What Types Of Hormone Therapy Are Used For Breast Cancer
Several strategies are used to treat hormone-sensitive breast cancer:
Blocking ovarian function: Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. Blocking ovarian function is called ovarian ablation.
Ovarian ablation can be done surgically in an operation to remove the ovaries or by treatment with radiation. This type of ovarian ablation is usually permanent.
Alternatively, ovarian function can be suppressed temporarily by treatment with drugs called gonadotropin-releasing hormone agonists, which are also known as luteinizing hormone-releasing hormone agonists. By mimicking GnRH, these medicines interfere with signals that stimulate the ovaries to produce estrogen.
Estrogen and progesterone production in premenopausal women. Drawing shows that in premenopausal women, estrogen and progesterone production by the ovaries is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which then causes the pituitary gland to make and secrete LH and follicle-stimulating hormone . LH and FSH cause the ovaries to make estrogen and progesterone, which act on the endometrium .
Examples of ovarian suppression drugs are goserelin and leuprolide .
Blocking estrogens effects: Several types of drugs interfere with estrogens ability to stimulate the growth of breast cancer cells:
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 After menopause, when the ovaries are no longer active, a small amount continues to be produced in other tissues such as fat, muscle and adrenal glands.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.
What Are The Side Effects Of Hormone Therapy
The side effects of hormone therapy depend largely on the specific drug or the type of treatment . The benefits and harms of taking hormone therapy should be carefully weighed for each person. A common switching strategy used for adjuvant therapy, in which patients take tamoxifen for 2 or 3 years, followed by an aromatase inhibitor for 2 or 3 years, may yield the best balance of benefits and harms of these two types of hormone therapy .
Hot flashes, night sweats, and vaginal dryness are common side effects of all hormone therapies. Hormone therapy also may disrupt the menstrual cycle in premenopausal women.
Less common but serious side effects of hormone therapy drugs are listed below.
Tamoxifen
- breathing problems, including painful breathing, shortness of breath, and cough
- loss of appetite
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If You Cant Have Surgery
Surgery is the main treatment for breast cancer, but some women have health problems that mean they cant have surgery. Some women choose not to have surgery.
In this case, if your breast cancer is oestrogen receptor positive, your doctor might recommend hormone therapy. This treatment won’t get rid of the cancer but can stop it growing or shrink it.
The treatment can often control the cancer for some time. Your doctor might change you to a different type of hormone treatment if your cancer starts growing again.
How Are Aromatase Inhibitors Taken
Aromatase inhibitors are pills. You take one pill every day.
Postmenopausal women with hormone receptor-positive breast cancer can:
- Begin hormone therapy with an aromatase inhibitor
- Begin hormone therapy with tamoxifen and then after a few years, switch to an aromatase inhibitor
When an aromatase inhibitor is the only hormone therapy given, its taken for 5-10 years.
When an aromatase inhibitor is taken after tamoxifen, the drugs are taken for a combined total of 5-10 years.
Talk with your health care provider about how long you should take an aromatase inhibitor.
Find a list of questions on hormone therapy you may want to ask your health care provider.
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Hormone Therapy For Reducing The Risk Of Breast Cancer
Women at moderate or high risk of breast cancer because of their family history may be offered hormone therapy to reduce their risk of developing breast cancer.
Drugs used to reduce the risk of breast cancer in women who have not had breast cancer include:
These drugs are usually taken for five years.
When Are Hormone Blockers Used
Hormone inhibitors and blocker options may depend on a persons stage of life.
- Hormone inhibitors are only used in postmenopausal women. They can be given to premenopausal women if steps are taken by the treatment team to put the ovaries to sleep by blocking the ovaries from producing estrogen or progesterone.
- Hormonal therapy may also be called anti-hormone treatment. Think of it as the opposite of hormone replacement therapy . If pathology tests show that the tumor in your breast has hormone receptors , then hormonal therapy may be recommended for you after the completion of your acute treatment .
- Hormonal therapy keeps breast cancer cells from receiving or using the natural female hormones in your body which they need to grow. Hormonal therapy also blocks the ability of health breast cells to receive hormones that could stimulate breast cancer cells to regrow again in the form of recurrence of the breast cancer within the breast or elsewhere in the body.
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Side Effects Of Tamoxifen And Toremifene
The most common side effects of tamoxifen and toremifene are:
- Hot flashes
- Vaginal dryness or discharge
- Changes in the menstrual cycle
When tamoxifen treatment starts, a small number of women with cancer that has spread to the bones might have a tumor flare which can cause bone pain. This usually decreases quickly, but in some rare cases a woman may also develop a high calcium level in the blood that is hard to control. If this happens, the treatment may need to be stopped for a time.
Rare, but more serious side effects are also possible:
What Other Information Should I Know
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body’s response to anastrozole.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
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What Is An Estrogen Blocker
Estrogen blockers are chemicals that stop estrogen from carrying out its role in specific bodily functions. There are several types of estrogen blockers: aromatase inhibitors, antiestrogens, and specific estrogen receptor modulators. Aromatase inhibitors actually prevent the production of new estrogen. Antiestrogens and specific estrogen receptor modulators block estrogen receptors, so that the hormone cannot bind itself to certain body parts. Your doctor can prescribe this to you in the form of a pill or a monthly shot to be given in a doctor’s office.
Length Of Treatment With An Aromatase Inhibitor
Randomized clinical trials have compared outcomes for women who used aromatase inhibitors for 10 years versus 5 years . Taking an aromatase inhibitor for 10 years :
- Improves disease-free survival
- Lowers the risk of cancer in the opposite breast
However, overall survival is the same whether a woman takes an aromatase inhibitor for 5 years or 10 years . For most women, the benefit of the extra 5 years of treatment is small .
Women who take an aromatase inhibitor for more than 5 years continue to have side effects from the drug, including a higher number of bone fractures and a higher rate of osteoporosis .
Talk with your health care provider about how long you should take an aromatase inhibitor.
Learn about the importance of completing treatment with an aromatase inhibitor.
Possible side effects of aromatase inhibitors include muscle pain, joint pain and menopausal symptoms .
Aromatase inhibitors also cause a loss of bone density. Youll get a baseline measure of your bone density so changes in your bone density can be monitored.
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Can Hormone Therapy Be Used To Prevent Breast Cancer
Yes. Most breast cancers are ER positive, and clinical trials have tested whether hormone therapy can be used to prevent breast cancer in women who are at increased risk of developing the disease.
A large NCI-sponsored randomized clinical trial called the Breast Cancer Prevention Trial found that tamoxifen, taken for 5 years, reduces the risk of developing invasive breast cancer by about 50% in postmenopausal women who were at increased risk . Long-term follow-up of another randomized trial, the International Breast Cancer Intervention Study I, found that 5 years of tamoxifen treatment reduces the incidence of breast cancer for at least 20 years . A subsequent large randomized trial, the Study of Tamoxifen and Raloxifene, which was also sponsored by NCI, found that 5 years of raloxifene reduces breast cancer risk in such women by about 38% .
As a result of these trials, both tamoxifen and raloxifene have been approved by the FDA to reduce the risk of developing breast cancer in women at high risk of the disease. Tamoxifen is approved for this use regardless of menopausal status. Raloxifene is approved for use only in postmenopausal women.
How Hormone Therapy Is Given
Hormone therapy may be given in many ways. Some common ways include:
- Oral. Hormone therapy comes in pills that you swallow.
- Injection. The hormone therapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly.
- Surgery. You may have surgery to remove organs that produce hormones. In women, the ovaries are removed. In men, the testicles are removed.
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Less Common Types Of Hormone Therapy
Some other types of hormone therapy that were used more often in the past, but are rarely given now include:
- Megestrol acetate , a progesterone-like drug
- Androgens , like testosterone
These might be options if other forms of hormone therapy are no longer working, but they can often cause side effects.
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.
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Turning Off Or Removing The Ovaries
Turning off or removing the ovaries lowers the levels of oestrogen in the blood. This is another way of starving cancer cells of oestrogen to stop them growing. This treatment only works before menopause.This treatment is not necessary for women who have already gone through menopause because the ovaries naturally stop making oestrogen after menopause.
Turning off or removing the ovaries:
- reduces the risk of cancer returning or new cancer developing
- can be combined with other treatments for breast cancer like breast surgery, radiotherapy, chemotherapy, aromatase inhibitors and tamoxifen
Surgical removal of the ovaries reduces the risk of breast cancer returning and has the added benefit of reducing the risk of developing cancer of the ovaries, although cancer of the ovaries is uncommon.
What Is Hormone Receptor
Breast cancer tumors that are hormone receptor-positive need the hormones estrogen or progesterone to grow. Approximately 75% of breast cancers are hormone-positive in post-menopausal patients. Your healthcare provider will perform a biopsy and laboratory testing to determine the cancer type and most effective treatment.
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What Is Estrogen Suppressing Therapy
Estrogen suppressing therapy is a form of antiestrogen therapy that slows or reduces the amount of estrogen in a females body.
A group of estrogen suppressants called aromatase inhibitors, for example, block the enzyme aromatase, which turns the hormone androgen into small amounts of estrogen in the body.
This results in less estrogen being available elsewhere to contribute to the growth of breast cancer cells that are sensitive to hormones.
While estrogen suppressing therapies cant stop ovaries from making estrogen, they can reduce the bodys production of estrogen.
Generally taken as a pill, estrogen suppressants are best for treating early stage breast cancer thats sensitive to hormones. Joint stiffness and joint pain are two common side effects of the medication.
However, like all medications, estrogen suppressants may also have serious side effects. Heart complications and increased bone loss are rare but possible.
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
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How Can Hormones Affect The Growth Of Breast Cancer
Hormones like estrogen and progesterone are chemicals produced by glands in the body. Normally, these hormones help regulate body cycles, like menstruation. However, sometimes these same hormones can cause cancer to grow.
The pathologist will perform tests on the breast cancer cells to determine if they have receptors that feed on estrogen or progesterone, stimulating their growth. If the cancer cells have these receptors, your doctor may recommend hormone therapy drugs, such as blockers or inhibitors. Both types of drugs help to destroy cancer cells by cutting off their supply of hormones.
Surgical Removal Of The Ovaries
The operation to remove the ovaries is called oophorectomy. Surgical removal of the ovaries is a permanent way to reduce the levels of oestrogen.
It is a very effective treatment to stop early breast cancer returning or to slow the progress of metastatic cancer. This can also reduce the risk of developing ovarian cancer.
Surgery to remove the ovaries can be done with keyhole surgery or with an open operation .
Your surgeon will discuss with you the pros and cons of these different techniques. Oophorectomy is done under a general anaesthetic .
Usually the fallopian tubes are also removed but the uterus is left intact. After oophorectomy, the symptoms of menopause may come on suddenly. This is different to turning off the ovaries with medication which brings menopausal symptoms on gradually
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Antiestrogen Vs Estrogen Blockers
Both antiestrogen and estrogen blockers aim to slow or stop the progression of breast cancer. The two different treatments dont work the same way, though.
Tamoxifen, a widely used estrogen blocker, stops estrogen from affecting breast tissue. Aromatase, an antiestrogen therapy, lowers the production of estrogen in postmenopausal women.
Tamoxifen is well known and widely used as chemoprevention a medication to prevent disease for women with a high risk of developing invasive breast cancer, according to
, researchers found that when postmenopausal women in the increased risk category took tamoxifen for 5 years, it lowered their risk of developing invasive breast cancer by 50 percent.
A 2017 study found that use of tamoxifen and antiestrogen medications led to a 50 to 65 percent decrease in breast cancer development in high risk groups.
Both estrogen blockers and antiestrogen therapies are effective, but there are side effects, too. Its important to weigh the benefits and risks with your care team before deciding on this course of action.
Hormones And Breast Cancer
The hormones estrogen and progesterone make some breast cancers grow. They are called hormone-sensitive breast cancers. Most breast cancers are sensitive to hormones.
Estrogen and progesterone are produced in the ovaries and other tissues such as fat and skin. After menopause, the ovaries stop producing these hormones. But the body continues to make a small amount.
Hormone therapy only works on hormone-sensitive cancers. To see if hormone therapy may work, doctors test a sample of the tumor that has been removed during surgery to see if the cancer might be sensitive to hormones.
Hormone therapy can work in two ways:
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