Authors: Richard R. Love, Nguyen Van Dinh.
Background: Cancer registry data suggest that one third of all annual new cases of breast cancer in Vietnam are in premenopausal women with hormone receptor-positive tumors. There is now an emerging picture of how 80% of these women can be alive after 10 years with cost-effective, limited symptom-associated and beneficial secondary effects treatment.
Methods: We summarize data from 949 premenopausal Vietnamese women data in two randomized clinical trials investigating surgical oophorectomy plus tamoxifen (SO+T) adjuvant therapy (x5 years).
Results: 77% of hormone receptor-positive tumors had high Allred estrogen receptor scores. Despite lower population incidence rates for breast cancer in Vietnam, prognostic factors for recurrence (stage, axillary nodal status, tumor size, age) were the same and of similar magnitudes to those seen in high income-country populations. Almost one-third more of treated women were alive after ten years than women receiving no adjuvant treatment. Her-2/neu positive patients benefitted more from this treatment than Her-2/neu negative patients. Cost-effectiveness analysis suggested this intervention returned $350/year of life saved. Vasomotor symptoms, elevated in the first year after treatment, were no different than those for untreated women after one year. Few patients suffered blood clots, and none developed endometrial cancer.
Conclusion: By all critical measures, SO+T is the optimal treatment for premenopausal Vietnamese women with hormone receptor-positive tumors, a conclusion consistent with findings from the SOFT/TEXT high-income country trials.
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