Friday, April 19, 2024

Hormone Therapy For Estrogen Positive Breast Cancer

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Minimize Exposure To Heavy Metals

Adjuvant Hormonal Therapy for Estrogen Receptor Positive Early Stage Breast Cancer – Mayo Clinic

Heavy metals including copper, cobalt, arsenic, cadmium, mercury and lead have been found to stimulate estrogen receptors. Sources of arsenic include some brands of rice, seafood, well water cadmium is high in cigarettes and can be found in some soils mercury is mainly prevalent in larger fish and old dental amalgams and lead contamination is a component of air pollution, paint and dyes, and ceramic glazes among other sources.

Essentially, heavy metal and toxin exposure is hard to completely avoid in our world, even with careful choices. Because of this, I advise my patients to use compounds that provide safe, gentle detoxification of heavy metals and other contaminants, on a daily or periodic basis.

Modified citrus pectin, is derived from the pith of citrus fruit and has been shown in human studies to remove harmful heavy metals and reduce toxic body burden over time. MCP is able to cross the intestinal barrier and circulate in the bloodstream, where it binds to toxins and heavy metals and helps safely excrete them, without removing essential minerals. I also recommend ingredients such alpha-lipoic acid, N-acetyl cysteine, garlic, cilantro and other herbs and nutrients that provide support for our bodys complex detoxification systems.

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.

Does Estrogen Cause Breast Cancer

To address our primary question, estrogen replacement alone for 6 years does not cause breast cancer. Using estrogen REDUCES the risk of breast cancer. At 10-15 years, the picture changes. Observational data of women who continue to use CEE alone tend to see an increased rate of breast cancer. These cancers, however, were noted to be small

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Is Estrogen A Cause Of Breast Cancer

While the link between estrogen and breast and ovarian cancer in women has been known for many years, its been unclear if there is a link between male breast cancer and estrogen. Now an international study has found that men with naturally high levels of estrogen may have a higher-than-average risk of breast cancer.

Ospemifene: An Estrogen Receptor Agonist/antagonist

Breast Cancer Basics: Endocrine (âHormonalâ?) Therapy Drugs For Hormone ...

Ospemifene is an estrogen receptor agonist/antagonist, a class of drugs previously called selective estrogen receptor modulators . It is FDA-approved to treat moderate to severe dyspareunia secondary to vulvar and vaginal atrophy.

Ospemifene has unique estrogenic effects on the vaginal mucosa, having been shown to increase the number of epithelial cells, lower the vaginal pH, and decrease the percentage of parabasal cells seen on Papanicolaou smears after 12 weeks of use.14

Unlike tamoxifen, another drug of this class, ospemifene does not change the endometrial lining.14 Similarly, ospemifene acts as an estrogenic agonist in bone and, thus, has the potential for use in preventing and managing osteoporosis or for use in women at risk of fractures.

Breast cancer impact

In preclinical trials, ospemifene was found to have antiestrogenic effects on breast tissue, similar to those seen with tamoxifen.

In a model using human tumor grafts, ospemifene decreased tumor growth in mice implanted with estrogen receptor-positive breast cancer cells.15

In a mouse model using breast cancer cells that were biologically and histologically similar to those of humans, ospemifene had strong antiestrogenic effects on the breast tissue.16 The evidence suggests that ospemifene has a favorable effect on vulvar and vaginal atrophy.17

Ospemifene is FDA-approved to treat moderate to severe dyspareunia secondary to menopause. Recommended dosing is 60 mg/day orally with food.

Read Also: How To Regulate Hormones During Perimenopause

Can Other Drugs Interfere With Hormone Therapy

Certain drugs, including several commonly prescribed antidepressants , inhibit an enzyme called CYP2D6. This enzyme plays a critical role in the body’s use of tamoxifen because CYP2D6 metabolizes, or breaks down, tamoxifen into molecules, or metabolites, that are much more active than tamoxifen itself.

The possibility that SSRIs might, by inhibiting CYP2D6, slow the metabolism of tamoxifen and reduce its effectiveness is a concern given that as many as one-fourth of breast cancer patients experience clinical depression and may be treated with SSRIs. In addition, SSRIs are sometimes used to treat hot flashes caused by hormone therapy.

Many experts suggest that patients who are taking antidepressants along with tamoxifen should discuss treatment options with their doctors, such as switching from an SSRI that is a potent inhibitor of CYP2D6, such as paroxetine hydrochloride , to one that is a weaker inhibitor, such as sertraline or citalopram , or to an antidepressant that does not inhibit CYP2D6, such as venlafaxine . Or doctors may suggest that their postmenopausal patients take an aromatase inhibitor instead of tamoxifen.

Other medications that inhibit CYP2D6 include the following:

  • quinidine, which is used to treat abnormal heart rhythms

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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When Is Hormone Therapy Used For Breast Cancer

Hormone therapy is often used after surgery to help reduce the risk of the cancer coming back. Sometimes it is started before surgery .

It is usually taken for at least 5 years. Treatment longer than 5 years might be offered to women whose cancers have a higher chance of coming back. A test called the Breast Cancer Index might be used to help decide if a woman will benefit from more than 5 years of hormone therapy.

Hormone therapy can also be used to treat cancer that has come back after treatment or that has spread to other parts of the body.

Estrogen And Progesterone Receptor Testing For Breast Cancer

Advancements in Estrogen ReceptorPositive Breast Cancer

To help doctors give their patients the best possible care, the American Society of Clinical Oncology and the College of American Pathologists developed evidence-based guidelines to improve the accuracy of testing for estrogen and progesterone receptors for breast cancer. This guide for patients is based on ASCO’s and CAP’s 2020 updated recommendations.

Read Also: Does Birth Control Lower Estrogen

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:

What Hormone Causes Breast Cancer

This means that these breast cancers are fueled by the natural hormones estrogen or progesterone. A doctor who specializes in analyzing blood and body tissue determines if your cancer is ER positive or PR positive by analyzing a sample of your cancer cells to see if they have receptors for estrogen or progesterone.

Also Check: How To Heal Hormones Naturally

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.

Why Is Knowing Hormone Receptor Status Important

Hormone therapy resistance: What you should know

Knowing the hormone receptor status of your cancer helps doctors decide how to treat it. If your cancer has one or both of these hormone receptors, hormone therapy drugs can be used to either lower estrogen levels or stop estrogen from acting on breast cancer cells. This kind of treatment is helpful for hormone receptor-positive breast cancers, but it doesnt work on tumors that are hormone receptor-negative .

All invasive breast cancers should be tested for both of these hormone receptors either on the biopsy sample or when the tumor is removed with surgery. About 3 of 4 breast cancers have at least one of these receptors. This percentage is higher in older women than in younger women. DCIS should also be checked for hormone receptors.

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Possible Side Effects Of Hormone Therapy

Some side effects are common to all methods of hormone therapy and are due to the reduced levels of oestrogen.

These include:

Tamoxifen and aromatase inhibitors also produce some different side effects. You may experience some of the side effects listed, but are unlikely to experience them all.

For most people who are recommended to take hormone therapy for breast cancer, the risks of treatment are outweighed by the benefits.

Here is a list of possible side effects that might be experienced on tamoxifen and aromatase inhibitors:

Tamoxifen

Side Effects Of Tamoxifen And Toremifene

The most common side effects of tamoxifen and toremifene are:

  • 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:

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Hormone Therapy Has A Bigger Impact Than Chemotherapy On Womens Quality Of Life

Cellules cancéreuses. Expression de la protéine PML en rouge et du gène ZNF703 en vert dans des cellules de la lignée de cancer du sein MCF7. ©Inserm/Ginestier, Christophe

Analysis of the CANTO cohort published in the journal Annals of Oncology will upset received wisdom on the effects that hormone therapy and chemotherapy have on the quality of life in women with breast cancer. Contrary to the commonly held view, 2 years after diagnosis, hormone therapy, a highly effective breast cancer treatment worsens quality of life to a greater extent and for a longer time, especially in menopausal patients. The deleterious effects of chemotherapy are more transient. Given that current international guidelines recommend the prescription of hormone therapy for 5 to 10 years, it is important to offer treatment to women who develop severe symptoms due to hormone antagonist medication and to identify those who might benefit from less prolonged or intensive treatment strategies.

This work was directed by Dr Inès Vaz-Luis, specialist breast cancer oncologist and researcher at Gustave Roussy in the lab Predictive Biomarkers and Novel Therapeutic Strategies in Oncology .

Hormone Therapy After Surgery For Breast Cancer

Hormonal Therapy for Breast Cancer: We Teach You

After surgery, hormone therapy can be given to reduce the risk of the cancer coming back. Taking an AI, either alone or after tamoxifen, has been shown to work better than taking just tamoxifen for 5 years.

These hormone therapy schedules are known to be helpful for women who are post-menopausal when diagnosed:

  • Tamoxifen for 2 to 3 years, followed by an AI for 2 to 3 years
  • Tamoxifen for 2 to 3 years, followed by an AI for 5 years
  • Tamoxifen for 4½ to 6 years, followed by an AI for 5 years
  • Tamoxifen for 5 to 10 years
  • An AI for 5 to 10 years
  • An AI for 2 to 3 years, followed by tamoxifen for 2 to 3 years
  • For women who are unable to take an AI, tamoxifen for 5 to 10 years is an option

For most post-menopausal women whose cancers are hormone receptor-positive, most doctors recommend taking an AI at some point during adjuvant therapy. Standard treatment is to take these drugs for about 5 years, or to take in sequence with tamoxifen for 5 to 10 years. For women at a higher risk of recurrence, hormone treatment for longer than 5 years may be recommended. Tamoxifen is an option for some women who cannot take an AI. Taking tamoxifen for 10 years is considered more effective than taking it for 5 years, but you and your doctor will decide the best schedule of treatment for you.

These therapy schedules are known to be helpful forwomen who are pre-menopausal when diagnosed:

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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.

Educated Patient Metastatic Breast Cancer Summit Overview Of Management Of Hormone Receptor

Although certain treatments such as Ibrance , Kisqali and Verzenio have become the standard first-line treatment option for hormone receptor-positive breast cancer, recent study findings have shown that they may no longer be interchangeable.

Now, according to Dr. Seth A. Wander, health care providers are actively debating as to why two drugs in this instance, Ibrance and Kisqali could elicit similar improvements in progression-free survival but drastic results in overall survival.

Of note, progression-free survival and overall survival are common endpoints that trial investigators assess when analyzing new treatments.

As part of a larger discussion, Wander, an assistant professor of medicine at Harvard Medical School and a medical oncologist at Massachusetts General Hospital in Boston, highlighted the first- and second-line management of hormone receptor-positive breast cancer during CURE®s recent Educated Patient® Metastatic Breast Cancer Summit.

Most Common Cancer

Wander noted that breast cancer, according to statistics released by the American Cancer Society in 2020, is the most common type of malignancy diagnosed in women.

In fact, more than 275,000 new cases of breast cancer were expected to be diagnosed in women in the U.S. Of those cases, approximately 70% are hormone receptor positive.

Hormone Therapy

CDK4/6 Inhibitors

Mechanisms of Treatment Resistance

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Recommended Reading: Does Estrogen Make Endometriosis Worse

What Is Ovarian Suppression In Breast Cancer

Because the ovaries produce the majority of estrogen in premenopausal women, removing them or blocking them is one way to lower estrogen levels in breast cancer:

  • Oophorectomy: Oophorectomy involves surgical removal of the ovaries.
  • Luteinizing hormone-releasing hormone analogs: These block the signals that stimulate estrogen production in the ovaries. Common LHRH drugs include goserelin and leuprolide.
  • Chemotherapy medications: Some chemotherapy medications damage the ovaries temporarily or permanently so that the ovaries stop producing estrogen.

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