الفهرس 
Introduction
Epidemiology of breast cancerOnly 14 pages are availabe for public view
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Abstract
Endocrine therapy remains a central treatment for women with ER positive breast cancer. Hormone receptor expression should be used to guide therapy decisions in both the adjuvant and metastatic disease settings. The widespread usage of adjuvant therapy has had a positive impact on overall survival. Given that women with ER positive breast cancer remain at long term risk of relapse. Endocrine therapy for early-stage breast cancer has the biggest single effect on enhancing survival from the disease, with tamoxifen alone contributing to saving many thousands of lives, it is considered the gold standard adjuvant endocrine treatment after chemotherapy in premenopausal women. In postmenopausal women, enormous progress has been made by the incorporation of aromatase inhibitors into the treatment of early-stage ER-positive breast cancer, and large well-conducted trials have established “up-front” or “switch” strategies that are now widely used in clinical practice. The peri-operative/ neoadjvant setting remains a powerful tool in which to explore the efficacy and safety of novel agents, It initially proposed for elderly women who were not candidates for surgery or cytotoxic chemotherapy, and for postmenopausal patients with large operable or locally advanced ER Positive breast cancer. Several types of endocrine therapy are available for use in managing metastatic breast cancer, including ovarian ablation, hormonal agonists, synthetic agents, and selective AIs. A tumor’s response to first-line therapy is predictive of future responses to second-line and third-line agents. A potentially negative side of oral medication is poor patient adherence and/or discontinuation, which reduces the treatment effectiveness, accelerating progression of the disease and reducing the patient survival rate. In recurrent disease, the measurement of the biomarker/pathway in the primary tumour may not be valid, especially if the pathway exposed to a specific endocrine therapy. Consideration therefore needs to be given to repeat biopsy at the time of disease recurrence, and where possible, at disease progression following a targeted agent. where there has been benefit to a specific therapy this will enable, pathways of resistance to be identified, enabling the rational development or selection of subsequent therapy. Toxicities of novel agents can be a challenge, and it is not entirely unlikely that the choice of agents in the future may be driven by the toxicity profile. The development of clear guidelines for the management of such toxicities to ensure that novel agents are not inappropriately continued or discontinued is vital. Attention must be paid to the reporting of subsequent treatments and benefits achieved to help guide decision making beyond the first and second lines of treatment. Science has provided many novel agents with which to potentially prevent/reverse endocrine resistance, and recent trials have delivered both practice changing successes as well as disappointments.