The importance of identifying and managing oral mucosa-related adverse effects (AEs) associated with long-term use of adjuvant endocrine therapy in patients with early-stage breast cancer was emphasized in a review article published in Supportive Care in Cancer.

Commonly known AEs of long-term adjuvant endocrine therapy for early-stage, hormone receptor-positive breast cancer include increased bone loss, arthralgia and myalgia, and hot flashes in patients taking an aromatase inhibitor, such as anastrozole, exemestane, or letrozole, as well as hot flashes and increased risks of stroke and endometrial cancer for those receiving tamoxifen.

“However, few articles have focused on the oral mucosal reactions related to adjuvant endocrine therapies which clearly differ from those reported with chemotherapies or other targeted therapies used for breast cancer,” according to the authors of this paper, most of whom were from the Institut Universitaire du cancer Toulouse-Oncopole University in Toulouse, France.

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A review of the medical literature identified xerostomia; dysgeusia; gingival bleeding, tooth pain, and tooth mobility; and bacterial or fungal superinfection as AEs related to oral mucosal changes associated with the use of adjuvant endocrine therapy.

“To date, the underlying mechanisms of [adjuvant endocrine therapy]-induced oral mucosal changes remain poorly understood; although, microbiological, cellular, vascular, and immunological hypotheses have been put forward,” the authors stated.

The report cited general supportive care measures focused on patient education as being essential to the management of these AEs. In addition, it also suggested patients undergo dental and periodontal screening, with appropriate treatment, if necessary, prior to initiation of adjuvant endocrine therapy.

Some recommended approaches for addressing oral mucosal AEs included the use of sugar-free gum to stimulate the flow of saliva for patients experiencing xerostomia; frequent hydration and avoidance of spicy foods, alcohol, and tobacco for those with xerostomia, dysgeusia, and gingival issues; and referral to a dentist for patients with grade 2/3 xerostomia, gingival bleeding, or evidence of a bacterial/fungal superinfection.

The authors stressed the importance of improving the awareness of the entire oncologic community, including patients, regarding oral mucosal reactions to adjuvant endocrine therapies to provide the best supportive care to women with breast cancer receiving these agents.

They further added that “dentists should be part of the multidisciplinary team to improve patients’ oral quality of life, to limit the impact of [adjuvant endocrine therapy]-related oral mucosal changes on dose modification or adherence to the treatment.”


de Bataille C, Castellan M, Massabeau C, et al. Oral mucosal changes induced by adjuvant endocrine therapies in breast cancer patients: clinical aspects and proposal for management. Support Care Cancer [published online November 2, 2020]. doi:10.1007/s00520-020-05797-z