Do you ever offer neoadjuvant endocrine therapy to pre-menopausal women?

I do not tend to offer neoadjuvant endocrine therapy to premenopausal women, unless it is in a clinical trial setting. There is limited data available but 6 months of ovarian suppression plus an aromatase inhibitor was found to be more effective in reducing tumor size than tamoxifen (clinical partial or complete response occured in 70% vs 50%) in the STAGE study. It may be reasonable in selected premenopausal patients who have low grade, ER high breast cancer, who do not wish chemotherapy.