If Cancer Has Come Back Or Spread
Hormone therapy can be used to treat breast cancer that has come back or that has spread to another part of the body .
Its given either alone or with other treatments, depending on what treatments you had before.
If your breast cancer came back during or after treatment with hormone therapy, you may be offered a different type of hormone therapy.
Hormone Therapy Versus Menopausal Hormone Therapy
Hormone therapy for breast cancer treatment is different than menopausal hormone therapy .
- Hormone therapies used in breast cancer treatment act as anti-hormone or anti-estrogen therapies. They block hormone actions or lower hormone levels in the body.
- MHT is used to increase hormone levels in the body to treat menopausal symptoms.
MHT increases the risk of breast cancer. Its not usually recommended for women with breast cancer. For other women, its only recommended at the lowest dose, for the shortest time needed, to ease symptoms .
MHT is also called postmenopausal hormone use or hormone replacement therapy .
Learn more about talking with your healthcare provider.
If youve been recently diagnosed with breast cancer or feel too overwhelmed to know where to begin to gather information, Susan G. Komen® has a Questions to Ask Your Doctor About Hormone Therapy and Side Effects resource that might help.
You can download, print and write on the resource at your next doctors appointment. Or you can download, type and save it on your computer, tablet or phone during a telehealth visit using an app such as Adobe. Plenty of space and a notes section are provided to jot down answers to the questions.
There are other Questions to Ask Your Doctor resources on many different breast cancer topics you may wish to download.
Hot Flashes And Night Sweats
Hot flashes and night sweats happen to a lot of women during menopause. Theyâre also side effects of both tamoxifen and aromatase inhibitors.
âFor tamoxifen, younger premenopausal women whose ovaries are still working tend not to have symptoms that are as severe,â says Patricia Ganz, MD, director of the Center for Cancer Prevention & Control Research at UCLAâs Jonsson Comprehensive Cancer Center. âAs you get nearer to the age of natural menopause, in your 40s and 50s, these symptoms can get worse.â
What helps: To manage hot flashes and night sweats, Mayer recommends starting with environmental approaches, like keeping your bedroom cool at night, dressing in layers, and keeping a fan on.
You can also keep a bottle of cold water by your bed or keep an ice pack under your pillow. Acupuncture may also help with many side effects linked to aromatase inhibitors, including hot flashes, Mayer says.
But if these approaches donât help and hot flashes and night sweats are interfering with your daily life, medication might be helpful.
What helps: âCertain medicines that are used to treat anxiety or depression also actually can treat hot flashes,â says Jessica Jones, MD. Sheâs an assistant professor in the oncology division of The University of Texas Health Science Center McGovern Medical School in Houston.
Jones is talking about medications such as selective serotonin reuptake inhibitors , serotonin-norepinephrine reuptake inhibitors , and gabapentin.
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Hormone Replacement Therapy After Breast Cancer
Many women in the UK take hormone replacement therapy to reduce menopausal symptoms. But doctors dont routinely recommend taking HRT after breast cancer.
The concern is that HRT could increase the risk of your breast cancer coming back . The risk for women who have had breast cancer is uncertain because research so far has not drawn any firm conclusions. This might depend on the type of HRT and how long you have it.
The risk is thought to be greater in women:
- whose breast cancer has receptors for the female hormones hormone receptor positive breast cancer
- who take HRT that contains oestrogen and progestogen
Its important that you talk to a health professional if you are finding menopausal symptoms difficult to cope with. Ideally you should speak to your cancer doctor as well as a doctor that specialises in the menopause.
Your doctor might suggest that you try other things first, such as non hormonal medicines. But they may offer HRT if your symptoms are severe. For example, if hot flushes or low mood, or a combination of symptoms are affecting your quality of life. Your doctor should discuss the risks and benefits of HRT with you.
Predictors For Extended Adjuvant Hormone Therapy
Information on age, tumor size, lymph nodes status, tumor grade, progesterone receptor status, HER2 status at diagnosis, and treatments was retrieved from the Stockholm-Gotland Quality Register for Breast Cancer. Information on therapy type at baseline was retrieved from the Swedish Prescribed Drug Register. Family history of breast cancer or death from breast cancer at diagnosis was obtained by linking the Multi-Generation Register to the Swedish Cancer Register and the Cause-of-Death Register. Socioeconomic status at diagnosis, including education and personal income, was retrieved from the Swedish Longitudinal Integrated Database for Health Insurance and Labor Market Studies. Income was measured using average 5-year income before diagnosis and categorized into three groups according to tertiles.
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How Do You Treat A Tumor
Hormonal therapy is often given in conjunction with other treatments. The timing varies depending on the tumor, its stage and its location, among other factors: 1 Neoadjuvant hormonal therapy is when hormones are given before surgery or radiotherapy. The goal is to make a tumor shrink, so its smaller, which can make it easier to treat. 2 Adjuvant hormonal therapy is given after the patient has received surgery, radiation therapy or chemotherapy. Given after treatment, hormones decrease the risk of cancer recurring or spreading.
For The Population Studied As A Whole There Was An Overall Deterioration In The Quality Of Life At Two Years From Diagnosis This Deterioration Was Greater In Patients Who Had Received Hormone Therapy Especially After The Menopause By Contrast Chemotherapy Had A Bigger Effect On Quality Of Life In Non
It is important in the future that we are able to predict which women are going to develop severe symptoms with anti-hormonal treatment so that we can support them, added Dr Vaz-Luis. While it has been shown that hormone therapy provides a real benefit in reducing the relapse rate of hormone-dependent cancers which represent 75% of all breast cancers, the deterioration in quality of life may also have a negative effect on patient adherence to treatment. It is, therefore, important to offer them symptomatic treatment, in particular for menopausal symptoms, musculoskeletal pain, depression, severe fatigue and cognitive dysfunction and to combine this with supportive measures such as physical exercise and cognitive behaviour therapy.
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What Are The Side Effects Of Hormone Therapy For Breast Cancer
Potential side effects of hormone therapy for breast cancer include:
- Fatigue or feelings of weakness
- Pain in joints and muscles
- Vaginal dryness, irritation, or discharge
- Loss of menstrual periods .
More serious, but less frequent, side effects may include cataracts, osteoporosis, blood clots, stroke, heart ailments, and uterine or endometrial cancers.
Treatments For Vaginal Dryness
Vaginal dryness and discomfort can be bothersome menopausal symptoms for some women.
Devices that use lasers or other forms of energy to rejuvenate vaginal tissue are now being studied as well, although its not yet clear how helpful they might be. Its important to discuss the possible risks and benefits of these treatments with your doctor before deciding if one is right for you.
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Extension Of Adjuvant Hormone Therapy
Among patients who finished the 5-year adjuvant hormone therapy and remained free of recurrence at the end of 5-year therapy, we defined whether the patients extended their therapy or not. Specifically, extended therapy was defined as continuing the therapy for 6 months and filling 2 prescriptions of tamoxifen or aromatase inhibitors beyond the 5-year adjuvant hormone therapy. Information on the prescription of tamoxifen or aromatase inhibitors was obtained from the Swedish Prescribed Drug Register.
Ovarian Function Suppression For Premenopausal Patients
To optimize the endocrine treatment for premenopausal patients, ovarian function suppression was tested in the SOFT and TEXT trials . Premenopausal women were randomly assigned to receive 5 years of tamoxifen, tamoxifen plus OFS, or exemestane plus OFS in SOFT and to receive tamoxifen plus OFS or exemestane plus OFS in TEXT after chemotherapy. In SOFT, the 8-year DFS rate was 78.9% with tamoxifen alone, 83.2% with tamoxifen plus OFS, and 85.9% with exemestane plus OFS . The 8-year rate of OS was 91.5% with tamoxifen alone, 93.3% with tamoxifen plus OFS, and 92.1% with exemestane plus OFS .
OFS can be initiated concurrently with or after chemotherapy . Starting before chemotherapy supports fertility preservation .
Even if there are no data the AGO-Mamma recommends an extended treatment with another 5 years of tamoxifen after 5 years of tamoxifen plus OFS for premenopausal women at risk .
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Turning Off The Ovaries With Medication
The ovaries can be shut down temporarily with medication. This is usually done by giving a course of monthly injections of goserelin . This gradually causes the levels of oestrogen to fall, which leads to temporary menopause.The menstrual periods stop and other symptoms of menopause may develop . These symptoms can be reversed. If the injections are stopped, the oestrogen levels and menstrual periods return to normal. Some women who are considering having their ovaries removed have these injections for a few months to test out the menopausal symptoms. They still have the choice of reversing the effect if the side effects are too intense. The use of goserelin is strictly controlled by the Australian Pharmaceutical Benefits Scheme and may not be available to all women.
The Efficacy Of Subsequent Therapy
The subsequent hormone therapy produced one PR, two long SD, one SD and five cases of PD. The CB of the second-line hormone therapy was 33% . The subsequent chemotherapy produced one CR, two PRs, one long SD and two PDs. The CB of the chemotherapy was 66% . The efficacy of hormone therapy for three cases with lymph node metastases was unable to be evaluated because another therapy, such as radiation or surgical resection, was used in combination with the hormone therapy. Two patients treated with chemotherapy dropped out of their treatment because of its adverse effects. All luminal A cases received hormone therapy, and they all obtained either a long SD or SD. However, in most luminal B and luminal HER2 cases, hormone therapy did not have any CB . All patients with bone metastasis obtained a CB from hormone therapy. Both of the PD cases treated with chemotherapy had lymph node metastases . We could not statistically compare the TTF of hormone therapy and chemotherapy because of the small number of patients. However, the TTF of hormone therapy seemed to be shorter than that of chemotherapy .
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Tamoxifen And Breast Cancer Prevention
A large study by the National Cancer Institute looked at whether tamoxifen lowered cases of breast cancer in healthy women who were known to be likely to get the disease. The results of the trial showed a 50% reduction in breast cancer in the women who took the drug.
Studies have also shown that tamoxifen lessens the risk of breast cancer returning in women who have had the earliest form of the disease, ductal carcinoma in situ .
How Hormone Therapy Works
Oestrogen and progesterone are hormones which are naturally produced in the human body. Before menopause, oestrogen is mostly produced by the ovaries. After menopause, when the ovaries are no longer active, a small amount continues to be produced in other tissues such as fat, muscle and adrenal glands.
Normal breast cells contain receptors that are able to recognise these hormones and allow them to access the cells, where they release signals encouraging growth and development. All breast cancers are tested for the presence of these oestrogen and progesterone receptors, using tissue taken at the time of biopsy or surgery. Approximately 70% of breast cancers retain these receptors, and rely on these hormones to grow. These hormone-sensitive cancers are described as oestrogen receptor positive and/or progesterone receptor positive .
Hormone therapy is also used to shrink or slow the growth of a breast cancer when surgery is not appropriate, for example in an older person with other major health issues. It is also used to help shrink advanced stage breast cancers or slow their growth.
Hormone therapy for breast cancer is not the same as HRT . HRT raises the level of oestrogen +/- progesterone in the body and is not used in the treatment of breast cancer.
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Estrogen Receptor Blockers Estrogen Receptor Blocker Drugs Attach Directly To And Block The Estrogen Receptors On Cancer Cells So That The Cancer Cells Cant Use Estrogen They Do Not Affect The Level Of Estrogen In The Body Estrogen Receptor Blockers Are Also Called Selective Estrogen Receptor Modulators
Tamoxifen
Tamoxifen is the most commonly used anti-estrogen drug. It is used in post-menopausal and premenopausal women. Tamoxifen is given by mouth as a pill.
Tamoxifen is the hormonal therapy drug used most often to lower the risk that DCIS or LCIS will lead to an invasive breast cancer.
Tamoxifen very slightly increases the risk for uterine cancer, deep vein thrombosis and stroke. Doctors will carefully weigh these risks against the benefits of giving this drug before they offer it to women who have a personal or a strong family history of these conditions. Usually the benefits of taking tamoxifen outweigh these risks.
Fulvestrant
Fulvestrant is an anti-estrogen drug that reduces the number of estrogen receptors on breast cancer cells. It is given as an injection into the muscles of the buttocks.
Fulvestrant is used in post-menopausal women if the breast cancer has grown after they were treated with tamoxifen. It is also used in postmenopausal women with locally advanced or metastatic breast cancer that have never been treated with hormonal therapy.
Aromatase Inhibitors Reduce Estrogen By Blocking An Enzyme Called Aromatase And Keeping It From Converting Androgens Into Estrogen
All three aromatase inhibitors have known side effects. The most common is bone and joint pain. Other side effects include fatigue, dizziness, hot flashes, and weight gain. All of these side effects can affect your quality of life, and you may be able to tolerate some more than others. If you find that the side effects are keeping you from taking the hormone therapy that you were prescribed, you can talk to your doctor about switching to one of the other aromatase inhibitors. You can also discuss switching to tamoxifen.
In June 2014, ASCO updated its hormone treatment guidelines. The new guidelines incorporate new research findings, including a large study that found 10 years of tamoxifen was more effective than five years of tamoxifen followed by a placebo.
The new treatment guidelines for women with hormone-sensitive breast cancer are:
Premenopausal women:
- Tamoxifen for five years.
- After five years assess menopausal status. If not yet menopausal, consider continuing on tamoxifen for five more years. If menopausal, consider staying on tamoxifen or switching to an aromatase inhibitor.
Postmenopausal women:
- Tamoxifen for 10 years or
- An aromatase inhibitor for five years or
- Tamoxifen for five years followed by an aromatase inhibitor for up to five years or
- Tamoxifen for two to three years followed by an AI for up to five years
You can also use this page on BreastCancer.orgto understand your treatment options and possible side effects.
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Treatments To Stop Ovarian Function In Premenopausal Women
Women who haven’t undergone menopause â either naturally or as a result of cancer treatment â may opt to undergo treatment to stop their ovaries from producing hormones.
Options may include:
- Surgery to remove the ovaries
- Radiation therapy aimed at the ovaries
- Medications, such as goserelin
Treatments to stop ovarian function may allow premenopausal women to take medications only available to postmenopausal women.
The Risk Of Late Recurrence
Hormone receptor-positive breast cancers are characterized by a risk of late recurrence for years. Recurrences occur at a steady rate throughout the period from 5 to 20 years, strongly correlated with the original tumor and nodal status and the tumor grade. At least 50% of recurrences occur more than 5 years after diagnosis. The long-term risk of recurrence is about 12% per year. Estimating the risk of recurrence accurately is important because if the risk is low, even the most effective adjuvant therapy can only result in limited overall improvement. In an analysis by Pan et al. , after 5 years of ET for patients with stage T1 disease the risk of distant recurrence in the period from 5 to 20 years was 13% for N0, 20% with N13 status, and 34% with N49 status. Among T2 tumors, the risks were 19, 26, and 41%, respectively. Considering the impact of grade among patients with T1 N0 disease, the risk of distant recurrence was 10% for low-grade and 17% for high-grade disease. An EBCTCG analysis on this question presented by Pan et al. showed an improved outcome for patients after only 5 years of ET diagnosed after the year 2000 in comparison with diagnosis of breast cancer before the year 2000. Possible explanations for the 25% reduction of distant recurrences in years 59 are the detection of lower-risk lesions by early detection and screening, an improved compliance to treatment and treatment guidelines, and real treatment improvements.
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