Side Effects Of Hormone Blocking Therapy For Breast Cancer

Muscle And Bone Changes

You might develop pains in your joints. This often settles down after a few weeks. You can take a mild painkiller to help control aches and pains.

Some hormone therapies such as aromatase inhibitors can cause thinning of your bones. Tamoxifen can cause bone thinning in pre menopausal women. Tamoxifen doesnt cause bone thinning in post menopausal women, and it can help to maintain the strength of your bones.

Weight bearing exercise can help to build up the bones and protect them. This means any exercise where you are carrying your own weight, such as walking, running, cycling or exercise in the gym.

Swimming is not weight bearing exercise. So, although it is good for you in other ways, it won’t help with bone thinning. Check with your doctor before starting any new type of exercise, especially if you have not exercised for a while.

Bone thinning can lead to osteoporosis and bone fractures if it continues for a few years. So, your doctor may treat you with a drug to strengthen your bones.

• Get more information on osteoporosis risk and hormone therapy

What Are Hormones And Hormone Receptors

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 .

Cancer That Clearly Has Spread

If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.

When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get chemotherapy along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.

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Drugs That Block Estrogen

Some drugs work by blocking estrogen from causing cancer cells to grow.

Tamoxifen is a drug that prevents estrogen from telling cancer cells to grow. It has a number of benefits:

• Taking Tamoxifen for 5 years after breast cancer surgery cuts the chance of cancer coming back by half. Some studies show that taking it for 10 years may work even better.
• It reduces the risk that cancer will grow in the other breast.
• It slows the growth and shrinks cancer that has spread.
• It reduces the risk of getting cancer in women who are at high risk.

Other drugs that work in a similar way are used to treat advanced cancer that has spread:

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Selective Estrogen Receptor Modulators

Also called SERMs, these drugs prevent breast cancer cells from binding to estrogen. SERMs block the effects of estrogen in breast tissue but not in other tissues within the body.

Traditionally, these drugs are usually used in premenopausal women. The most commonly used SERMs include:

• Tamoxifen . This medication blocks estrogen from binding to estrogen receptors on breast cancer cells. This helps stop the cancer from growing and dividing. People who take tamoxifen for 10 years following breast cancer treatment are less likely to have the cancer return and more likely to live longer than people who took the drug for only 5 years, according to the National Cancer Institute .
• Fulvestrant . This is an injected ER-blocking medication thats commonly used to treat advanced breast cancer. Unlike other SERMs, it blocks the effect of estrogen throughout the entire body. Fulvestrant is often used with other drugs such as palbociclib .
• Toremifene .This drug, which isnt commonly used in the United States, is only approved to treat HR-positive breast cancer in postmenopausal women thats spread to other parts of the body. It may not be beneficial for people whove had limited success using tamoxifen.

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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.

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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Looking After Your Bones While Taking An Aromatase Inhibitor

Aromatase inhibitors can reduce bone density. This may increase the risk of breaks in the bones. To keep your bones healthy while you are taking this medication, your doctor may recommend that you:

• have a bone density test before and during treatment
• do regular weight-bearing exercise
• maintain a healthy intake of calcium
• ensure a healthy intake of vitamin D
• take other prescription medications to build up your bones if your bone density is already low

If you do show signs of bone thinning or weakening you may need to see your GP or specialist for special treatment for your bones.

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 Hormone Treatment For Breast Cancer

• Hormone therapies for hormone receptor-positive breast cancer can lead to side effects such as hot flashes, vaginal dryness, pain, and nausea.
• A variety of strategies can help you manage many side effects and improve your quality of life during hormonal treatment.

In hormone receptor -positive breast cancer, the cancer cells contain receptors to estrogen or progesterone or both and rely on signals from these hormones to help them grow. By reducing those signals, hormone treatments for HR-positive breast cancer work very effectively.

Although hormonal therapies also called endocrine therapies may be necessary for treating HR-positive breast cancer, they often have unwanted side effects. There are many strategies for managing these side effects and feeling your best while taking hormone treatments for HR-positive breast cancer.

Joint Discomfort And Pain

Joint symptoms related to hormone therapy for breast cancer do not tend to improve with the use of medications that you might take for typical arthritis, like acetaminophen or ibuprofen, Mayer says.

What helps: Acupuncture and activity both show promise. âWe do have evidence that acupuncture can be helpful for joint pain,â Mayer says. âRegular exercise can also help reduce joint pain as well as helping you sleep better at night.â

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Hormone Therapy Can Cause Side Effects

Because hormone therapy blocks your bodys ability to produce hormones or interferes with how hormones behave, it can cause unwanted side effects. The side effects you have will depend on the type of hormone therapy you receive and how your body responds to it. People respond differently to the same treatment, so not everyone gets the same side effects. Some side effects also differ if you are a man or a woman.

Some common side effects for men who receive hormone therapy for prostate cancer include

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.

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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:

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.

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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.

Questions To Ask The Health Care Team

• What side effects are common from the hormone therapy treatment you are recommending for me?

• When is it likely that side effects will occur? How often?

• How long will side effects last? Could any of them be permanent?

• Is there anything I can do to prepare for these side effects?

• What can the health care team do to prevent or relieve side effects?

• Who should I tell if I begin experiencing side effects from hormone therapy? How soon?

• What side effects are considered emergencies? What should I do if I experience an urgent side effect?

• Who do I contact if I have questions about specifci side effects?

• How can I reach them during regular business hours? After hours?

• Are there any support groups you can recommend to help cope with the fear of side effects?

• Are there other ways I can cope with my fears about the effects of treatment?

• Can you recommend a social worker, counselor, or supportive or palliative care specialist for me to talk with?

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Who Gets Hormone Therapy For Breast Cancer

When youâre diagnosed with breast cancer, your doctor will test cells from your tumor to see if they have parts on their surfaces called receptors that use estrogen or progesterone. If they do, it means that they depend on these hormones to grow. In that case, your doctor will probably recommend hormone therapy as part of your treatment plan.

If youâve already been treated for breast cancer, you might use hormone therapy to help keep it from coming back. It also helps lower your odds of getting new cancers in the other breast.

Also, if you don’t have the disease but have a family history of it, or genes that raise your risk, your doctor may recommend hormone therapy to lower your chances of getting it.

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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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.

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:

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