The role of ovarian ablation in the adjuvant therapy of breast cancer

Increasing interest has emerged in the role of ovarian function suppression, which has shown equivalence to adjuvant CMF (cyclophosphamide, methotrexate, 5-fluorouracil), whether achieved by surgery or irradiation, in breast cancer patients. Studies have suggested temporary amenorrhea can confer benefit in early breast cancer, giving luteinizing hormone-releasing hormone (LH-RH) agonists an advantage over oophorectomy or radiation. Compared with no therapy, LH-RH agonists reduce risks of recurrence and death among women younger than 50 years of age who have hormone receptor-positive tumors. Trials are assessing the benefits of adding LH-RH agonists to aromatase inhibitors, tamoxifen, or after chemotherapy in women remaining premenopausal, and the necessity for adjuvant chemotherapy with combined ovarian ablation and antiestrogen therapy.