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Hormonal Therapy Drugs For Breast Cancer

Ovarian Ablation Or Suppression

Hormonal Therapy for Breast Cancer: We Teach You

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 , but you may be more prone to complications if you have diabetes or obesity, or smoke cigarettes.

Blocking The Effects Of Estrogen

Different kinds of drugs are used to block the effects of estrogen.

Selective estrogen receptor modulators block the effects of estrogen in breast tissue. SERMs mimic estrogen and attach to the estrogen receptors, preventing estrogen from binding to receptors.

Examples of SERMs include:

Another drug that blocks the effects of estrogen is Faslodex . The difference is that, unlike SERMs, Faslodex doesnt mimic estrogen.

How To Tell If Hormone Therapy Is Working

If you are taking hormone therapy for prostate cancer, you will have regular PSA tests. If hormone therapy is working, your PSA levels will stay the same or may even go down. But, if your PSA levels go up, this may be a sign that the treatment is no longer working. If this happens, your doctor will discuss treatment options with you.

If you are taking hormone therapy for breast cancer, you will have regular check-ups. Checkups usually include an exam of the neck, underarm, chest, and breast areas. You will have regular mammograms, though you probably wont need a mammogram of a reconstructed breast. Your doctor may also order other imaging procedures or lab tests.

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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.

Managing The Side Effects Of Tamoxifen

Holistic Breast Cancer Treatment

Hot Flashes

Hot flashes are one of the most common and bothersome side effects of tamoxifen, being reported in up to 80% of patients undergoing therapy29. They also occur to a much lesser extent in patients taking ais. Drugs that inhibit the activity of CYP2D6, such as the selective serotonin reuptake inhibitors, reduce the occurrence of tamoxifen-related hot flashes by decreasing the conversion of tamoxifen to its most active metabolite, endoxifen30. However, strong CYP2D6 inhibitors could adversely affect drug efficacy. Therefore, moderate CYP2D6 inhibitors are preferred over strong inhibitors for the treatment of hot flashes.

Venous Thromboembolism

The relative risk of venous thromboembolism is increased by a factor of 23 in older women receiving tamoxifen31,32. The risk seems to be further pronounced when therapy is extended to 10 years from 5 in the adjuvant setting8. Risk factors for tamoxifen-induced venous thromboembolism include prior surgery, fracture, immobilization, and heterozygous factor v Leiden carrier status33. However, the risk of fatal pulmonary embolism does not seem to increase with tamoxifen use extended to 10 years , especially for women less than 54 years of age6,8.

Endometrial Cancer

Tamoxifen-Induced Ocular Pathologies

Tamoxifen-Induced Fatty Liver Disease

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How Anastrozole Is Given

Anastrozole is taken as a tablet once a day, with or without food. Its best to take it at the same time every day.

If you miss a dose, you dont need to take an extra dose the next day. The level of drug in your body will remain high enough from the day before.

Some brands of anastrozole contain small amounts of lactose. If you know you are lactose intolerant discuss this with your treatment team or pharmacist.

What Happens When Hormone Therapy Stops Working

After some months or years the hormone treatment usually stops working and the cancer starts to grow again. Your doctor might recommend stopping or changing hormone treatment at this stage. If youre having anti androgens and your PSA level has started to rise again your doctor might get you to stop taking them.

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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.

What Are The Possible Side Effects Of Goserelin


Like any drug, goserelin can cause side effects. Everyone reacts differently to drugs and some people have more side effects than others. Having few or no side effects doesnt mean the drug isnt effective. As goserelin can be given in addition to chemotherapy or other hormone therapies, its sometimes difficult to know which side effects are being caused by which treatment.

You can talk to your treatment team about any side effects youre having from goserelin and how best to manage them.

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What Are Hormone Inhibitors And How Do They Work

Hormone inhibitors also target breast cancer cells with hormone receptors, but unlike hormone blockers, they work by reducing the bodys hormone production. When breast cancer cells are cut off from the food supply the tumor begins to starve and die.Generally, the benefits of using hormone therapy and chemotherapy together have a much greater combined effect than using either alone. If your breast cancer is positive for hormone receptors, your doctor may recommend both therapies.

How Metastatic Breast Cancer Is Treated

In cancer care, different types of doctors often work together to create a patients overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Breast cancer multidisciplinary care teams typically include medical oncologists, surgical oncologists, radiation oncologists, radiologists, and pathologists. In addition, cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, genetic counselors, social workers, pharmacists, counselors, dietitians, financial advisors, and other supportive care members. Ask the doctor in charge of your treatment which health care professionals will be part of your treatment team and what they do. This can change over time as your health care needs change.

A treatment plan is a summary of your cancer and the planned cancer treatment. It is meant to give basic information about your medical history to any doctors who will care for you during your lifetime. Before treatment begins, ask your doctor for a copy of your treatment plan. The treatment plan can be updated over time as your treatments change.

The main goals of metastatic breast cancer treatment are to make sure that you have the:

  • Longest survival possible with the disease

  • Fewest possible side effects from the cancer and its treatment

  • Best and longest quality of life possible

Treatment options for metastatic breast cancer vary based on:

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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.

Are There Risks To Taking Tamoxifen

Cancer drug hormone therapy

Yes. The risks include:

  • Fertility. Tamoxifen can increase your fertility for a short time. But it might harm a growing baby, so itâs important to use some form of barrier birth control while youâre taking it, like condoms or a diaphragm. Donât use birth control pills. They can change how the drug works and affect the breast cancer. Tell your doctor right away if you think youâve become pregnant while youâre taking tamoxifen.
  • Blood clots. Women who take tamoxifen may have a slightly higher risk of blood clots in their lungs or large veins. Itâs an even bigger risk for smokers.
  • Uterine cancer or sarcoma. The drug may make a woman more likely to get these diseases. But this risk is small, and it may be outweighed by the benefits of tamoxifen for breast cancer treatment. Talk to your doctor to know for sure.
  • Cataracts. Tamoxifen seems to give some women a higher chance of having this condition, which clouds the lens inside the eye. People have also reported eye problems such as corneal scarring or retinal changes.
  • Medications. Tamoxifen may affect how other drugs work in your body.

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What Are Hormone Receptors

Breast cancers that are hormone receptor positive have receptors for the female hormones oestrogen and/or progesterone on the inside of the cancer cells.

In breast cancer cells that are hormone receptor positive, oestrogen and/or progesterone, which are naturally produced in the body, make the cancer grow. You can think of it as the receptor being the lock and oestrogen being the key. The oestrogen fits into the receptor and switches the cancer cell on, causing it to grow. Hormone therapy for breast cancer can starve cancer cells by upsetting this process.

Testing for hormone receptors is part of the routine pathology testing following surgery. Testing is done on a core biopsy sample if surgery is not planned.

Your doctor will be able to tell you if your breast cancer is hormone receptor positive or not. Most, but not all breast cancer is hormone receptor positive.

The hormonal therapies described in this brochure only work against breast cancers that are hormone receptor positive. Other treatments need to be used for cancers that are hormone receptor negative.

Data Extraction And Quality Assessment

Data from included articles was extracted using data collection forms with information regarding study design, in- and exclusion criteria, number of included patients, age, tumor stage and grade, estrogen and progesterone receptor status, previous treatment and complete response , partial response , stable disease , progressive disease, progression free survival , and overall survival was noted. Additional information was requested from study authors if necessary.

The quality of each individual study was assessed in five domains based of the National Institute of Health Quality Assessment Tool for Case Series Studies . Each full-text article was evaluated independently by three authors and risk of bias was subsequently discussed in a consensus meeting.

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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.

Turning Off The Ovaries With Medication

Hormonal therapy in breast cancer

The ovaries can be shut down temporarily with medication. This is usually done by giving a course of monthly injections of goserelin . This gradually causes the levels of oestrogen to fall, which leads to temporary menopause.The menstrual periods stop and other symptoms of menopause may develop . These symptoms can be reversed. If the injections are stopped, the oestrogen levels and menstrual periods return to normal. Some women who are considering having their ovaries removed have these injections for a few months to test out the menopausal symptoms. They still have the choice of reversing the effect if the side effects are too intense. The use of goserelin is strictly controlled by the Australian Pharmaceutical Benefits Scheme and may not be available to all women.

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Breast Cancer And Tamoxifen

Tamoxifen is a pill that doctors have prescribed for more than 30 years to treat breast cancer. It works by keeping estrogen from attaching to the cancer cells.

Doctors first used tamoxifen to treat women whose breast cancer had spread in their bodies because it slowed or stopped the growth of the disease. The drug also lowers the chance that some early stage breast cancers will come back. And it can lower the risk that a woman will get cancer in the other breast later on.

Women who are at high risk for breast cancer can take tamoxifen to try to lower their chances of getting the disease. Itâs an alternative to watchful waiting or having surgery to remove a breast, called a mastectomy, before they get the disease.

Tamoxifen is an option for:

  • Treatment of the earliest form of breast cancer, ductal carcinoma in situ , along with surgery
  • Treatment of abnormal cells in the glands that make milk, called lobular carcinoma in situ , to lessen the chance that theyâll become more advanced breast cancer
  • Treatment of breast cancer in men and women whose cancers use estrogen
  • Treatment of breast cancer that has spread to other parts of the body or that comes back after treatment
  • To prevent breast cancer in women at high risk for the disease

Some people should not use tamoxifen:

Talk to your doctor to see if tamoxifen is right for you.

When Is Letrozole Given

Letrozole is usually given after surgery to reduce the risk of breast cancer coming back or spreading.

If youre having chemotherapy or radiotherapy, your specialist will tell you when its best to start letrozole.

Occasionally, letrozole may be used as the first treatment for breast cancer, for example when surgery isnt appropriate or needs to be delayed. Its sometimes given before surgery to shrink a larger breast cancer.

Letrozole can also be used to treat breast cancer that has come back . It can also be given to treat breast cancer that has spread to another part of the body , when its often given alongside another drug.

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Hormone Therapy After Surgery For Breast Cancer

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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