How does age factor into your planning whether to give a high risk pre-menopausal patient with breast cancer ovarian function suppression?

Generally, my age cutoff is 50, but it depends on the patient’s documented menopausal status prior to chemotherapy. If the patient is perimenopausal, then I initiate ovarian suppression plus aromatase inhibitor and check estradiol and FSH every 12 months. When she is clearly post-menopausal, then I continue AI only to complete 5 years of treatment. I discuss extended endocrine therapy for up to 10 years depending on duration of OS, tolerability of AI and comorbidities, particularly in higher risk (node+) cases, or consider using gene profiling with tests such as BCI where some but not all studies have shown that a high score predicts benefit from extended endocrine therapy. If OS was continued for 5 years, then I discontinue endocrine thera...

Presumably, for someone at high risk of disease recurrence, she will have received chemotherapy. In that setting, if the woman was premenopausal at the time of chemotherapy initiation and developed amenorrhea, one needs to be quite cautious up to at least age 50 if starting AI plus OFS because of the risk of ovarian function recovery. While the risk of regaining ovarian function is higher for younger women, there are documented cases of women who are 50 years old at the time of chemotherapy who have ovarian function recovery. Therefore, frequent (monthly) ultrasensitive estradiol assessments are warranted for at least 6 months if OFS is not initiated. In addition, if OFS is initiated, it is important to confirm that estradiol is actually su...