| You are here: Home: BCU 4|2002: Program Supplement: Case 6
Miami Breast Cancer
Conference
Tumor Board Case 6: Patrick Borgen, MD
An elderly woman with
a tumor too large for breast conservation |
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| The patient is a 73-year-old woman
who had coronary bypass at age 68 and is now on multiple
cardiovascular medications. She has claudication upon
climbing one flight of stairs. She presented 6 months
ago with a 4 cm breast mass. Core biopsy revealed intraductal
carcinoma, strongly ER-positive. She has small breasts
and has been on neoadjuvant tamoxifen for 6 months.
The tumor is now 2.5 cm, but she is still not a good
candidate for excision and radiotherapy. What is your
recommendation?
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Aromatase inhibitors have been reported to have greater response
rates in the neoadjuvant setting than tamoxifen, and almost half
of the attendees would switch this patient to an aromatase inhibitor.
The faculty was split in terms of management, noting that mastectomy
carries some risk in this older patient with cardiovascular disease.
Dr Borgen switched the patient to anastrozole, and the tumor has
further decreased in size. Breast-conserving surgery is being considered
at this time.
Dixon JM et al. The effects of neoadjuvant anastrozole (Arimidex)
on tumor volume in postmenopausal women with breast cancer: A randomized,
double-blind, single-center study. Clin Cancer Res 2000;6(6):2229-35.
Abstract
Ellis MJ. Preoperative endocrine therapy for older women with
breast cancer: Renewed interest in an old idea. Cancer Control
2000;7(6):557. Full
Text
Ellis MJ et al. Letrozole is more effective neoadjuvant endocrine
therapy than tamoxifen for ErbB-1- and/or ErbB-2-positive, estrogen
receptor-positive primary breast cancer: Evidence from a phase III
randomized trial. J Clin Oncol 2001;19:3808-16. Abstract
Mandelblatt JS et al. Measuring and predicting surgeons’practice
styles for breast cancer treatment in older women. Med Care
2001;39(3):228-42. Abstract
Milla-Santos A et al. Anastrozole (A) as neoadjuvant (NEO)
therapy for hormone-dependent locally advanced breast cancer (LABC)
in postmenopausal (PM) patients (pts). Breast Cancer Res
Treat 2001; Abstract
302.
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