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Though many young women with breast cancer are treated with chemotherapy to help destroy cancer cells and prevent a recurrence of the disease, chemotherapy can cause infertility in these women. Now, a new study shows that hormonal drug therapy may be as effective as chemotherapy in young women with breast cancer, while helping women to preserve their fertility. Though the number of young women who died from breast cancer was equal in the study regardless of treatment, those who were given hormonal therapy were less likely to experience a recurrence of breast cancer, compared to the women who received chemotherapy. Based on these results, researchers say hormonal therapy is a viable alternative to chemotherapy for young women with breast cancer. The majority of women who are diagnosed with breast cancer are over 60 years of age. Those who are diagnosed at a young age (less than 40) tend to have more aggressive-type breast cancers than older women. Therefore, many young women are treated with chemotherapy in addition to breast cancer surgery to help prevent a recurrence of the disease and improve the chances of survival. While chemotherapy has been shown to be effective in these women, it is associated with a number of side effects, most notably early menopause. That is, young women who are treated with chemotherapy tend to experience menopause during treatment and are usually unable to have children afterwards. To test whether hormonal drug therapy is as effective as chemotherapy in preventing deaths or recurrences of breast cancer in young women, researchers from the Austrian Breast and Colorectal Cancer Study Group Trial 5 enrolled 1,000 women who had estrogen-sensitive breast cancers. Half of the women were given six 28-day cycles of chemotherapy with the drugs cyclophosphamide, methotrexate, and fluorouracil. The other half were given two drugs: goserelin for a period of three years and tamoxifen for a period of five years. After five years, the researchers found that the women who were given the hormonal treatment with goserelin and tamoxifen were less likely to experience a recurrence of breast cancer. Deaths from breast cancer were approximately equal in the two groups of women. Therefore, the researchers conclude that hormonal treatment is more effective than chemotherapy in pre-menopausal patients with stage I and II breast cancer. Though women who are treated with hormonal drug therapy instead of chemotherapy do not experience premature menopause, there are a number of side effects associated with hormonal drugs, including hot flashes. Because of the long period of treatment (three years of goserlin and five years of tamoxifen), the women in the study had to endure these side effects for years. Though chemotherapy is also associated with several side effects in addition to infertility, including hair loss, fatigue, or nausea/vomiting, these side effects cease after a few months. Experts say further studies are needed before researchers can conclusively determine whether hormonal drug therapy is better than chemo therapy for young women with breast cancer. However, this study shows that women have a choice when it comes to their treatment. It is also feasible that combined treatment with hormonal drugs and chemotherapy may be even more effective than hormonal therapy alone. Further studies will also investigate this possibility. Additional Resources and References The report, "Randomized Adjuvant Trial of Tamoxifen and Goserelin Versus Cyclophosphamide, Methotrexate, and Fluorouracil: Evidence for the Superiority of Treatment With Endocrine Blockade in Premenopausal Patients With Hormone-Responsive Breast Cancer—Austrian Breast and Colorectal Cancer Study Group Trial 5," is published in the December 2002 issue of the Journal of Clinical Oncology (Vol. 20, No. 24), http://www.jco.org/ To learn more about chemotherapy, please visit http://www.imaginis.com/breasthealth/chemo.asp To learn more about tamoxifen, please visit http://www.imaginis.com/breasthealth/tamoxifen.asp

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