Purpose To update the ASCO clinical practice guideline on adjuvant endocrine therapy on the basis of emerging data on the optimal duration of treatment, particularly adjuvant tamoxifen. Methods ASCO convened the Update Committee and conducted a systematic review of randomized clinical trials from January 2009 to June 2013 and analyzed three historical trials. Guideline recommendations were based on the Update Committee's review of the evidence. Outcomes of interest included survival, disease recurrence, and adverse events. Results This guideline update reflects emerging data on duration of tamoxifen treatment. There have been five studies of tamoxifen treatment beyond 5 years of therapy. The two largest studies with longest reported follow-up show a breast cancer survival advantage with 10-year durations of tamoxifen use. In addition to modest gains in survival, extended therapy with tamoxifen for 10 years compared with 5 years was associated with lower risks of breast cancer recurrence and contralateral breast cancer. Recommendations Previous ASCO guidelines recommended treatment of women who have hormone receptor–positive breast cancer and are premenopausal with 5 years of tamoxifen, and those who are postmenopausal a minimum of 5 years of adjuvant therapy with an aromatase inhibitor or tamoxifen followed by an aromatase inhibitor (in sequence). If women are pre- or perimenopausal and have received 5 years of adjuvant tamoxifen, they should be offered 10 years total duration of tamoxifen. If women are postmenopausal and have received 5 years of adjuvant tamoxifen, they should be offered the choice of continuing tamoxifen or switching to an aromatase inhibitor for 10 years total adjuvant endocrine therapy.

The Update Committee recommends that postmenopausal women with hormone receptor-positive breast cancer consider incorporating AI therapy at some point during adjuvant treatment, either as up-front therapy or as sequential treatment after tamoxifen. The optimal timing and duration of endocrine treatment remain unresolved. The Update Committee supports careful consideration of adverse effect profiles and patient preferences in deciding whether and when to incorporate AI therapy.

Women's experience of breast cancer is complex, affecting all aspects of life during and after treatment. Patients' perspectives about common impairments and functional limitations secondary to breast cancer treatment, including upper extremity motion restriction, lymphedema, fatigue, weight gain, pain, and chemotherapy-induced peripheral neuropathy, are addressed. Women often report being uninformed regarding these side effects and surprised that they do not always disappear after treatment, but remain part of their lives. Breast cancer patients express strong, unmet needs for education, information, and intervention for these side effects. Evidence suggests that rehabilitation and exercise are effective in preventing and managing many physical side effects of breast cancer treatment. Nevertheless, few women are referred to rehabilitation during or after treatment, and fewer receive baseline assessments of impairment and function to facilitate early detection of impairment and functional limitations. The prospective surveillance model of rehabilitation will serve the needs of women with breast cancer by providing education and information about treatment side effects, reducing the incidence and burden of side effects through early identification and treatment, and enhancing access to timely rehabilitation. Integration of exercise as a component of the model benefits patients at every phase of survivorship, by addressing individual concerns about exercise during and after treatment and highlighting the important contribution of exercise to overall health and survival. The prospective surveillance model of rehabilitation can meet the evident and often expressed needs of survivors for information, guidance, and intervention-thus addressing, and potentially improving, overall quality of life for individuals diagnosed with and treated for breast cancer. Women's experience of breast cancer is complex, affecting all aspects of their lives during and after treatment. Although each woman's experience with breast cancer is unique, they share common perspectives related to the physical and functional side effects of breast cancer treatment. Activity limitation, upper extremity motion restriction, lymphedema, fatigue, pain, and chemotherapy-induced peripheral neuropathy (CIPN) are well-documented concerns of breast cancer survivors.1-5 Impairments such as limited range of motion, pain, and fatigue appear to be inter-related, and may have an additive effect. Women note that upper extremity issues, fatigue, pain, depression, and body image disturbance tend to compound each other and impact quality of life.6-9 Less information is available about women's concerns regarding other treatment side effects addressed in this supplement (eg, arthralgias, osteoporosis, and cardiotoxicity). This may be because of lack of awareness of these potential long-term side effects, as research about their prevalence and time course is more recent. Cumulatively, these observations provide strong evidence of an unmet need for cancer patients gene...

The last decade has been marked by rapid growth in the breast cancer advocacy movement around the world. Today such movements are well established in North America and western Europe, and are emerging and gaining momentum in regions of the world with limited resources--Africa, Asia, eastern Europe, and Latin America. Internationally breast cancer advocates have faced the challenges of dealing with many languages, cultures, countries, and health systems. Because of these differences, existing models of breast cancer advocacy are not always appropriate or reproducible across countries. At the second biennial Global Summit Consensus Conference on International Breast Health Care, 12 breast cancer survivor-advocates and advocates from around the world gave statements describing the experiences of women with breast cancer and with advocacy in their countries, and attended a roundtable meeting to discuss breast cancer advocacy from a global perspective. We used the "long table" method to analyze their comments and identify common experiences. Although participants came from diverse settings, the analysis revealed five common experiences that were consistent across cultures: 1) the experiences and fears of breast cancer survivors, 2) beliefs and taboos about breast cancer that hinder awareness programs and treatment, 3) the need for public education and breast cancer awareness programs in countries with limited resources, 4) difficulty in translating the concept and ethos of advocacy into many languages, and 5) the experiences in establishing and maintaining advocacy groups to promote breast cancer awareness and to inform public policy. These themes constitute an action agenda for breast cancer advocacy groups in countries with limited resources. In addition, they provide invaluable insight for policymakers, program planners, and others undertaking efforts to improve breast cancer outcomes in low-resource settings.