For bony or soft tissue metastases in patients with estrogen or progesterone receptor-positive breast cancer, hormonal agents such as tamoxifen, anastrozole, letrozole, exemestane, or luteinizing hormone-releasing hormone agonists (in premenopausal women) can be used for effective palliation lasting many months. Newer drugs that target growth factor pathways in breast cancer are currently in development.

Reference:

• National Cancer Database: http://www.facs.org/cancer/ncdb/index.html
• National Guideline Clearinghouse: http://www.guideline.gov/
• PDQ Cancer Information Summaries: http://www.cancer.gov/
• SEER Cancer Statistics Review, 1975-2000: http://seer.cancer.gov/csr/1975_2000/

Overall induction response rates range from 55% to 65%. Median survival times are 14-18 months. The survival rates depend more on the site of the metastatic disease than on the treatment, with visceral disease faring more poorly than bony or soft tissue metastases. Most patients receive more than one treatment regimen, since the median time to failure of most programs is about 6 months.

Reference: DeVita T Jr, Hellman S, Rosenberg SA (eds): Cancer: Principles and Practice of Oncology, 6th ed. Philadelphia, Lippincott Williams & Wilkins, 2001.

Among the most effective chemotherapy agents for breast cancer are doxorubicin, epirubicin, paclitaxel, docetaxel, vinorelbine, cyclophosphamide, methotrexate, fluorouracil, capecitabine, and prednisone. These agents are used singly or in combination in the treatment of advanced or metastatic breast cancer. If the tumor overexpresses the Her/neu oncogene, trastuzumab (Herceptin) may be added to improve the effectiveness of chemotherapy.

Reference: Casciato DA, Lowitz BB (eds): Manual of Clinical Oncology, 5th ed. Boston, Little, Brown, 2000.

The basic choice is systemic chemotherapy or hormone therapy, depending on hormone receptor status, reserving surgery and radiotherapy for local control.

Reference: American Joint Committee on Cancer: Cancer Staging Manual, 6th ed. New York, Springer-Verlag, 2002.

Modified radical mastectomy is performed with postoperative chemotherapy and/or hormonal therapy, depending on estrogen and progesterone receptor status of the tumor and menopausal status of the patient, followed by local radiotherapy. For very large or fixed tumors that are initially deemed to be inoperable, preoperative chemotherapy or hormonal therapy may render such cancers surgically removable.

Reference: American Joint Committee on Cancer: Cancer Staging Manual, 6th ed. New York, Springer-Verlag, 2002.

Modified radical mastectomy with postoperative chemotherapy and/or hormonal therapy, depending on estrogen and progesterone receptor status of the tumor and menopausal status of the patient.

Reference:  American Joint Committee on Cancer: Cancer Staging Manual, 6th ed. New York, Springer-Verlag, 2002.

Recent studies have shown that for women at high risk for breast cancer due to a previous personal history of breast cancer, first-degree family members with breast cancer, and other factors, the use of tamoxifen can reduce the occurrence of new breast cancers by about half. Some women who are known to carry the BRCA1 or BRCA2 gene mutations choose to undergo prophylactic simple mastectomies, which reduce the incidence of breast cancer by about 90%.

Reference: Vogel VG: Breast cancer prevention: A review of current evidence. CA Cancer J Clin 50:156-170, 2000.