What are the recommended management strategies for early-stage breast cancer in postmenopausal women?

Management of early-stage breast cancer in postmenopausal women primarily involves surgery followed by adjuvant systemic therapies tailored to tumour biology and risk factors. Surgery typically includes breast-conserving surgery or mastectomy depending on tumour size and patient preference, followed by radiotherapy if breast-conserving surgery is performed ¹.

For hormone receptor-positive, HER2-negative early breast cancer, adjuvant endocrine therapy is strongly recommended. Aromatase inhibitors (either non-steroidal or steroidal) are the preferred first-line endocrine treatment for postmenopausal women, including those with no prior endocrine therapy or those previously treated with tamoxifen ¹. This approach is supported by evidence showing improved disease-free survival and overall survival with aromatase inhibitors compared to tamoxifen alone (Lumachi et al., 2016).

In cases of high-risk, node-positive hormone receptor-positive breast cancer, the addition of abemaciclib to endocrine therapy is recommended to reduce recurrence risk ¹.

Neoadjuvant endocrine therapy may be considered for postmenopausal women with ER-positive invasive breast cancer to reduce tumour size when chemotherapy is not clearly indicated ¹.

Adjuvant chemotherapy is considered based on tumour characteristics and risk assessment, with neoadjuvant chemotherapy an option in selected cases of ER-positive disease ¹. For patients with germline BRCA1/2 mutations and high-risk HER2-negative early breast cancer treated with chemotherapy, olaparib is recommended as adjuvant therapy ¹.

Bone health management is critical during aromatase inhibitor therapy due to increased risk of bone loss; adjuvant bisphosphonates are recommended to reduce bone loss and may also reduce breast cancer recurrence in postmenopausal women (Brufsky, 2007; Mathew and Brufsky, 2014).

Overall, the integrated management strategy for early-stage breast cancer in postmenopausal women involves surgery, radiotherapy as indicated, adjuvant endocrine therapy with aromatase inhibitors, consideration of targeted agents like abemaciclib in high-risk cases, chemotherapy based on risk stratification, and bone health optimization with bisphosphonates ¹ (Lumachi et al., 2016; Brufsky, 2007; Mathew and Brufsky, 2014).