Senior Breast Cancer Patients may not Need Hormone Therapy

Taking an estrogen-blocking medicine after breast cancer surgery is a normal course of treatment for many patients. New research finds this may not be necessary for all women.

Women over the age of 60 who have early stage breast cancer that's driven by hormones may not need adjuvant (after surgery) hormonal therapy. A recently published study finds that these women are not at increased risk of dying, compared to women of the same age who do not have breast cancer.

Discuss the risks of hormone therapy after breast cancer surgery.

Hormone-responsive breast cancers are those that use hormones (estrogen or progesterone) to grow. Estrogen receptor-positive (ER+) breast cancer is the most common form of the disease. And nearly all ER+ patients receive medications to block the hormone following surgery.

While these recommendations are accepted around the world, no research has been conducted to determine if some patients can do without the therapy.

Peer Christiansen, M.D., of the Aarhus University Hospital in Denmark and his colleagues, looked at 3,197 breast cancer patients between the ages of 35 and 74. The patients did not have any lymph node involvement and had not received hormone therapy or chemotherapy.

Researchers estimated mortality risks of these women and compared them with those of the general population. Here's what they found:

• Risk of death was highest among patients ages 35-39.
• Mortality risks were lowest among those 60-64.
• Patients with tumors larger than 10 millimeters (mm) were at greater risk of dying than the general population.

The study concluded that patients who had tumors that were 10 mm or less and had low-grade disease may not benefit from adjuvant hormone therapy.

Jennifer J. Griggs, M.D., M.P.H., and Daniel F. Hayes, M.D., of the University of Michigan, wrote in an accompanying editorial that this study confirms earlier findings that local therapy is adequate for treating older women with small, node-negative cancers that are hormone receptor positive.

The editorial goes on to suggest that some patients may still want the therapy and that they should discuss the risks and benefits with their healthcare team.

This study was published in the Journal of the National Cancer Institute.