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Can some postmenopausal women with breast cancer skip chemotherapy?

T. Salewa Oseni, M.D., Harvard Health Blog on

Published in Health & Fitness

Premenopausal women responded better to hormone therapy and chemotherapy

Of the women enrolled in the RxPonder trial, 3,350 were postmenopausal and 1,665 were premenopausal. Further analysis by menopausal status revealed that there was no difference in five-year survival for postmenopausal women treated with hormone therapy alone versus hormone therapy with chemotherapy.

However, for premenopausal women there was a 46% reduction in the risk of invasive disease. For this subgroup of women, the five-year, invasive disease-free survival rates were 94.2% in women treated with hormone therapy and chemotherapy, compared to 89% in women treated with hormone therapy alone. The premenopausal women who received both chemotherapy and hormone therapy had an additional benefit of around 5%. It is unclear if the survival benefit seen in premenopausal women is primarily due to chemotherapy’s effect, or indirectly by ovarian suppression due to chemotherapy

What does this mean for breast cancer treatment decision-making?

The treatment of breast cancer has truly become personalized. It has always been important to know the stage of your caner, but now it is also important to know the type of your cancer. With this information, women can make an informed discussion with their oncologist about the risks and benefits of chemotherapy.

 

If you are a premenopausal woman with a HR-positive, node-positive breast cancer, chemotherapy and hormone therapy may give you the greatest chance of decreasing your risk of the cancer coming back. However, for a postmenopausal woman with HR-positive breast cancer, chemotherapy may not add many treatment benefits to hormone therapy, and it carries risks that may affect your quality of life. Studies like the TailorRx and RxPonder trials have provided more information to help you make an informed decision.

(T. Salewa Oseni, M.D., is a contributor to Harvard Health Publications.)

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