Drugs That Lower Estrogen Levels
Some drugs, called aromatase inhibitors , stop the body from making estrogen in tissues such as fat and skin. But, these drugs do not work to make the ovaries stop making estrogen. For this reason, they are used mainly to lower estrogen levels in women who have been through menopause . Their ovaries no longer make estrogen.
Premenopausal women can take AIs if they are also taking drugs that stop their ovaries from making estrogen.
Aromatase inhibitors include:
Types Of Breast Cancer Hormone Therapy
Hormone therapy treats breast cancer by delivering drugs to block your bodys production of the hormones that are encouraging breast cancer cells to grow. Many women take hormone therapy for about five years after breast cancer surgery to prevent a recurrence or growth of their cancer.
Types of hormone therapy include:
- Aromatase inhibitor drugs: These drugs block production of estrogen in the body. We primarily recommend these drugs for postmenopausal women, unless they are combined in premenopausal women with ovarian function-blocking drugs. Examples of AI drugs include anastrozole exemestane and letrozole .
- Gonodotropin-releasing hormone agonists, also known as luteinizing hormone-releasing hormone agonists: These drugs block ovarian function. The ovaries are the main source of estrogen production in women. Blocking the ovaries function minimizes estrogen in the body, which can help minimize the growth of hormone-sensitive breast cancer. Examples of these types of drugs are leuprolide and goserelin .
- Selective estrogen receptor modulator drugs: SERMs prevent estrogen from attaching to breast cancer tells. Tamoxifen is the best known among this class of drug.
Benefits Of Hormone Therapies In Early And Locally Advanced Breast Cancer Treatment
Treatment with the hormone therapies tamoxifen and/or an aromatase inhibitor lowers the risk of :
- Breast cancer recurrence
- Breast cancer in the opposite breast
- Death from breast cancer
Premenopausal women who get ovarian suppression plus tamoxifen or an aromatase inhibitor may lower these risks more than premenopausal women who get tamoxifen or an aromatase inhibitor alone .
Learn more about tamoxifen.
Aromatase inhibitor plus androgen deprivation therapy
What Is Hormone Therapy
Hormone therapy slows or stops the growth of hormone-sensitive tumors by blocking the bodys ability to produce hormones or by interfering with effects of hormones on breast cancer cells. Tumors that are hormone insensitive do not have hormone receptors and do not respond to hormone therapy.
Hormone therapy for breast cancer should not be confused with menopausal hormone therapy treatment with estrogen alone or in combination with progesterone to help relieve symptoms of menopause. These two types of therapy produce opposite effects: hormone therapy for breast cancer blocks the growth of HR-positive breast cancer, whereas MHT can stimulate the growth of HR-positive breast cancer. For this reason, when a woman taking MHT is diagnosed with HR-positive breast cancer she is usually asked to stop that therapy.
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.
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Treatment To Lower Androgen Levels From Other Parts Of The Body
LHRH agonists and antagonists can stop the testicles from making androgens, but cells in other parts of the body, such as the adrenal glands, and prostate cancer cells themselves, can still make male hormones, which can fuel cancer growth. Some drugs can block the formation of androgens made by these cells.
Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making androgens.
Abiraterone can be used in men with advanced prostate cancer that is either:
This drug is taken as pills every day. It doesnt stop the testicles from making testosterone, so men who havent had an orchiectomy need to continue treatment with an LHRH agonist or antagonist. Because abiraterone also lowers the level of some other hormones in the body, prednisone needs to be taken during treatment as well to avoid certain side effects.
Ketoconazole , first used for treating fungal infections, also blocks production of androgens made in the adrenal glands, much like abiraterone. Its most often used to treat men just diagnosed with advanced prostate cancer who have a lot of cancer in the body, as it offers a quick way to lower testosterone levels. It can also be tried if other forms of hormone therapy are no longer working.
Ketoconazole also can block the production of cortisol, an important steroid hormone in the body, so men treated with this drug often need to take a corticosteroid .
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Side Effects Are Different For Everyone
Side effects can vary, depending on which specific drug is prescribed. Not everyone will react the same way to a drug or have the same side effects.
Talk with your healthcare provider about whether these drugs are right for you. They can discuss the potential risks along with the benefits, given your medical situation.
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What Is Breast Cancer
Who should consider it? Breast cancer is a malignant tumor that begins and grows in the breast. Malignant tumors can grow and invade nearby tissues or travel to distant organs. This progression is called metastasis. Breast cancer treatment aims to remove these tumors and prevent future tumor growth.
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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How Hormone Therapy Is Used Against Cancer
Hormone therapy is used for two main reasons.
- Treat cancer. Hormone therapy can stop or slow cancer’s growth and reduce the chance it will return.
- Ease cancer symptoms. Hormone therapy may be used to reduce or prevent symptoms in men with prostate cancer who are not able to have surgery or radiation therapy.
Benefitsof Hormone Therapy For Breast Cancer Treatment
Preventcancer from coming back
Reducesthe risk of developing tumors to other breast tissues or another organ
Slow orstop the growth of cancer that has spread
Reducethe size of a tumor before surgery.
Whileusing hormone therapy for breast disease you may have to experience some sideeffects and they are mentions below read them carefully.
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Why Is This Study Important
Most invasive breast cancers are hormone receptor-positive . Hormone therapy, also called endocrine therapy, can be an important part of treatment for patients with hormone receptor-positive breast cancer. Hormone therapy reduces the risk of cancer returning and may improve overall survival. However, many patients who are prescribed hormone therapy do not begin or complete treatment. This study looked at the reasons behind these decisions.
How Is Hormone Therapy Used To Treat Breast Cancer
There are three main ways that hormone therapy is used to treat hormone-sensitive breast cancer:
Adjuvant therapy for early-stage breast cancer:Tamoxifen is FDA approved for adjuvant hormone treatment of premenopausal and postmenopausal women with ER-positive early-stage breast cancer, and the aromatase inhibitorsanastrozole, letrozole, and exemestane are approved for this use in postmenopausal women.
Research has shown that women who receive at least 5 years of adjuvant therapy with tamoxifen after having surgery for early-stage ER-positive breast cancer have reduced risks of breast cancer recurrence, including a new breast cancer in the other breast, and reduced risk of death at 15 years .
Until recently, most women who received adjuvant hormone therapy to reduce the chance of a breast cancer recurrence took tamoxifen every day for 5 years. However, with the introduction of newer hormone therapies , some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common .
Some premenopausal women with early-stage ER-positive breast cancer may have ovarian suppression plus an aromatase inhibitor, which was found to have higher rates of freedom from recurrence than ovarian suppression plus tamoxifen or tamoxifen alone .
Men with early-stage ER-positive breast cancer who receive adjuvant therapy are usually treated first with tamoxifen. Those treated with an aromatase inhibitor usually also take a GnRH agonist.
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Surgery To Stop The Ovaries From Working
This is also a type of ovarian ablation. You might choose to have an operation to remove your ovaries instead of having drug treatment to stop them working. You have this operation as keyhole surgery. It is called laparoscopic oophorectomy and you have it under general anaesthetic . You usually stay in hospital overnight.
The surgeon makes a number of small cuts into your tummy . They put a long bendy tube called a laparoscope into one of the cuts. The laparoscope connects to a video screen.
The surgeon puts small instruments through the other cuts to carry out the operation and remove the ovaries. They close the cuts with stitches and cover them with small dressings.
Removing your ovaries causes you to have a sudden menopause. The symptoms include hot flushes, sweating and mood swings.
What Is A Breast Tumor That Has Estrogen And/or Progesterone Receptors Called
Breast tumors that contain estrogen and/or progesterone receptors are sometimes called hormone receptor positive . Most ER-positive breast cancers are also PR positive. Breast cancers that lack ERs are called ER negative, and if they lack both ER and PR they may be called HR negative. Approximately 67%80% of breast cancers in women
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How Long After Mastectomy Do You Start Hormone Therapy
Many clinical trials are also now giving treatments in the neoadjuvant setting. Neoadjuvant hormone therapy is only an option for women whose tumors are estrogen receptor -positive and/or progesterone receptor -positive. Typically, a woman will take hormone therapy for three or four months prior to surgery.
Hormone Therapy For Breast Cancer In Men
Hormone therapy is a way to treat cancer by using hormones or drugs or other treatments that affect hormones. Hormone therapy is a form of systemic therapy, like chemotherapy. It can be used after surgery to help lower the risk of cancer coming back, or before surgery . It is also used to treat cancer that has spread, or cancer that has come back after treatment .
Some breast cancers grow in response to the hormones estrogen or progesterone. Estrogen and progesterone are usually thought of as female hormones, but men have them in their bodies also, just at lower levels. About 9 of 10 breast cancers in men are hormone receptor-positive. This makes them more likely to respond to hormone treatments. Breast cancers can be estrogen receptor -positive, or progesterone receptor -positive, or both. Hormone therapy does not help people whose tumors are both ER- and PR-negative.
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Treating Prostate Cancer With Combined Hormonal
Androgens, the family of male sex hormones that includes testosterone, function as a fuel for growth in normal development. However, in some men they can also drive the progression of prostate cancer. Hormonal therapy treats prostate cancer by dramatically reducing levels of testosterone and other androgens.
Hormonal therapy is sometimes given in conjunction with external beam radiation to boost the effectiveness of treatment. Hormonal therapy may also be used to shrink the size of large prostate glands before brachytherapy takes place, to enable proper placement of the radioactive seeds.
Combination hormonal/radiation therapy is now a standard option for men with cancer that has extended beyond the prostate or whose cancer is considered high-risk based on other clinical findings, with studies showing that it reduces the risk of dying from prostate cancer and other causes more than with either treatment given alone..
Combination therapy can also be considered for men with localized prostate cancer in the intermediate-risk category. Whether men with low-risk prostate cancer would benefit from a hormonal therapyradiation combination is uncertain.
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What Is Hormone Therapy For Cancer
Also referred to as hormonal or endocrine therapy, this cancer treatment is different from menopausal hormone replacement therapy , which refers to the prescription of supplemental hormones to help relieve the symptoms of menopause.
Certain cancers rely on hormones to grow. In these cases, hormone therapy may slow or stop their spread by blocking the bodys ability to produce these particular hormones or changing how hormone receptors behave in the body.
Breast and prostate cancers are the two types most commonly treated with hormone therapy. Most breast cancers have either estrogen or progesterone receptors, or both, which means they need these hormones to grow and spread. By contrast, prostate cancer needs testosterone and other male sex hormones, such as dihydrotestosterone , to grow and spread. Hormone therapy may help make these hormones less available to growing cancer cells.
Hormone therapy is available via pills, injection or surgery that removes hormone-producing organs, namely the ovaries in women and the testicles in men. Its typically recommended along with other cancer treatments.
If hormone therapy is part of your treatment plan, discuss potential risks or side effects with your care team so that you know what to expect and can take steps to reduce them. Let doctors know about all your other medications to avoid interactions.
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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:
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
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If Cancer Comes Back Or Has Spread
AIs, tamoxifen, and fulvestrant can be used to treat more advanced hormone-positive breast cancers, especially in post-menopausal women. They are often continued for as long as they are helpful. Pre-menopausal women might be offered tamoxifen alone or an AI in combination with an LHRH agonist for advanced disease.
Ovarian Ablation Or Suppression
For women who havent gone through menopause, ovarian ablation may be an option. This can be done medically or surgically. Either method stops estrogen production, which can help inhibit the growth of cancer.
Surgical ablation is done by removing the ovaries. Without production of estrogen from the ovaries, you will enter permanent menopause.
Symptoms of menopause may include:
- vaginal dryness
- changes in sex drive
Serious complications after surgical ablation are rare, but you may be more prone to complications if you have diabetes or obesity, or smoke cigarettes.
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Hormone Therapy For Breast Cancer: What You Should Know
Your treatment team will determine whether you might benefit from hormone therapy based on the type of cancer you have. Here are more details:
- What is hormone therapy for breast cancer? In certain types of breast cancers, called hormone receptor-positive breast cancers, the hormone estrogen helps cancer cells to grow. Hormone therapy is a type of medicine that aims to prevent cancer cells from using estrogen to grow or spread.
- How we use hormone therapy: Your doctor will tailor treatment recommendations to your specific circumstances. Hormone therapy may be used alone or with other breast cancer treatments. Your doctor may recommend you use hormone therapy at different times:
- For cancer recurrences, meaning if a cancer comes back after successful treatment
- After cancer has spread to other parts of the body