Since hidden breast cancer cells may remain in the body after initial treatment, it is extremely important that before any female hormones of any kind are taken by a woman who has had breast cancer, she should discuss the potential risk with her oncologist .
• Hormonal Therapy in Special Situations Tamoxifen may be the primary tumor treatment in some very
special situations—for elderly patients who cannot have or refuse to have surgery, for example, or for patients
with estrogen receptor positive tumors who can't have surgery or chemotherapy because of medical problems.
In older patients, especially those over 80, tamoxifen will often shrink 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.
