Mood Swings Depression And Sleep Disturbances
These side effects sometimes happen with both tamoxifen and aromatase inhibitors. If they do, tell your doctor.
What helps: If you have depression, there are treatments that can help, including medications and therapy. Other approaches that may help with mood swings, depression, and sleep disturbances include cognitive behavioral therapy , tai chi, and meditation.
Remember, depression is a medical condition. Itâs more than having the âbluesâ or the normal range of emotions we all have. Donât hesitate to tell your doctor or therapist.
How Long Will I Be On Treatment
Duration of treatment depends on your individual situation, but its usually at least five to 10 years.
Youll still see your treatment team regularly for follow-up visits. If youre experiencing any side effects or unusual symptoms, tell your healthcare provider. They can often help with side effects or offer tips to minimize them. Theyll also monitor your cancer for any changes or recurrence.
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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Combined Hrt And Breast Cancer
Combined estrogen and progesterone may have the highest risk factor of any type of HRT. According to BreastCancer.org, the risk of developing breast cancer increases by 75% for those taking combined HRT.
The organization also noted that combined HRT increases the chance that a healthcare professional may diagnose a persons breast cancer at a more advanced stage, which increases the likelihood of mortality.
According to the , the risk of breast cancer increases the longer a person takes HRT. However, it also decreases significantly after a person discontinues HRT.
The American Cancer Society states that the risk of breast cancer returns to average 3 years after a person discontinues combined HRT.
However, the researchers for the 2020 study found that risk reduced after 5 years for medroxyprogesterone, and 10 years for levonorgestrel, which are types of progesterone.
Combined HRT is also linked to breast density, which can make it harder to locate cancer on a mammogram. Breast density is a term to describe the amount of dense tissue compared to fatty tissue in a persons breast. Dense tissue is more fibrous than fatty tissue.
HRT containing estrogen alone can also increase the risk of a person developing breast cancer. However, it may only increase the risk after 10 years of continued use.
A person who has had or has breast cancer should not take HRT. Instead, they should speak with a doctor about alternative options.
Reducing Vaginal Dryness And Vaginal Atrophy
- Nonhormonal moisturizers.We recommend nonhormonal vaginal moisturizers like Replens and Hyalo GYN to hydrate, increase comfort with sexual activity, and help restore elasticity of the vaginal tissue, Dr. Goldfarb says. They can also be used in combination with lubricants for intercourse. Some women especially those who are taking aromatase inhibitors, which lower estrogen levels may need to use vaginal moisturizers more often than the three times per week recommended on the package in order to get the most benefit.
Along with Jeanne Carter, Director of MSKs Female Sexual Medicine and Womens Health Program, and medical oncologist Maura Dickler, Dr. Goldfarb is studying different ways of using these moisturizers and other intravaginal therapies to determine the optimal treatment and frequency of application in women with breast cancer. We are also investigating whether the product helps reduce insertional pain experienced by some patients at the beginning of intercourse, she says.
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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:
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Longest survival possible with the disease
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Fewest possible side effects from the cancer and its treatment
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Best and longest quality of life possible
Treatment options for metastatic breast cancer vary based on:
Other Serms Such As Evista And Fareston
Raloxifene and toremifene are other SERMs that act similarly to tamoxifen. They stop cancer growth by binding to estrogen receptors and blocking the ability of estrogen to bind to these receptors. However, SERMs can also mimic the effects of estrogen in other parts of the body, such as the uterus, which can increase the risk of certain cancers. These drugs are not usually recommended if previous treatment with tamoxifen has not been successful. Toremifene is only approved for the treatment of metastatic breast cancer in postmenopausal women, so its uses are more limited than those of tamoxifen.
Some healthcare providers may prescribe raloxifene over tamoxifen due to its lower risk of serious side effects, such as uterine cancer. Raloxifene may be prescribed to postmenopausal women with osteoporosis who are at a high risk of invasive breast cancer. However, raloxifene may be less effective at preventing breast cancer than tamoxifen and has only been tested in postmenopausal women. On the other hand, tamoxifen is an option to prevent breast cancer in premenopausal women.
SERMs are generally taken by mouth. Side effects may include hot flashes, muscle or joint pain, and leg cramps. Serious side effects may include an increased risk of uterine or endometrial cancer and blood clots in the legs or lungs.
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Potential Benefits Of Risk
The USPSTF found convincing evidence that risk-reducing medications provide at least a moderate benefit in reducing risk for invasive estrogen receptorpositive breast cancer in postmenopausal women at increased risk for breast cancer .
Trials included women whose 5-year risk of breast cancer may have been lower than 3%.
Per 1000 women over 5 years of use.
§Results from the National Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene trial.
Both tamoxifen and raloxifene can reduce risk of some types of skeletal fractures, independent from the risk of breast cancer.
The USPSTF found that the benefits of taking tamoxifen, raloxifene, and aromatase inhibitors to reduce risk for breast cancer are no greater than small in women not at increased risk for the disease.
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Anastrozole May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- joint, bone, or muscle pain
- difficulty falling asleep or staying asleep
- difficulty swallowing or breathing
- swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles, or lower legs
Anastrozole may cause or worsen osteoporosis. It can decrease the density of your bones and increase the chance of broken bones and fractures. Talk to your doctor about the risks of taking this medication and to find out what you can do to decrease these risks.
Anastrozole may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
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Where Does Evidence About The Health Effects Of Mht Come From
The most comprehensive evidence about the health effects of MHT comes from two randomized clinical trials that were sponsored by the National Institutes of Health as part of the Womens Health Initiative :
- The WHIEstrogen-plus-Progestin Study, in which women with a uterus were randomly assigned to receive either a hormone pill containing both estrogen and progestin or a placebo. The median duration of treatment was 5.6 years.
- The WHI Estrogen-Alone Study, in which women without a uterus were randomly assigned to receive either a hormone pill containing estrogen alone or a placebo. The median duration of treatment was 7.2 years.
More than 27,000 healthy women who were 50 to 79 years of age at the time of enrollment took part in the WHI hormone therapy trials. The goals of these trials were to see if MHT prevents heart disease and bone fractures in postmenopausal women and to determine if MHT affects risks of breast cancer and, for women with a uterus, endometrial cancer. Both trials were stopped early , when it was determined that both types of therapy were associated with specific health risks, but long-term follow up of the participants continues to provide new information about the health effects of MHT.
How Does Hormone Therapy Work
About 2 out of 3 breast cancers are hormone receptor-positive. Their cells have receptors for estrogen and/or progesterone which help the cancer cells grow and spread.
There are several types of hormone therapy for breast cancer. Most types of hormone therapy either lower estrogen levels in the body or stop estrogen from helping breast cancer cells grow.
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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.
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
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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.
Who Should Consider Pbi
The American Society of Therapeutic Radiology and Oncology provides the following recommendations:
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Does Estrogen Cause Cancer
Estrogen plays a role in causing certain cancers.
Cells in your body have hormone receptors. The hormone receptors are a type of protein. Estrogen in your bloodstream can attach to the receptors. This hormone-receptor process is part of typical body function. In healthy cells, estrogen aids normal cell function and growth.
Today, experts know that several different factors play a role in turning healthy cells cancerous. When these factors are present, estrogen can act as a spark. The hormone causes cancer cells to multiply and spread.
Summary Of Treatment Options For Metastatic Breast Cancer
Hormone receptor-positive, HER2-negative breast cancer
Hormonal therapy is considered the standard initial treatment for HER2-negative metastatic breast cancer that is also hormone receptor-positive. It is often given in combination with targeted therapy. However, chemotherapy may also be given. A clinical trial may also be an option for treatment at any stage.
Hormone receptor-negative, HER2-negative breast cancer
In general, chemotherapy or targeted therapy is given for treatment of triple-negative breast cancer. A clinical trial may also be an option for treatment at any stage.
HER2-positive breast cancer that has spread to parts of the body other than the brain
In general, HER2-targeted therapy is regularly added to treatment for HER2-positive breast cancer that has spread. The drugs used depend on the treatments already given and whether the cancer is hormone receptor-positive. The treatment recommendations for first-line, second-line, and third-line or higher treatment are described below. A clinical trial may also be an option for treatment at any stage.
First-line treatment
Second-line treatment
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For people with advanced breast cancer that has grown during or after first-line treatment with a HER2-targeted therapy, ASCO recommends trastuzumab deruxtecan as a second-line treatment.
Third-line or higher treatment
HER2-positive breast cancer that has spread to the brain
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Taking Estrogen With A Progestin Vs Estrogen Alone
Treating menopausal symptoms with estrogen and progestin together is known as estrogen-progestin therapy or combined hormone therapy. Although estrogen alone improves the symptoms of menopause, it increases the risk of cancer of the uterus . Adding a progestin to the estrogen lowers the risk of endometrial cancer back to normal. Because of this, EPT is given to women who still have a uterus . EPT can be given 2 ways:
- Continuous EPT means the same dose of estrogen and progestin is taken each day. Women often prefer continuous EPT because it rarely leads to menstrual-like bleeding.
- Sequential EPT means different amounts of each hormone are taken on specific days. There are different ways to do this. For example, estrogen can be taken by itself for 14 days, then estrogen plus progestin for 11 days, then neither hormone for 3 to 5 days. Other schedules involve taking progestin only every few months. This lowers the amount of progestin that you are exposed to. Monthly regimens are also thought to result in hormone levels that are more like the natural menstrual cycle. Cyclical EPT can produce bleeding like a menstrual period, but it can occur less often than monthly.
Having Hormonal Therapy For Breast Cancer
Hormonal therapy drugs reduce the risk of breast cancer coming back. It is important to take it for as long as you have been prescribed it for. Try to make taking it part of your daily routine so it becomes a habit.
Most women cope well with the side effects of hormonal therapy. They may be more of a problem in the first few months, but usually get better over time. If the side effects do not improve or are difficult to cope with, talk to your specialist nurse or cancer doctor. They can prescribe drugs to help and suggest ways of coping.
If you are still having problems after this, then your cancer doctor may suggest changing to a different type of hormonal therapy.
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