NCCN Guidelines for Patients
Breast Cancer – Locally Advanced (STAGE III)
Endocrine therapy is used to treat hormone
receptor–positive breast cancer. The breast cancer
can have estrogen or progesterone receptors or
both. Options are based on menopausal status.
Menopause is the point in time when you won’t have
another menstrual period again. When a woman
hasn’t had a period in one or more years, she’s often
considered in postmenopause. If you get menstrual
periods, you are in premenopause.
If you don’t get periods, blood tests may be needed
to confirm your menopausal status. Your periods may
stop during chemotherapy but you may not be in
menopause. The amount of estrogen or FSH (
ormone) in your blood will be measured.
Sometimes, these blood tests can’t be done until
you’ve been off certain medicines for some time.
All options involve taking an antiestrogen, an
aromatase inhibitor, or both back-to-back. These
medicines are usually taken for 5 to 10 years. The
first regimen received is called the initial treatment.
Sometimes a second medicine is taken within the
5-year period. This is called sequential treatment.
Endocrine therapy taken beyond the 5-year period is
called extended treatment.
lists two options if you are in
premenopause. Treatment occurs for at least 5 years
and often longer. The first option starts with taking
tamoxifen for 5 years. To lower hormone levels,
ovarian ablation or suppression may be part of
After 5 years of tamoxifen, your menstrual status
will be assessed. If in premenopause, you may
continue tamoxifen for 5 years or stop treatment. If in
postmenopause, options include taking tamoxifen or
an aromatase inhibitor for 5 years.
The second option for initial treatment includes taking
an aromatase inhibitor for 5 years. It also includes
ovarian suppression or ablation. These treatments
will lower hormone levels.
lists options if you are in postmenopause.
In your body, estrogen is made in small amounts by
the adrenal glands, liver, and body fat. To reduce
estrogen levels, an aromatase inhibitor, tamoxifen,
or both may be used. Treatment occurs for at least 5
years and often longer.
Men with breast cancer
One out of every 100 breast cancers occurs
in men. Men with breast cancer are treated
much like women. One important difference
is treatment with endocrine therapy. Your
options are the same as for women in
postmenopause. However, aromatase
inhibitors should be taken with a treatment
that stops the making of testosterone by your
testes. Aromatase inhibitors alone won’t stop
hormone-related cancer growth.