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Breast Cancer
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my personal edition > breast cancer > news
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DGDispatch
New Breast Cancer Guidelines Define Menopause: Presented at NCCN
By Ed Susman
HOLLYWOOD, FL -- March 18, 2005 -- The newest edition of the National Comprehensive Cancer Network's guidelines on breast cancer treatment contains a definition of menopause -- required because new treatments with aromatase inhibitors are most effective in post-menopausal women.
"You wouldn't think a definition of menopause would be need," said Robert Carlson, MD, professor of medicine, Stanford University Medical School, Stanford, California, United States. "But just about all studies that have been done in post-menopausal women define it differently."
Dr. Carlson introduced the algorithms first definition of menopause here on March 17th at the Network's 10th Annual Conference on Clinical Practice Guidelines and Data Outcomes Research:
"Clinical trials in breast cancer have utilized a variety of definitions of menopause," the guideline states. "Menopause is generally the permanent cessation of menses, and as the term is utilized in breast cancer management, includes a profound and permanent decrease in ovarian estrogen synthesis."
The criteria for determining menopause, according to the guideline, are as follows:
- Prior bilateral oophorectomy.
- Age less than 60 years and amenorrheic for 12 of more months in the absence of chemotherapy, tamoxifen, toremifene or ovarian suppression and follicle stimulating hormone and plasma estradiol in the postmenopausal range.
- If taking tamoxifen or toremifene, and age is under 60 years, then follicle stimulating hormone and plasma estradiol level should be in the postmenopausal range.
- It is not possible to assign menopausal status to women who are receiving a lutenizing hormone-releasing hormone agonist or antagonist. In women premenopausal at the time of adjuvant chemotherapy, amenorrhea is not a reliable indicator of menopausal status.
Just because therapy for cancer has created a postmenopausal situation in some women, "that condition can be reversed," said Beryl McCormick, MD, clinical director, department of radiation oncology, Memorial Sloan-Kettering Cancer Center, New York, United States.
There are women who undergo chemotherapy treatments that permanently stop menses, Dr. Carlson said, "but they may still produce estradiol at levels that are premenopausal."
Production of estrogen at premenopausal levels can impact treatment of women who receive treatment with drugs such as anastrozole, letrozole and exemestane, he said.
[Presentation title: Update: Breast Cancer Guidelines.]
All contents Copyright (c) 1995-2008 Doctor's Guide Publishing Limited. All rights reserved.
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