Systemic Treatment in Premenopausal Patients with Breast Cancer

摘要

In young, premenopausal women, diagnosis and therapy of breast cancer is a challenge in daily clinical routine. Host and tumor strikingly differ from the postmenopausal situation. Besides clinical examination of the breast, no early detection program is established in young women - except for women carrying a BRCA mutation. Because of the higher density of the breasts, routine mammographic controls are not useful for early detection in young women, and magnetic resonance imaging (MRI) - which clearly overcomes this problem and is used for screening in high-risk BRCA mutation carriers - has limited access, needs high expertise and has to be performed according to the menstrual cycle. The missing early detection is at least in part responsible for the higher tumor stage in young patients. Menstrual cycle might not only impact on detection but also on efficacy of therapy and outcome, even though Grant et al. [1] elegantly demonstrated that this is not true for surgical treatment of breast cancer. Other factors which obviously show differences due to menopausal status are known. High body mass index (BMI) clearly increases breast cancer risk in postmenopausal women, whereas it seems to have no impact or even leads to risk reduction in premenopausal women. Recently, Dowsett et al. [2] hypothesized that this inverse relation of BMI and breast cancer risk in premenopausal women may be due to reduced progesterone serum levels in obese women. Conversely it has been shown that BMI impacts breast cancer outcome especially in premenopausal but not postmenopausal women [3,4].