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Rethinking neoadjuvant chemotherapy for breast cancer

BMJ 2018; 360 doi: (Published 11 January 2018) Cite this as: BMJ 2018;360:j5913

Re: Rethinking neoadjuvant chemotherapy for breast cancer

Dear Sirs
I read with interest the increasingly polarised views regarding the use of neoadjuvant chemotherapy (NACT) in the management of early breast cancer. Whilst many will assert that patients should be given NACT, there are some circumstances where this will lead to challenges and may even be detrimental. Within the NHS we are operating within and judged by a "time-target" work model.

The use of NACT in nulliparous pre-menopausal women means clinicians must include a discussion about fertility preservation treatments. Often the additional stages of different fertility preservation techniques (cryopreservation of oocytes after ovarian stimulation, cryopreservation of ovarian tissue or use of a GnRH agonist as an oocyte protector) can all add time or potential delays to a patient’s treatment pathway. We must also be cautious about the use of ovarian hyperstimulation in patients with estrogen receptor positive disease.

Whether these fertility treatments and their potential delays may affect breast cancer outcome is uncertain but these also must be included as part of the discussion with the patient.

Ultimately, as clinicians we must provide our patients with balanced information and make the patient (and their family) aware of the implications and possible ramifications of treatment options so that they can be confident in the choices that they make.

Yours sincerely

Mr Nathan Coombs
Consultant Breast Surgeon
Great Western Hospital

Competing interests: None

Competing interests: No competing interests

08 March 2018
Nathan J Coombs
Consultant Breast Surgeon
Department of Breast Surgery
Great Western Hospital, Swindon, United Kingdom