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Robert W. Carlson, Susan J. Moench, M. Elizabeth H. Hammond, Edith A. Perez, Harold J. Burstein, D. Craig Allred, Charles L. Vogel, Lori J. Goldstein, George Somlo, William J. Gradishar, Clifford A. Hudis, Mohammad Jahanzeb, Azadeh Stark, Antonio C. Wolff, Michael F. Press, Eric P. Winer, Soonmyung Paik, Britt-Marie Ljung, and for the NCCN HER2 Testing in Breast Cancer Task Force

amplification and response to either tamoxifen or aromatase inhibitors. 85 , 88 – 91 Despite inconsistent data, however, HER2 status has been, and may continue to be, considered in clinical decision-making involving hormonal therapies. 92 Trastuzumab with

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Robert A. Swarm, Amy Pickar Abernethy, Doralina L. Anghelescu, Costantino Benedetti, Sorin Buga, Charles Cleeland, Oscar A. deLeon-Casasola, June G. Eilers, Betty Ferrell, Mark Green, Nora A. Janjan, Mihir M. Kamdar, Michael H. Levy, Maureen Lynch, Rachel M. McDowell, Natalie Moryl, Suzanne A. Nesbit, Judith A. Paice, Michael W. Rabow, Karen L. Syrjala, Susan G. Urba, Sharon M. Weinstein, Mary Dwyer, and Rashmi Kumar

are known inhibitors of hepatic drug metabolism via inhibition of cytochrome P450 enzymes, especially CYP2D6. Tamoxifen is an estrogen receptor blocker commonly used in patients with hormone receptor-positive breast cancer. Tamoxifen undergoes

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William J. Gradishar, Benjamin O. Anderson, Ron Balassanian, Sarah L. Blair, Harold J. Burstein, Amy Cyr, Anthony D. Elias, William B. Farrar, Andres Forero, Sharon Hermes Giordano, Matthew Goetz, Lori J. Goldstein, Clifford A. Hudis, Steven J. Isakoff, P. Kelly Marcom, Ingrid A. Mayer, Beryl McCormick, Meena Moran, Sameer A. Patel, Lori J. Pierce, Elizabeth C. Reed, Kilian E. Salerno, Lee S. Schwartzberg, Karen Lisa Smith, Mary Lou Smith, Hatem Soliman, George Somlo, Melinda Telli, John H. Ward, Dorothy A. Shead, and Rashmi Kumar

lumpectomy alone, both with tamoxifen for 5 years. Locoregional recurrence rates were 1% in the lumpectomy, radiation, and tamoxifen arm and 4% in the lumpectomy plus tamoxifen arm. No differences were seen in overall survival, disease-free survival, or need

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Laura M. Spring, Yael Bar, and Steven J. Isakoff

women. 66 , 70 , 71 Among postmenopausal women, it is well established that aromatase inhibitors are more effective than tamoxifen. 66 , 72 , 73 Several studies have explored combination approaches with endocrine therapy and targeted therapy. For

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Stephen B. Edge

-inferiority phase 3 trial . Lancet 2010 ; 376 : 91 – 102 . 32 Hughes KS Schnaper LA Berry D . Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer . N Engl J Med 2004 ; 351 : 971 – 977

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Oxana Palesh, Arianna Aldridge-Gerry, Ayhan Ulusakarya, Elisabet Ortiz-Tudela, Lucile Capuron, and Pasquale F. Innominato

relationship between sleep and age in patients and survivors diagnosed with breast cancer. Cancer Treatments Lorizio et al 33 reported that women with higher levels of endoxifen, the most active metabolite of tamoxifen, were more likely to experience

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NCCN Guidelines® Insights: Breast Cancer, Version 4.2021

Featured Updates to the NCCN Guidelines

William J. Gradishar, Meena S. Moran, Jame Abraham, Rebecca Aft, Doreen Agnese, Kimberly H. Allison, Sarah L. Blair, Harold J. Burstein, Chau Dang, Anthony D. Elias, Sharon H. Giordano, Matthew P. Goetz, Lori J. Goldstein, Sara A. Hurvitz, Steven J. Isakoff, Rachel C. Jankowitz, Sara H. Javid, Jairam Krishnamurthy, Marilyn Leitch, Janice Lyons, Jennifer Matro, Ingrid A. Mayer, Joanne Mortimer, Ruth M. O'Regan, Sameer A. Patel, Lori J. Pierce, Hope S. Rugo, Amy Sitapati, Karen Lisa Smith, Mary Lou Smith, Hatem Soliman, Erica M. Stringer-Reasor, Melinda L. Telli, John H. Ward, Kari B. Wisinski, Jessica S. Young, Jennifer L. Burns, and Rashmi Kumar

-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer . JAMA 2006 ; 295 : 1658 – 1667 . 16609087 10.1001/jama.295.14.1658 4. Paik S , Shak S , Tang G , A multigene assay to predict recurrence of tamoxifen

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Renee W. Pinsky and Mark A. Helvie

density changes risk. Tamoxifen has been proven to decrease breast cancer risk and cause decreased breast density in many women. 35 Making the mammogram less dense may also diminish the effect of masking. The antiestrogen effect of tamoxifen in the breast

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Amy Cyr

-negative and node-positive postmenopausal patients with breast cancer treated with anastrozole or tamoxifen: a TransATAC study . J Clin Oncol 2010 ; 28 : 1829 – 1834 . 5. Grotenhuis BA Vrijland WW Klem TM . Radiofrequency ablation for early

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Michael B. Streiff

drug therapy in women with stage II breast cancer . N Engl J Med 1988 ; 318 : 404 – 407 . 12. Pritchard KI Paterson AH Paul NA . Increased thromboembolic complications with concurrent tamoxifen and chemotherapy in a randomized trial of