In what context is estrogen blocking used for women with breast cancer?

Estrogen blocking, commonly achieved through medications such as tamoxifen or aromatase inhibitors, is primarily utilized in the treatment of estrogen receptor-positive breast cancer. In the context of downstaging, the objective is to shrink the tumor size to make it more manageable before surgical intervention, particularly when the cancer is diagnosed at a larger size or has spread locally.

In cases of estrogen receptor-positive lesions, the cancer cells are influenced by estrogen, stimulating their growth. By blocking estrogen, these therapies can effectively reduce the tumor burden and potentially improve surgical outcomes. This strategy not only helps in downstaging tumors but can also lower the risk of recurrence and aid in long-term management of the disease.

In contrast, estrogen receptor-negative lesions do not rely on estrogen for growth, making estrogen-blocking therapies ineffective in these cases. While these treatments are beneficial for postmenopausal women—where aromatase inhibitors are frequently used—they can still be relevant in premenopausal women when combined with other treatments. Thus, option B encompasses the broader use of estrogen blocking in both premenopausal and postmenopausal women with estrogen receptor-positive lesions, particularly when downstaging is a goal.