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Lester and Sue Smith Breast Center

Houston, Texas

The Lester and Sue Smith Breast Center's mission is to improve prevention, diagnosis and treatment of breast disease.
Lester & Sue Smith Breast Center
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Guidelines for Use of Endocrine Therapy in Postmenopausal Women

General guidelines

  1. All patients must have a breast tumor that is estrogen receptor (ER) positive or progesterone receptor (PR) positive.
  2. Prior to consideration of an aromatase inhibitor( AI), lab work must include a serum estradiol level and follicle stimulating hormone level (FSH) for women less than 55 years of age. These values should both be in the postmenopausal range. The serum estradiol level should be repeated at six months to determine if it remains in the postmenopausal range.
  3. Patients who are ER+ and/or PR+ will be offered:
    1. tamoxifen for two years, then an AI for at least three years or
    2. aromatase inhibitor for at least five years.
  4. For women who are premenopausal before chemotherapy and < 50 years of age:
    1. offer tamoxifen as initial agent of choice for two years
    2. use AI with caution, following serum estradiol levels every six months.
  5. For women on an AI, intravaginal estrogen is relatively contraindicated.

Choice of agent

Estrogen
receptor
Progesterone
receptor
HER2
Endocrine
Therapy
+
+
+
TAM 2-3 years, then AI x 2-3 years
Optimal duration -unknown
+
-
-
AI x 5 years
+
+
+
AI x 5 years or TAM x 2-3 years,
then AI x 2-3 years
+
-
+
AI x 5 years

Reviewed, updated Feb. 15, 2006
Jenny Chang, M.D.
Richard Elledge, M.D.
Mamta Kalidas, M.D.
Rush Lynch, M.D.
Kent Osborne, M.D.
Suzanne Perez, RN, BSN
Mari Rude, RN, ANP

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