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Side Effects Of Hormonal Therapy For Breast Cancer

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What Are Hormones And Hormone Receptors

Hormone Therapy for Breast Cancer and the Side Effects of Tamoxifen

Hormones are substances that function as chemical messengers in the body. They affect the actions of cells and tissues at various locations in the body, often reaching their targets through the bloodstream.

The hormones estrogen and progesterone are produced by the ovaries in premenopausal women and by some other tissues, including fat and skin, in both premenopausal and postmenopausal women and in men. Estrogen promotes the development and maintenance of female sex characteristics and the growth of long bones. Progesterone plays a role in the menstrual cycle and pregnancy.

Estrogen and progesterone also promote the growth of some breast cancers, which are called hormone-sensitive breast cancers. Hormone-sensitive breast cancer cells contain proteins called hormone receptors that become activated when hormones bind to them. The activated receptors cause changes in the expression of specific genes, which can stimulate cell growth.

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 are ER positive . Approximately 90% of breast cancers in men are ER positive and approximately 80% are PR positive .

Coping With Menopausal Symptoms

One common way of coping with symptoms of natural menopause is hormone replacement therapy , which involves taking hormones to make up for the decreased production that occurs with age.

HRT is not the same as hormonal therapy taken as a breast cancer treatment hormonal therapy lowers hormone levels and HRT raises them. HRT is not an option for people with HR-positive breast cancer because it could cause cancer cells to grow. However, nonhormone prescription medications and alternative therapies can help relieve menopausal symptoms.

Hot Flashes and Night Sweats

Your doctor may prescribe medicines like venlafaxine or gabapentin for hot flashes or night sweats. Alternative approaches like supplements and acupuncture are also popular ways to cope with these symptoms.

In a 2016 study, researchers found that a course of up to 20 acupuncture treatments over six months reduced the number of hot flashes and night sweats participants experienced. In another study, menopausal women experienced fewer hot flashes after five weekly hypnosis sessions. There is limited evidence for other approaches, such as taking supplements.

Some supplements, like black cohosh, could make breast cancer treatments less effective, so be sure to discuss alternative medicine approaches and supplements with your oncologist before trying them.

Vaginal Dryness

Members have also shared several suggestions and success stories for coping with vaginal dryness:

Mood Swings

Weakened Bones

Analyses Starting At Year 5

Cumulative risks and annual rates of distant recurrence in each 5-year period during the period from 5 to 20 years for the 62,923 women who reached year 5 without breast-cancer recurrence or any second cancer and who were scheduled to discontinue endocrine therapy are shown in Figure 3. The results are presented separately for T1 and T2 tumors and are subdivided according to nodal status at diagnosis. Although all the women had been clinically disease-free for many years, the original tumor diameter and especially the original nodal status remained powerful determinants of late distant recurrence, even during the second decade after diagnosis. Within each TN-status category, distant recurrences continued to occur steadily throughout the period from 5 to 20 years.

Association between Pathological Nodal Status and the Risk of Distant Recurrence during Years 5 to 20 of the Study, According to Tumor Stage.

Even for women with the best prognosis, the risks were appreciable. For those with T1N0 disease, the annual rate of distant recurrence remained approximately 1% throughout the period from 5 to 20 years, resulting in a cumulative risk of distant recurrence of 13% . The associations of tumor diameter and nodal status with the risk of distant recurrence during the period from 5 to 20 years were approximately additive, with a progressive increase from 13% for T1N0 to 41% for T2N49 disease . Similar results were observed for rates of death from breast cancer .

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Managing Symptoms & Side Effects

General side effects can happen when hormonal therapy is given, but they depend on a number of things, including the specific cancer being treated, how your body responds to the treatment and the type of hormonal therapy being administered. Side effects vary between men and women and by drug. Some of the most common side effects include:

  • loss of interest in sex

We offer ways for you to document, track, recognize and reduce your symptoms and side effects. Even with all these resources available, we want to remind you that its still important to discuss your symptoms with your healthcare team.

Do You Need More Information Or Help With Side Effects

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It is important to know that most people tolerate anti-hormonal therapy quite well. Side effects can interfere with your quality of life. These medications are an important part of your treatment plan for your breast cancer. If you experience side effects it is important to talk to someone on your health care team about them.

The Breast Cancer Patient & Family Educator at the Breast & Gyne Cancer Centre of Hope can help you understand your cancer and treatments including anti-hormonal therapy. As a nurse, the educator can help you with side effects and make suggestions that may help you. Call 204-787-4130 or Toll-Free 1-866-561-1026.

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Adjuvant Endocrine Therapy For Bca

Adjuvant therapy is often decided by the oncologist based on clinical, pathologic, and genetic scoring parameters. Several meta-analyses have demonstrated a consistent benefit for a patients survival with the addition of endocrine therapy in hormone receptorpositive nonmetastatic bca. The three classes of agents used are the selective estrogen receptor modulators , the aromatase inhibitors , and ovarian suppression. Figure 1 summarizes the sequencing strategies for those agents, and notes key definitions .

Algorithm for choice of endocrine therapy in the adjuvant setting. aMenopause: Defined as any patient less than 60 years of age who previously underwent bilateral oophorectomy or who has not had any menstrual periods for 12 months or more in the absence of tamoxifen, chemotherapy, or ovarian suppression, and whose serum estradiol is in the postmenopausal range or who is amenorrheic on tamoxifen, with follicle-stimulating hormone and serum estradiol in the postmenopausal range. bAny patient 60 years of age or older. cAny patient less than 35 years of age or any premenopausal patient who has received chemotherapy in the adjuvant setting. dAdditional treatments to be decided in conjunction with an oncologist, on a case-by-case basis. OS = ovarian suppression Tam = tamoxifen AI = aromatase inhibitor .

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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How Hormone Therapy Is Given

Hormone therapy may be given in many ways:

  • 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.

Managing The Side Effects Of Hormone Therapy

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Before hormone therapy begins, talk with your doctor about what side effects could happen and how they can be managed. Ask questions about anything that is unclear to you. This will help you feel more prepared if you start experiencing those side effects. Let your health care team know about any new or worsening medical problems you have as soon as possible. This is important to do even if you do not think your symptoms are serious or related to your hormone therapy. Tracking your side effects can make getting the relief you need easier. One way to track side effects is using the free Cancer.Net Mobile app. You can securely record when side effects occur and their severity, and you can easily share these details with your health care team to describe your experience.

Some people may need to take hormone therapy for a long time. Working with your health care team to manage side effects can help maintain quality of life while on this kind of extended cancer treatment.

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Stopping The Ovaries Working

In premenopausal women, doctors might use a type of hormone treatment to stop the ovaries from producing oestrogen. This type of drug is called a luteinising hormone releasing hormone . For example, goserelin and leuprorelin . You might have this on its own or with other hormone therapy drugs.

LHRH drugs work by blocking a hormone made in the pituitary gland that stimulates your ovaries to make and release oestrogen. This stops your ovaries from working. So you won’t have periods or release eggs while you are having the injections.

When you stop taking the drug, your ovaries should start working again. But, if you’re close to the age at which your menopause would naturally start, your periods might not start again.

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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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.

Possible Side Effects Of Ais

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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.

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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.

Managing The Side Effects Of Ais

AI-Induced Bone Loss

Estrogen deficiency has long been recognized as a risk factor for osteoporosis by increasing bone resorption through osteoclastogenesis. In a meta-analysis of seven trials comparing ais with tamoxifen in postmenopausal women with early-stage bca, use of ais significantly increased the risk of bone fractures 13. The U.S. National Comprehensive Cancer Network recommends an evaluation with baseline bone mineral density testing and follow-up every 2 years for women with bca undergoing therapy that lowers sex steroids14. Given osteoclastogenesis from estrogen deficiency, the use of osteoclast inhibitors such as bisphosphonates not only prevents bone loss, but, in postmenopausal women, is associated with a reduction in bca recurrence and bca mortality 15. The latest guidelines from Cancer Care Ontario and the American Society of Clinical Oncology therefore indicate that postmenopausal women and patients on ovarian suppression receiving adjuvant systemic treatment should be considered for intravenous zoledronic acid or oral clodronate for 35 years16. Supplementation with 1200 mg elemental calcium and 800 IU vitamin D daily is recommended for all patients14.

AI-Induced Musculoskeletal Symptoms

The use of ais has been associated with an increased risk of arthralgias, significantly increased tendon thickness, and carpal tunnel syndrome1719. Most of the carpal tunnel syndrome cases were mild-to-moderate in severity and did not require treatment.

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Joint And Muscle Pain

Joint pain and muscle pain are common side effects of aromatase inhibitors . The pain may be in the hands and wrists, feet and ankles, knees, back or other parts of the body. Joint and muscle pain are most common after youve been sleeping or inactive.

Almost half of women taking aromatase inhibitors have joint pain and about 15 percent have muscle pain .

Joint and muscle pain can mimic carpal tunnel syndrome. In rare cases, aromatase inhibitors can cause carpal tunnel syndrome .

Although aromatase inhibitors can cause joint and muscle pain, they dont cause permanent joint or muscle damage.

Which Treatment Is Best For You

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The best treatment for you depends on a variety of things: your age, your overall health, the type of cancer you have and its stage, various factors with your cancer like hormone receptor status, and any other medical conditions you might have.

You and your treatment team will review all of your treatment options and go over the risks and benefits of each one. Together, you can gather all of the necessary information to make an informed decision about your treatment.

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Prices And Where To Get It

The cost of hormone therapy depends on a few things, including what drug youre taking, where you live, how long youll be on it, and the dosage.

If you have health insurance, call them to find out what your benefits are with hormone therapy. They can give you an estimate of your out-of-pocket expenses and copays . You can also talk with the finance or billing department of your health providers office or treatment center.

If you do not have health insurance, speak with the billing department of your treatment place. They may have financial aid programs or know of grants or programs you can apply for to help pay for cancer treatment.

What Is Hormonal Therapy

Hormones help control how cells grow and what they do in the body. The hormones oestrogen and progesterone, particularly oestrogen, can encourage some breast cancers to grow.

Hormonal therapies reduce the amount of oestrogen in the body or stop it attaching to the cancer cells. They only work for women with oestrogen-receptor positive cancers.

Your cancer doctor will advise you to take hormonal therapy to reduce the risk of the breast cancer coming back. It also helps reduce the risk of getting a new breast cancer in your other breast. Sometimes hormonal therapy drugs are given before surgery to shrink a cancer and avoid a mastectomy.

You usually take hormonal therapy drugs for a number of years. For some women, this could be up to 10 years. You usually start taking them after surgery or chemotherapy.

The type of hormonal therapy you have depends on:

  • whether you have been through the menopause or not
  • the risk of the cancer coming back
  • how the side effects are likely to affect you.

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How Does It Work

There are two main kinds of hormone therapies:

  • Those that block the production of hormones
  • Those that interfere with the behavior of hormones in the body

Hormone therapy may be used for breast cancer when the tumor cells have hormone receptors for estrogen or progesterone. In people with prostate cancer, hormone therapy may be used to reduce or block androgen hormones.

Easing Joint Or Muscle Pain

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If you have joint or muscle pain while taking an aromatase inhibitor, talk with your health care provider.

Your health care provider may recommend anti-inflammatory medications , special exercises or acupuncture to ease the pain . Getting regular physical activity may reduce joint and muscle pain .

Your health care provider may also switch you to another aromatase inhibitor or recommend tamoxifen .

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