The prevention and management of distant metastases in women with breast cancer.

About one-third of all women diagnosed with breast cancer face the risk of recurrence, which can occur at any stage of disease, observation time, and after any treatment modality. Most recurrence comes in the form of distant metastasis, which is the major cause of death in women with breast cancer. Treatments shown to decrease the risk of breast cancer recurrence, especially distant metastasis, will likely produce a survival benefit and a potentially significant improvement in quality of life in women with early breast cancer. New third-generation aromatase inhibitors (anastrozole, exemestane, and letrozole) that have been shown to be well tolerated have the potential to contribute to benefits beyond those seen with tamoxifen.