From the Edinburgh Breast Unit. University of Edinburgh, Edinburgh, Scotland, United Kingdom
Authors disclosures of potential conflicts of interest are found at the end of this article
Address reprint requests to Professor J M Dixon, BSc (Hons), MBChB, MD, FRCSEd, FRCSEng, FRCP (Hon), Professor of Surgery & Consultant Surgeon, Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU., Scotland, UK.; e-mail: mike.dixon{at}ed.ac.uk, E Jane Macaskill, BSc, MBChB, e-mail: ejanemacaskill{at}nhs.net
Overview: Neoadjuvant endocrine therapy is emerging as an alternative to neoadjuvant chemotherapy in postmenopausal women with large operable or locally advanced breast cancers. The aromatase inhibitors are the agents of choice as they have a significantly higher objective response rate and rate of conversion to breast-conserving surgery than tamoxifen. Treatment can continue beyond 3 to 4 months and in appropriately selected patients produces continued tumor shrinkage. A characteristic histological feature for responding patients is the appearance of a central scar, which causes the cancer to implode and makes is possible to excise large cancers when they have shrunk by breast-conserving surgery.