Premenopausal Breast Cancer Hormone Therapy

Future Perspectives And Challenges

Despite significant recent improvements, both healthcare professionals and patients still face several challenges in the future. One of the most striking and urgent needs is to learn how to incorporate the information achieved during modern randomized clinical trials into the individual routine patient care. Improving quality of life and reducing side effects is also pivotal in order to best exploit, e.g., the use of AIs and extended therapy in patients with early disease. Furthermore, considering the high number of young women living with advanced BC worldwide, we must develop new strategies and drugs as first-line treatment and to overcome resistance in pretreated patients.

Study Of Acupuncture In The Treatment Of Hot Flashes In Patients With Hormone Receptor

Acupoint selection: 4 general points + syndrome differentiation acupoints , and adjust acupoints according to symptoms every week.

Frequency: 3 times a week for a total of 8 weeks of continuous treatment.

Diet And Dietary Supplements

Some women find that changing the way they eat, such as eating smaller meals and avoiding triggers is helpful for them.

The effects of specific foods and dietary supplements on menopausal symptoms are not clear. This doesnt mean they wont help, but its important to understand that the evidence supporting their use is limited.

Phytoestrogens: These are estrogen-like substances found in certain plants, such as soy, red clover, and black cohosh. Some women take supplements containing these substances to try to help with symptoms of menopause.

Eating soy foods seems to be safe for breast cancer survivors, although its not clear if it can help relieve menopause symptoms. Women can get higher doses of phytoestrogens in some dietary supplements . However, not enough is known about these supplements to know for sure if they are safe and if they work. If you are considering taking one of these supplements, be sure to talk with your doctor first.

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Possible Side Effects Of Ais

The most common side effects of AIs are:

• Bone and joint pain

AIs tend to have side effects different from tamoxifen. They don’t cause uterine cancers and very rarely cause blood clots. They can, however, cause muscle pain and joint stiffness and/or pain. The joint pain may be similar to a feeling of having arthritis in many different joints at one time. Options for treating this side effect include, stopping the AI and then switching to a different AI, taking a medicine called duloxetine , or routine exercise with nonsteroidal anti-inflammatory drugs . But the muscle and joint pain has led some women to stop treatment. If this happens, most doctors recommend using tamoxifen to complete 5 to 10 years of hormone treatment.

Because AIs drastically lower the estrogen level in women after menopause, they can also cause bone thinning, sometimes leading to osteoporosis and even fractures. If you are taking an AI, your bone density may be tested regularly and you may also be given bisphosphonates or denosumab , to strengthen your bones.

Is It Safe For Women Who Have Had A Cancer Diagnosis To Take Mht

One of the roles of naturally occurring estrogen is to promote the normal growth of cells in the breast and uterus. Some cancers also use estrogen to promote their growth. Thus, it is generally believed that MHT may promote further tumor growth in women who have already been diagnosed with breast cancer. However, studies of MHT use in breast cancer survivors have produced conflicting results, with some studies showing an increased risk of breast cancer recurrence and others showing no increased risk of recurrence .

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Hormone Therapy For Postmenopausal Women

After menopause, hormone therapy for women with metastatic breast cancer can be an aromatase inhibitor, tamoxifen, fulvestrant or other hormone therapy drug.

If the first hormone therapy stops working and the cancer starts to grow again, a second hormone therapy can be used. If the second drug stops working, another can be tried.

Ovarian suppression isnt helpful for postmenopausal women because their ovaries have already stopped producing large amounts of estrogen.

Learn more about tamoxifen.

Learn more about aromatase inhibitors.

Data On Cancer Risk From Hormone Therapy Reassuring Menopause Experts Say

Hormone therapy is used to treat night sweats, hot flashes and other symptoms associated with menopause.

A new scientific paper and other recent evidence offer important reassurances about the risk of breast cancer from hormone therapy to treat menopause symptoms, two School of Medicine menopause experts say.

Hormone therapy can help relieve menopause symptoms such as hot flashes, night sweats, sleep disturbances, vaginal issues, sexual problems and loss of bone density. But information has been conflicting on whether or how much this treatment increases recipients risk of breast cancer.

The new review in the scientific journal Menopause, combined with other recent findings, provides much-needed clarity, according to UVA Healths JoAnn V. Pinkerton, MD, and Carolyn S. Wilson, MD. Pinkerton and Wilson have outlined their thoughts on the review in an accompanying editorial co-written with Andrew M. Kaunitz, MD, of the University of Florida College of Medicine Jacksonville.

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Hormonal Therapy For Pre

Anna Mazzucco, PhD, Brandel France de Bravo, MPH, Caroline Halsted, Danielle Shapiro, MD, MPH, and Diana Zuckerman, PhD, Cancer Prevention and Treatment Fund

Breast cancer is the most common type of cancer in women around the world, and the second leading cause of cancer deaths among U.S. women. The survival rate for early-stage breast cancer is very high. For women whose breast cancer is diagnosed before it has spread, the 5-year survival rate is 99%. For women whose breast cancer has spread to the lymph nodes, the 5-year survival rate is 85%.

Women who are diagnosed with early-stage breast cancer almost always undergo surgery to remove the cancer . Most will also choose at least one other treatment in addition to surgery:

1) If they have a lumpectomy, they often undergo radiation either to shrink the tumor before surgery or to kill any cancer cells in the breast that were missed during surgery.

2) If their cancer is estrogen receptor positive , many women will try to take hormonal therapy for at least five years after surgery to lower the chance of cancer in either breast in the future. For pre-menopausal women, the standard treatment is tamoxifen.

Use Of Other Predictive Factors

Recently, a considerable body of reports has suggested that women treated with tamoxifen may respond less well if their tumours over-express neu/erb B-2 antigen. Although some studies support this contention , others do not . Of even greater interest is that some studies have suggested that neu/erb B-2 over-expressing tumours may be more responsive to other endocrine agents such as aromatase inhibitors , but once again some analyses of this matter are contradictory . In addition, the only trial examining the role of neu/erb B-2 in premenopausal women, that of Love and coworkers , suggests that patients whose tumours over-express neu/erb B-2 are more likely to respond to adjuvant treatment with OA and tamoxifen than are patients whose tumours do not over-express. Thus, it appears that over-expression of neu/erb B-2 should not be used as a predictive factor to select endocrine versus chemotherapy or for particular types of endocrine therapy at this time. Further studies of the role of neu/erb B-2 over-expression in order to explain and clarify these contradictory findings are urgently required. Hopefully, neu/erb B-2 over-expression and other molecular markers will be useful in the near future as we refine and target endocrine therapy toward the women who are most likely to benefit from it.

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How Does Hormone Therapy For Breast Cancer Work

Hormones control nearly all of our bodily functions, from growth and development to emotions, sexual function and even sleep. But hormones, which occur naturally in our bodies, can also fuel the growth of certain breast cancers. We talked with breast medical oncologist Rachel Layman, M.D., to learn about hormone therapy for breast cancer, which can stop or slow the cancer-fueling action of hormones.

What is hormone therapy for breast cancer?

Hormone therapy is a form of treatment that deprives breast cancer of estrogen and progesterone, the two main female hormones that it needs to survive and grow.

Estrogen and progesterone are carried along in the bloodstream. When they encounter a breast cancer cell, they stick to proteins called hormone receptors on the cells surface. This connection acts as an on switch and triggers the cancer cell to grow. The goal of hormone therapy is to prevent hormones from attaching to cancer cells, which deprives the cancer cells of the fuel they need to grow.

Are all breast cancers fueled by hormones?

No, but most are. About 70% of all breast cancers depend on estrogen or progesterone for growth.

How do hormone therapies for breast cancer work?

Hormone therapies reduce or eliminate contact between hormones and breast cancer cells in several different ways:

How and when are hormone therapy medications delivered?

Most hormone therapy drugs are taken as a daily oral pill, though a few are given as injections in the clinic.

Screening Guidelines For Young Women

There are numerous screening guidelines for breast cancer. Most advise women at high risk to begin having regular mammograms much sooner than those at low or average risk. The National Comprehensive Cancer Network, for instance, recommends women who have a BRCA mutation or a first-degree relative with a BRCA mutation have a mammogram and breast magnetic resonance imaging yearly starting at 25.

After a younger woman discovers a lump in her breast or a growth shows up on a screening test, her doctor will take the same steps to diagnose it as they would for an older woman:

• Imaging, either a mammogram or an ultrasound
• Biopsy to remove fluid or tissue from the breast to study under a microscope

The doctor also may consider other possible causes of a breast lump, such as a cyst, fibroadenoma, lymphoma, duct ectasia, and a wart-like growth called a papilloma, among others.

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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.

Types Of Hormonal Therapies For Early Stage Breast Cancer

Hormonal therapy is the opposite of the type of hormones women sometimes take to reduce the symptoms of menopause. It lowers your estrogen levels instead of increasing them.

Hormonal therapy is recommended for most women with breast cancer, and sometimes it is taken by women who have not been diagnosed with breast cancer but are at high risk for it based on their genes or family history. When hormonal therapy is used before breast cancer develops, it is called primary prevention or chemoprevention. Chemoprevention is completely different from the drugs used in chemotherapy to treat breast cancer. See our article on breast cancer prevention.

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Is There A Standard Adjuvant Endocrine Treatment

Several therapeutic options are currently available and the individual choice should consider the risk of recurrence, the latest scientific evidence as well as the toxicity profile, the patient’s comorbidities, and her personal preference.

The first-ever endocrine therapy in premenopausal patients was ovarian suppression by surgical castration or ovarian irradiation . In developed countries, this approach has been progressively replaced by gonadotropin-releasing hormone analogues , with comparable results . Surgical castration remains a low-cost choice in developing countries. Bilateral salpingo-oophorectomy is also a valid alternative in BRCA1/2 mutation carriers with completed family planning.

For over 30 years, tamoxifen for 5 years has been the gold standard . The benefit of adjuvant tamoxifen is independent of age , with a 30% BC mortality reduction at 15 years. In women < 50 years, the greatest benefit is achieved in patients with axillary involvement .

Aromatase inhibitors block the conversion of androgens to estrogens, thereby reducing tissue and plasmatic estrogen levels . Third-generation AIs such as letrozole and anastrozole and exemestane are associated with a modest but significant improvement in disease outcomes over tamoxifen in menopausal women . AIs cannot be used alone in premenopausal patients due to the risk of ovarian stimulation resulting in a paradoxical increase in circulating estrogens.

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Anxiety And Mood Changes

Exercise, again, will help to stabilize your mood changes and reduce anxiety. If you have difficulty doing 20 to 30 minutes of aerobic exercise, three times a week, then begin with what you are comfortable with and try to increase your exercise program when you are ready.

Invoking the relaxation response by using deep abdominal breathing will also help you to relax, reduce anxiety and stabilize mood changes.

Talking with a professional also is recommended.

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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.

How Do Hormone Therapies Work

Hormone therapy drugs slow or stop the growth of hormone receptor-positive breast cancers in a couple of ways:

• Some hormone therapies, such as tamoxifen, attach to the hormone receptor in the cancer cell and block estrogen from attaching to the receptor.
• Others, such as aromatase inhibitors and ovarian suppression, lower the level of estrogen in the body so the cancer cells cant get the estrogen they need to grow.

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Hormone Therapy And Breast Cancer Risk

There have been longstanding questions about whether hormone therapy including progestogens and estrogen together or estrogen alone puts women at increased risk of breast cancer. The waters have been muddied by sometimes conflicting results from large observational studies and two large randomized Womens Health Initiative clinical trials.

The uncertainty prompted the authors of the new Menopause review to evaluate the differences between the trial data and the observational data. They set out to examine both the large WHI trials and smaller randomized controlled trials that could provide additional insight.

Their results, Pinkerton and her co-authors say in the accompanying editorial, make a strong case that hormone therapy taken at menopause does not increase the risk of invasive breast cancer for women who have received a hysterectomy.

The editorial notes that estrogen combined with progesterone increases breast cancer risk for women who have not undergone a hysterectomy, especially when used long-term. However, the authors point to another recent study indicating that the increased risk did not translate into a higher risk of death. The lack of higher mortality with combined estrogen and progesterone therapy is reassuring for women with a uterus who have been concerned about using hormone therapy at menopause, Wilson said.

Adjuvant Hormonal Therapy Treatment Time

For many years, women took hormonal therapy for five years after surgery for early-stage, hormone receptor-positive breast cancer. In most cases, the standard of care is five years of tamoxifen, or two to three years of tamoxifen followed by two to three years of an aromatase inhibitor, depending on menopausal status.

Recent research has found that in certain cases, taking tamoxifen for 10 years instead of five years after surgery lowered a womans risk of recurrence and improved survival.

In most cases, a post-menopausal woman diagnosed with early-stage, hormone receptor-positive breast cancer would take an aromatase inhibitor for five years after surgery to reduce the risk of recurrence. After that, if breast cancer had been found in the lymph nodes, called node-positive disease, a woman would take an aromatase inhibitor for an additional five years, for a total of 10 years of hormonal therapy treatment.

Doctors call taking hormonal therapy for 10 years after surgery extended adjuvant hormonal therapy.

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