Chemotherapy or Letrozole Before Surgery in Treating Postmenopausal Women With Breast Cancer That Can Be Removed By Surgery

DISEASE CHARACTERISTICS:

• Histologically proven primary invasive breast cancer that is thought to be suitable for neoadjuvant treatment

• No cytological proof of malignancy only

• T2 tumor or greater (≥ 20 mm by ultrasound) or any T stage with nodal disease ≥ 20 mm diameter on ultrasound assessment

• No evidence of distant metastatic disease as disclosed by bone scan, liver, and chest imaging

• Definite indication for neoadjuvant and adjuvant chemotherapy

• Primary tumor amenable to biopsy

• No inoperable disease that is judged very unlikely to be rendered operable by neoadjuvant treatment

• No inflammatory breast cancer

• No bilateral invasive breast cancer

• HER-2 positivity is NOT an exclusion criterion in the feasibility (pilot) study

• Estrogen receptor (ER) positive tumor

• No ER-poor disease as defined locally (e.g., H-score < 100, Allred 3/4/5)

• Allred 6/7/8, H-score H ≥100 allowed

PATIENT CHARACTERISTICS:

• Postmenopausal, meeting 1 of the following criteria:

• Over 12 months since last menstrual period

• Postmenopausal gonadotrophin levels (luteinizing hormone or follicle-stimulating hormone levels above local criteria)

• Postmenopausal estradiol levels below local criteria

• Prior bilateral oophorectomy

• Menopause induced by gonadotrophin-releasing hormone not allowed

• WHO performance status 0 or 1

• WBC ≥ 3.0 × 10^9/L

• ANC ≥ 1.5 × 10^9/L

• Platelets ≥ 100 × 10^9/L

• Hemoglobin > 9 g/dL

• AST/ALT ≤ 1.5 times upper limit of normal (ULN)

• Serum bilirubin ≤ 1.5 times ULN

• Alkaline phosphatase ≤ 1.5 times ULN

• Serum creatinine ≤ 1.5 times ULN

• No active, uncontrolled infection

• No malignancy within the past 10 years except for basal cell carcinoma or cervical carcinoma in situ

• Treatment for previous malignancy confined to resection alone

• No concomitant medical, psychiatric, or geographic problems that might prevent completion of treatment or follow-up

• No known severe hypersensitivity to aromatase inhibitors

• No contraindication to receiving aromatase inhibitors (clinical evidence or recorded history of osteoporosis)

• No other serious illness or medical condition including any of the following:

• Congestive heart failure or unstable angina pectoris

• Myocardial infarction within the past year

• Uncontrolled hypertension or high-risk uncontrolled arrhythmias

• History of significant neurologic or psychiatric disorders, including psychotic disorders, dementia, or seizures, that would prohibit the understanding and giving of informed consent

• Active peptic ulcer

• Unstable diabetes mellitus

• No definite contraindications for the use of corticosteroids

• No contraindication to receiving combination anthracycline/taxane chemotherapy

• Willing to undergo repeat biopsies

PRIOR CONCURRENT THERAPY:

• No hormone replacement therapy within 4 weeks of starting treatment

• No chronic oral treatment with corticosteroids unless initiated > 6 months prior to study entry and at low dose (≤ 20 mg methylprednisolone or equivalent)

• No concurrent warfarin or heparin therapy