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NCCN Guidelines for Patients



Breast Cancer – Locally Advanced (STAGE III)

Version 1.2017

Treatment guide

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.

Guide 10

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.

Guide 11

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.


Endocrine therapy

Treatment guide

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.