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 .
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.
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.
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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.
Hormone Replacement Therapy May Be Safe After Breast Cancer Treatment
Hormone replacement therapy was thought to increase risk of cancer recurrence after breast cancer treatment, but that may not be the case
Hormone replacement therapy comes in different forms, including pills and patches
In women with a history of breast cancer, using hormone replacement therapy didnt increase the risk of breast cancer recurrence or death.
The findings of this latest, small study add to a growing body of research examining the effects of HRT on cancer risk.
Most breast cancers rely on the hormone oestrogen to grow, says Debasish Tripathy at the University of Texas MD Anderson Cancer Center in Houston. As such, many breast cancer therapies work by reducing or halting oestrogen production, which can lead to menopause-like symptoms.
The concern, then, is that increasing oestrogen levels to alleviate menopause symptoms could increase breast cancer risk, especially in people with a personal or family history of the condition.
Several studies have found that HRT is associated with an increased risk of breast cancer. Last year, however, an analysis of 300,000 women allayed some concerns about safety: it found that taking HRT to alleviate menopause symptoms doesnt increase the risk of dying early. Past research has also found that, in people who have had breast cancer, HRT can increase the risk of recurrence.
More on these topics:
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Hormone Therapy For Premenopausal Women
For premenopausal women with metastatic breast cancer, hormone therapy almost always begins with ovarian suppression and either an aromatase inhibitor, tamoxifen or other hormone therapy drug.
Ovarian suppression lowers hormone levels in the body so the tumor cant get the estrogen it needs to grow. This may involve surgery to remove the ovaries or, more often, drugs to stop the ovaries from producing hormones.
Combining ovarian suppression and a hormone therapy drug improves survival over either treatment alone .
If breast cancer progressed during past treatment with a hormone therapy drug, the same hormone therapy drug may not be an option for treatment.
Learn more about ovarian suppression.
Learn more about tamoxifen.
Learn more about aromatase inhibitors.
Not All Estrogens Are Bad
Let me not vilify all estrogens, as they are not the same. There are 16 forms of estrogens but todays science has only gone deeper into understanding three estrogens: estrone , estradiol and estriol . Out of these three, estradiol tends to be the most aggressive estrogen that has been linked to breast cancer multiplication. In fact, estriol is a protective estrogen that is often prescribed for women with estrogen dominance.
Another thing I need you to know is that it is also certain metabolites that are broken down in the liver that can be antagonistic. In fact, one of the breast cancer risk tests used is a blood test called 2:16 hydroxy-estrone which measures the relationship between estrones metabolites to determine the risk factor. In my practice, I like to look at three markers to identify the risk factor of a women :
The first test can be ordered by your physician, while you can order the saliva test online from Canary Club. The urine tests need to be ordered by an integrative physician, one of whom you can find near you from the listing here .
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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
How Much Does Hrt Increase Risk
The risk of developing breast cancer between the ages of 50 and 69 is around:
- 63 in every 1,000 women who have never used HRT
- 83 in every 1,000 women who use combined HRT for five years from the age of 50
- 68 in every 1,000 women who use oestrogen-only HRT for five years from the age of 50
Oestrogen-only HRT increases the risk of womb cancer, so is generally only offered to women who have had their womb removed .
Tibolone is another type of HRT that contains a steroid that acts like oestrogen and progesterone. Tibolone users also have an increased risk of breast cancer, but probably less so than combined HRT users.
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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
When Are Hormone Blockers Used
Hormone inhibitors and blocker options may depend on a persons stage of life.
- Hormone inhibitors are only used in postmenopausal women. They can be given to premenopausal women if steps are taken by the treatment team to put the ovaries to sleep by blocking the ovaries from producing estrogen or progesterone.
- Hormonal therapy may also be called anti-hormone treatment. Think of it as the opposite of hormone replacement therapy . If pathology tests show that the tumor in your breast has hormone receptors , then hormonal therapy may be recommended for you after the completion of your acute treatment .
- Hormonal therapy keeps breast cancer cells from receiving or using the natural female hormones in your body which they need to grow. Hormonal therapy also blocks the ability of health breast cells to receive hormones that could stimulate breast cancer cells to regrow again in the form of recurrence of the breast cancer within the breast or elsewhere in the body.
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Lowering Estrogen Levels From The Ovaries
This type of treatment only works in premenopausal women who have functioning ovaries. It can help some types of hormone therapy work better. It is also used to treat cancer that has spread.
There are three ways to lower estrogen levels from the ovaries:
- Surgery to remove the ovaries
- Radiation to damage the ovaries so they no longer function, which is permanent
- Drugs such as goserelin and leuprolide that temporarily stop the ovaries from making estrogen
Any of these methods will put a woman into menopause. This causes symptoms of menopause:
- Loss of interest in sex
Age At Menarche Is More Influential Than Age At Menopause On Breast Cancer Risk
The observation that lengthening the reproductive life of a woman, either by an earlier menarche or later menopause, increases the risk of breast cancer would suggest that the overall duration of the exposure to estrogen is underlying the risk. However, a recent meta-analysis of reproductive events and breast cancer risk has found that age at menarche may be more of a deciding factor on the risk than age at menopause .
These findings contradict earlier theories that the influence of age at menarche and menopause on breast cancer risk was simply due to the duration of exposure to cycling ovarian hormones. Instead, it seems that the timing of the first exposure of the mammary gland to cyclic hormones sets up a developmental program that has consequences for breast cancer risk later in life.
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Side Effects Of Hormone Therapy
Like any treatment, hormone therapy can cause side effects. Everyone reacts differently to drugs and some people have more side effects than others.
Side effects can often be managed and those described here will not affect everyone.
Some side effects are common to all hormone therapies, while others are specific to certain drugs. You can read about specific side effects on our individual drug pages .
If youre concerned about any side effects, whether or not they are listed here, talk to your treatment team as soon as possible.
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.
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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?
How Estrogen Feeds Cancer
A high proportion of breast cancers are Estrogen Receptor Positive. This means they have a large number of estrogen receptors, indicating that estrogen is helping to feed their growth.
The American Cancer Society explains Estrogen Receptor Positive cancer like this:
Breast cancer that involves estrogen and progesterone receptors is likely to respond to treatments known as endocrine therapies. In medicine, drugs such as Tamoxifen are used to block the estrogen receptors and help prevent the cancer from recurring. In post-menopausal women, drugs called aromatase inhibitors may be more beneficial to help stop production of estrogen.
But what women with breast cancer are rarely told? That as well as taking medication , they can adopt diet and lifestyle strategies which can effectively reduce high levels of the antagonistic estrogen, estradiol.
And addressing estrogen dominance through lifestyle is equally important if you dont have cancer. By reducing your estradiol levels you stabilize your progesterone levels too which in the long-term, could reduce your risk of breasts cancers that are ER Positive and PR Positive.
Reducing Estrogen Dominance is also important to reduce the risk of other ER Positive cancers of the:
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Hormone Therapy For Reducing The Risk Of Breast Cancer
Women at moderate or high risk of breast cancer because of their family history may be offered hormone therapy to reduce their risk of developing breast cancer.
Drugs used to reduce the risk of breast cancer in women who have not had breast cancer include:
These drugs are usually taken for five years.
Easing Joint Or Muscle Pain
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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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.
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.
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Do You Need More Information Or Help With Side Effects
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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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.
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