In older patients, especially those over 80, tamoxifen will often shrink primary tumors. Except in such special circumstances, tamoxifen should not be considered an alternative to established primary therapy.
Investigational Women who have many positive axillary lymph glands at primary surgery are at very high risk for recurrent disease. Women with Stage IV cancer have a low cure rate with conventional therapy, including aggressive chemotherapy . Both conventional dose chemotherapy and tamoxifen benefit these patients. The prognosis in both situations might be improved if extremely high doses of chemotherapy could be given. But there is as yet no evidence that higher doses of chemotherapy will prolong the survival of patients at high-risk for recurrence (for example with 10 or more positive axillary lymph nodes). Recent investigational programs using high-dose chemotherapy and stem cell or bone marrow protection have tried to overcome this problem, but there is no evidence yet that cure is more likely with very high dose chemotherapy and bone marrow or stem cell protection than with high-dose chemotherapy alone.
• The use of autologous bone marrow transplantation (ABMT) for metastatic and even high-risk early-stage
breast cancer is currently under study. This is riskier than the usual treatment with chemotherapy. Because the
patient's own stem cells or marrow is used, the risk is not related to the grafting problems seen in allogeneic
bone marrow transplants, where marrow comes from another donor ( See Bone Marrow Transplantation ). Rather, it relates tothe fact that blood counts become very low for many weeks,
during which time there is a high risk of bleeding and/or infection. Less than 10 percent of patients will not
