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Editor’s note: In premenopausal, node-positive, endocrine-responsive patients, most clinical trials conducted to date have compared chemotherapy with chemotherapy plus endocrine therapy; i.e. they have addressed the efficacy of endocrine therapy once chemotherapy has already been given. Few trials have compared endocrine therapy with endocrine therapy plus chemotherapy – i.e. the efficacy of chemotherapy once endocrine therapy has already been given (
Lancet 2005,365:1687–717). This is not a moot point. Considering that trials in this area have shown that women who benefit from chemotherapy become menopausal during therapy – i.e. the efficacy depends on ovarian suppression – it is legitimate to question whether chemotherapy represents overtreatment in this setting (
J Clin Oncol 2000,18:2718–27).