Breast Care Center

Guidelines for Use of Endocrine Therapy in
Postmenopausal Women

General guidelines

  1. All patients must have a breast tumor that is estrogen receptor (ER) positive or progesterone receptor (PR) positive.

  2. Prior to consideration of an aromatase inhibitor( AI), lab work must include a serum estradiol level and follicle stimulating hormone level (FSH) for women less than 55 years of age. These values should both be in the postmenopausal range. The serum estradiol level should be repeated at six months to determine if it remains in the postmenopausal range.

  3. Patients who are ER+ and/or PR+ will be offered:
    1. tamoxifen for 2 years, then an AI for at least 3 years or
    2. aromatase inhibitor for at least 5 years.

  4. For women who are premenopausal before chemotherapy and < 50 years of age:
    1. offer tamoxifen as initial agent of choice for 2 years
    2. use AI with caution, following serum estradiol levels every 6 months.

  5. For women on an AI, intravaginal estrogen is relatively contraindicated.

Choice of agent

Estrogen
receptor
Progesterone
receptor
HER2
Endocrine
Therapy
+
+
+
TAM 2-3 years, then AI x 2-3 years
Optimal duration -unknown
+
-
-
AI x 5 years
+
+
+
AI x 5 years or TAM x 2-3 years,
then AI x 2-3 years
+
-
+
AI x 5 years

 

Reviewed, updated February 15, 2006
Jenny Chang, M.D.
Richard Elledge, M.D.
Mamta Kalidas, M.D.
Rush Lynch, M.D.
Kent Osborne, M.D.
Suzanne Perez, RN, BSN
Mari Rude, RN, ANP