{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:14:08Z","timestamp":1792055648696,"version":"4.4.0"},"reference-count":49,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2005,1,20]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> To update the 2003 American Society of Clinical Oncology technology assessment on adjuvant use of aromatase inhibitors. <\/jats:p><\/jats:sec><jats:sec><jats:title>Recommendations<\/jats:title><jats:p> Based on results from multiple large randomized trials, adjuvant therapy for postmenopausal women with hormone receptor\u2013positive breast cancer should include an aromatase inhibitor in order to lower the risk of tumor recurrence. Neither the optimal timing nor duration of aromatase inhibitor therapy is established. Aromatase inhibitors are appropriate as initial treatment for women with contraindications to tamoxifen. For all other postmenopausal women, treatment options include 5 years of aromatase inhibitors treatment or sequential therapy consisting of tamoxifen (for either 2 to 3 years or 5 years) followed by aromatase inhibitors for 2 to 3, or 5 years. Patients intolerant of aromatase inhibitors should receive tamoxifen. There are no data on the use of tamoxifen after an aromatase inhibitor in the adjuvant setting. Women with hormone receptor\u2013negative tumors should not receive adjuvant endocrine therapy. The role of other biomarkers such as progesterone receptor and HER2 status in selecting optimal endocrine therapy remains controversial. Aromatase inhibitors are contraindicated in premenopausal women; there are limited data concerning their role in women with treatment-related amenorrhea. The side effect profiles of tamoxifen and aromatase inhibitors differ. The late consequences of aromatase inhibitor therapy, including osteoporosis, are not well characterized. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> The Panel believes that optimal adjuvant hormonal therapy for a postmenopausal woman with receptor-positive breast cancer includes an aromatase inhibitor as initial therapy or after treatment with tamoxifen. Women with breast cancer and their physicians must weigh the risks and benefits of all therapeutic options. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2005.09.121","type":"journal-article","created":{"date-parts":[[2004,11,16]],"date-time":"2004-11-16T01:26:31Z","timestamp":1100568391000},"page":"619-629","source":"Crossref","is-referenced-by-count":705,"title":["American Society of Clinical Oncology Technology Assessment on the Use of Aromatase Inhibitors As Adjuvant Therapy for Postmenopausal Women With Hormone Receptor\u2013Positive Breast Cancer: Status Report 2004"],"prefix":"10.1200","volume":"23","author":[{"given":"Eric P.","family":"Winer","sequence":"first","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford","family":"Hudis","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harold J.","family":"Burstein","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio C.","family":"Wolff","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen I.","family":"Pritchard","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James N.","family":"Ingle","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowan T.","family":"Chlebowski","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Gelber","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan B.","family":"Edge","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Gralow","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melody A.","family":"Cobleigh","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftherios P.","family":"Mamounas","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori J.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J.","family":"Whelan","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor J.","family":"Powles","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Bryant","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl","family":"Perkins","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Perotti","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Braun","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy S.","family":"Langer","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George P.","family":"Browman","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark R.","family":"Somerfield","sequence":"additional","affiliation":[{"name":"From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)11423-4"},{"key":"R2","unstructured":"Baum M, on behalf of the ATAC Trialists' Group: The ATAC (Arimidex, Tamoxifen, Alone or in Combination) adjuvant breast cancer trial in post-menopausal women. Breast Cancer Res Treat 69,2001,  (abstr 8)"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.06.020"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.04.596"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040331"},{"key":"R6","doi-asserted-by":"crossref","unstructured":"Goss PE, Ingle JN, Martino S, et al: Updated analysis of the NCIC CTG MA. 17 randomized placebo controlled trial of letrozole after five years of tamoxifen in postmenopausal women with early stage breast cancer. Proc Am Soc Clin Oncol 23:87,2004,  (abstr 847)","DOI":"10.1200\/jco.2004.22.90140.847"},{"key":"R7","doi-asserted-by":"crossref","unstructured":"Whelan TJ, Goss PE, Ingle JN, et al: Assessment of quality of life in MA. 17, a randomized placebo-controlled trial of letrozole in postmenopausal women following five years of tamoxifen. Proc Am Soc Clin Oncol 23:6,2004,  (abstr 517)","DOI":"10.1200\/jco.2004.22.90140.517"},{"key":"R8","doi-asserted-by":"crossref","unstructured":"Paridaens R, Therasse P, Dirix L, et al: First line hormonal treatment for metastatic breast cancer with exemestane or tamoxifen in postmenopausal patients: A randomized phase III trial of the EORTC Breast Group. Proc Am Soc Clin Oncol 23:6,2004,  (abstr 515)","DOI":"10.1200\/jco.2004.22.90140.515"},{"key":"R9","doi-asserted-by":"crossref","unstructured":"Cameron DA, Winer EP, Campos S, et al: A comparative study of exemestane versus anastrozole in postmenopausal breast cancer subjects with visceral disease. Proc Am Soc Clin Oncol 23:34,2004,  (abstr 628)","DOI":"10.1200\/jco.2004.22.90140.628"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.14.3357"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19970215)79:4<730::AID-CNCR10>3.0.CO;2-0"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20011101)92:9<2247::AID-CNCR1570>3.0.CO;2-Y"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.22.3758"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.20.3.751"},{"key":"R15","unstructured":"Rose C, Vtoraya O, Pluzanska A, et al: Letrozole (Femara) vs. anastrozole (Arimidex): second-line treatment in postmenopausal women with advanced breast cancer. Proc Am Soc Clin Oncol 21:34,2002,  (abstr 131)"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.3.881"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)09088-8"},{"key":"R18","unstructured":"Boccardo F, Rubagotti A, Amoroso D, et al: Anastrozole appears to be superior to tamoxifen in women already receiving adjuvant tamoxifen treatment. Breast Cancer Res Treat 82: 2003 (abstr 3)"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032312"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11745"},{"key":"R21","doi-asserted-by":"crossref","unstructured":"Goss PE, Ingle JN, Martino S, et al: Updated analysis of the NCIC CTG MA. 17 randomized placebo (P) controlled trial of letrozole (L) after five years of tamoxifen in postmenopausal women with early stage breast cancer. Proc Am Soc Clin Oncol 23:87,2004,  (abstr 84)","DOI":"10.1200\/jco.2004.22.90140.847"},{"key":"R22","unstructured":"Smith I, Dowsett M: Comparison of anastrozole vs. tamoxifen alone or in combination as neoadjuvant treatment of estrogen receptor-positive (ER+) operable breast cancer in postmenopausal women: The IMPACT trial. Breast Cancer Res Treat 82,2003,  (abstr 1)"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.18.3808"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-031207"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.10.2596"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(03)00602-6"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1023\/B:BREA.0000025420.78346.f9"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.1177\/107327480200900603"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1999.17.8.2365"},{"key":"R30","unstructured":"Braverman AS, Sawhney A, Tendler A, et al: Premenopausal serum estradiol levels may persist after chemotherapy-induced amenorrhea in breast cancer. Proc Am Soc Clin Oncol 21:42,2002,  (abstr 164)"},{"key":"R31","doi-asserted-by":"publisher","DOI":"10.1016\/0960-0760(92)90201-S"},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(00)01705-2"},{"key":"R33","doi-asserted-by":"publisher","DOI":"10.1023\/A:1006289811540"},{"key":"R34","doi-asserted-by":"crossref","unstructured":"Cheung KL, Forward DP, Jackson L, et al: Combined use of goserelin (Zoladex) and anastrozole (Arimidex) as second-line endocrine therapy in premenopausal women with advanced breast cancer: A study of its clinical and endocrine effects. Eur J Cancer 37,2001, (suppl 1)","DOI":"10.1016\/S0959-8049(01)80055-1"},{"key":"R35","unstructured":"Howell A: Effect of anastrazole on bone minderaly density: 2-year results of \u201carimidex\u201d (anastrazole), tamoxifen, alone or in combination (ATAC) trial. Breast Cancer Res Treat 82,2003,  (abstr 129)"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(03)00061-9"},{"key":"R37","doi-asserted-by":"crossref","unstructured":"Lonning PE, Geisler J, Krag LE, et al: Effect of exemestane on bone: A randomized placebo controlled study in postmenopausal women with early breast cancer at low risk. Proc Am Soc Clin Oncol 23:7,2004,  (abstr 518)","DOI":"10.1200\/jco.2004.22.90140.518"},{"key":"R38","unstructured":"Gnant M, Hausmaninger H, Samonigg D, et al: Changes in bone mineral density caused by anastrazole or tamoxifen in combination with goserelin (+\/- zoledronate) as adjuvant treatment for hormone receptor-positive premenopausal breast cancer: Results of a randomized multicenter trial. Breast Cancer Res Treat 76:531,2002,  (suppl)"},{"key":"R39","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1997.15.4.1341"},{"key":"R40","doi-asserted-by":"publisher","DOI":"10.1054\/bjoc.2001.1729"},{"key":"R41","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1997.15.3.955"},{"key":"R42","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-137-6-200209170-00014"},{"key":"R43","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.08.017"},{"key":"R44","doi-asserted-by":"crossref","unstructured":"Powles TJ, Paterson E, McCloskey M, et al: Oral clodronate for adjuvant treatment of operable breast cancer: Results of a randomized, double-blind, placebo-controlled multicenter trial. Proceedings from the American Society of Clinical Oncology 23:9,2004,  (abstr 528)","DOI":"10.1200\/jco.2004.22.90140.528"},{"key":"R45","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.06.029"},{"key":"R46","unstructured":"Fallowfield LJ, Cella DF, CRC Oncology Group: Assessing the quality of life of postmenopausal women randomized into the ATAC adjuvant breast cancer trial. Proc Am Soc Clin Oncol 21:40,2002,  (abstr 159)"},{"key":"R47","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.20.2651"},{"key":"R49","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200010123431506"},{"key":"R50","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminoncol.2003.08.021"}],"container-title":["Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO.2005.09.121","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T20:42:38Z","timestamp":1653511358000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO.2005.09.121"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,1,20]]},"references-count":49,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2005,1,20]]}},"alternative-id":["10.1200\/JCO.2005.09.121"],"URL":"https:\/\/doi.org\/10.1200\/jco.2005.09.121","relation":{},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,1,20]]}}}