The Breast : official journal of the European Society of Mastology
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Gross lymphoedema is a devastating complication in patients with breast cancer and more so in young women. These patients present with more advanced disease and suffer a higher incidence of loco-regional recurrence. Young women are also subject to more traumas to the lymphatics by virtue of their being more active. ⋯ Lymphoedema treatment consists mainly of compression therapy, manual lymphatic drainage and containment. Surgery is rarely required. Lymphoedema is a chronic condition that requires long-term care with patient compliance and active cooperation.
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Tamoxifen has been the endocrine agent of choice for adjuvant hormonal therapy for early breast cancer since approval in 1986. Five years of tamoxifen treatment produced a significant reduction in recurrence and death over more than 10 years of follow-up in women with estrogen receptor-positive (ER+) breast cancer. ⋯ This review provides a synopsis of the most recent trial results and a discussion of remaining areas of uncertainties. Although currently tamoxifen still remains a valid option, increasing evidence from the new AI adjuvant trials suggests that optimised adjuvant endocrine treatment should incorporate an AI either as initial or as sequential therapy.
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There is increasing use of luteinising hormone-releasing hormone (LHRH) agonists in the adjuvant treatment of breast cancer (J. Clin. Oncol. 19(2) (2001) 343). ⋯ Soc. Clin. Oncol. 22 (2003), Abstr. 15).
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Adjuvant tamoxifen is still considered standard care for postmenopausal women with early stage hormone receptor-positive breast cancer. However, efficacy and safety of tamoxifen are limited by its partially estrogenic properties. ⋯ Results of several adjuvant aromatase inhibitor trials have been published and strongly indicate that efficacy may be increased compared with tamoxifen alone. This review will examine the published data, discuss ongoing trials, and address the question of how to best integrate the aromatase inhibitors into adjuvant treatment.
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Women are conventionally advised to stop tamoxifen before attempting pregnancy. The risks of congenital malformations or late teratogenic manifestations in adulthood are unknown. Following an informed discussion about the uncertainties of tamoxifen exposure on pregnancy women should be offered the choice whether to continue or stop tamoxifen before attempting pregnancy. An unexpected pregnancy in a women taking tamoxifen could continue if the pregnant woman accepts the possibility of a teratogenic effect that tamoxifen could have on the fetus.