surgery apply here. The advantages are the following:

1. The cancer will reduce in size and make surgery less deforming.

2.  There will be measurable and visible proof that the hormonal treatment is working.

3.  The surgery can be done in a nonemergent and convenient time frame.

4.  Many women are able to have breast-conserving surgery rather than a mastectomy.

Most of the use of preoperative hormonal therapy has been in postmenopausal women. Interestingly, the use of preoperative estrogen-targeted therapy is very common in Europe, where up to 40 percent of women with Luminal breast cancer receive preoperative tamoxifen or AI therapy for up to six months. For reasons that are unclear, U.S. oncologists rarely prescribe preoperative or neoadjuvant estrogen-directed treatment. Because of the merits of this approach, I believe this will change in the future, and in fact the subject is frequently addressed at national breast cancer conferences now. The length of time for treatment is longer than the preoperative chemotherapy protocols and is usually in the range of six months, but we have been using this approach successfully in Breastlink clinics. It requires careful monitoring, and the patient must have a good understanding of the approach and feel comfortable with delaying surgery.

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