Dose Dense or Endocrine therapy

I recently had a bilateral 28 Jan. Invasive ductal on right breast 1.4 cm node neg,Her2 negative, ER/PR positive, with some vascular/lymphatic involvement, margin was close (.02cm) to breast wall. Left breast 2cm tumor with .4 of 1 node positive, Her2 Neg, ER/PR positive. Path reported that both breasts had extensive LCIS/DCIS, atypical and hyperlasia,scleorsing adenoisis.Both tumors cribriforma and comedo types low,inter,and hig nuclear grades. I am 50 yrs premenopausal, and in excellent health. I have had 2 consults with 2 oncologists, 1 breast and 1 general. Both have suggested AC for 6 sessions at 3 week intervals, but Breast onc wants Taxol to follow for 2 sessions, while Med Onc suggestes same treatment but using Taxotere.Both suggesting Tamoxifen after Chemo. Breast Onc had mentioned dose dense regimen, but dropped subject. I have read that dose dense is more effective, with same amount of side affects. Also,is there a possibility of endocrine therapy? I have also read that for node + ER/PR + in premenopausal Zoladex with Tamoxifen works well. Are these treatments based on age/number of nodes +/and stage of BC. Bone scan and liver enzyme both neg.
Thanks for any info.
Orneville

[CCF-RN,MSN-JS]

Dear Orneville, The stage of breast cancer is an important factor in the treatment recommendations given.  To arrive at the stage of the cancer we look at tumor size, lymph node status and whether metastatic disease is present.  From the information provided above your disease would be staged as a Stage IIA, (tumor size between 2-5cm, lymphnode positive, no metastasis).  

Combination chemotherapy is commonly used as adjuvant treatment for stage IIA breast cancer, the protocols have some variation such as what drugs are given, or the sequence that they are given depending on different oncologists' practice.  

The "dose dense" regimen involves decreasing the time between doses of chemotherapy. In December 2002, at the San Antonio Breast Cancer Symposium, results of a study were reported that looked at differing ways of giving  at the drugs Adriamycin, Cytoxan and Taxol.  The results of the study showed that in the 2 arms of the study in which the "dose dense" regimen was used there was an increase in overall survival compared to other 2 regimens studied (in which dose density was not a factor).  These results are based on four years of follow-up data to date.  The women studied had Stage II or IIIA disease.  

Endocrine therapy is another term used for hormone therapy, tamoxifen is this type of therapy.  The idea of hormone/endocrine therapy for estrogen receptor positive breast cancer is to decrease estrogen.  Tamoxifen and Zoladex do that, but in different ways.  With tamoxifen estrogen action is blocked by competition for estrogen receptor sites on cells.  Zoladex blocks estrogen from being made altogether by interfering with ovarian function in pre-menopausal women.