Adjuvant Ovarian Ablation in the Treatment of Premenopausal Women with Early Stage Invasive Breast Cancer

Patient Population

Premenopausal women with hormone receptor-positive early-stage invasive breast cancer.

Intended Guideline Users

Clinicians and others involved in the care of the target population.

Research Question(s)

1. How does adjuvant ovarian ablation (OA) as systemic therapy improve clinically meaningful outcomes (disease-free survival, overall survival, quality of life and toxicity) when compared with and/or added to other systemic therapies, specifically chemotherapy and tamoxifen? As there are a number of ways that OA may be compared with or added to other systemic therapy, the following specific comparisons are addressed by this practice guideline:
   
   1. OA alone versus no systemic therapy
   2. OA plus chemotherapy versus chemotherapy alone
   3. OA alone versus chemotherapy alone
   4. OA alone versus tamoxifen alone
   5. OA plus tamoxifen versus tamoxifen alone
   6. OA plus tamoxifen and chemotherapy versus tamoxifen and chemotherapy
   7. OA plus tamoxifen versus chemotherapy alone
   8. OA plus tamoxifen versus no systemic therapy
   9. OA plus tamoxifen and chemotherapy versus chemotherapy alone
2. What is the best way to ablate or suppress ovarian function: surgical oophorectomy, ovarian irradiation, or medical suppression?