How Do Tamoxifen Raloxifene Anastrozole And Exemestane Reduce The Risk Of Breast Cancer
If you are at increased risk for developing breast cancer, four medications tamoxifen , raloxifene , anastrozole , and exemestane may help reduce your risk of developing this disease. These medications act only to reduce the risk of a specific type of breast cancer called estrogen receptor-positive breast cancer. This type of breast cancer accounts for about two-thirds of all breast cancers.
Tamoxifen and raloxifene are in a class of drugs called selective estrogen receptor modulators . These drugs work by blocking the effects of estrogen in breast tissue by attaching to estrogen receptors in breast cells. Because SERMs bind to receptors, estrogen is blocked from binding. Estrogen is the fuel that makes most breast cancer cells grow. Blocking estrogen prevents estrogen from triggering the development of estrogen-receptor-positive breast cancer.
Anastrozole and exemestane are in a class of drugs called aromatase inhibitors . These drugs work by blocking the production of estrogen. Aromatase inhibitors do this by blocking the activity of an enzyme called aromatase, which is needed to make estrogen.
Signs Breast Cancer Has Spread
Your doctor may use several imaging tests to determine if your cancer has spread. An ultrasound, CT scan or MRI are the most common tests to see if cancer has spread to other organs. You may also receive a chest x-Ray to see if the cancer has reached your lungs.
For more advanced imaging, your doctor can order a PET scan in which a radioactive sugar travels through your body before images are taken where the sugar collects. Similarly, a bone scan uses a radioactive substance to determine if cancer has spread to your bones. Bone scans can pick up cancer cells that may not show on other scans.
However, it is not uncommon to not need any additional imaging to check for tumor spread. You should work with your doctor to decide which imaging, if any, is best.
Optimal Wait Time Before Surgery
We lead busy lives. Some people wonder if they can wait until an upcoming vacation to have surgery, or until their children are back in school. Others hope to wait until their insurance kicks in at a new job, or until they are able to find insurance. And not everyone feels quite ready to have surgery right after being diagnosed.
The average wait time until surgery has actually been increasing, with the average delay being 21 days in 1998, 31 days in 2003, and 41 days in 2008.
How long can you wait? Let’s look at studies of overall survival as well as special groups.
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How Is Chemotherapy For Breast Cancer Given
Chemo drugs for breast cancer are typically given into a vein , either as an injection over a few minutes or as an infusion over a longer period of time. This can be done in a doctors office, infusion center, or in a hospital setting.
Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. These are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.
There are many different kinds of CVCs. The most common types are the port and the PICC line. For breast cancer patients, the central line is typically placed on the side opposite of the breast cancer. If a woman has breast cancer in both breasts, the central line will most likely be placed on the side that had fewer lymph nodes removed or involved with cancer.
Chemo is given in cycles, followed by a rest period to give you time to recover from the effects of the drugs. Chemo cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, chemo is given only on the first day of the cycle. With others, it is given one day a week for a few weeks or every other week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
The Breast Cancer Centers At Ctca
At the Breast Cancer Centers at each of our CTCA® hospitals, located across the nation, our cancer experts are devoted to a single missiontreating breast cancer patients with compassion and precision. Each patients care team is led by a medical oncologist and coordinated by a registered oncology nurse, who helps track the various appointments, follow up on tests and answer questions that come up along the way. Your care team also may include a breast surgeon, radiation oncologist, radiologist, pathologist and a plastic and reconstructive surgeon with advanced training in helping patients restore function and appearance. Fertility preservation and genetic testing are also available for qualifying patients who need them.
Our pathologists and oncologists are experienced and trained in tools designed to diagnose, stage and treat different types of breast cancer, from early-stage ductal carcinoma in situ to complex diseases such as triple-negative and inflammatory breast cancer. As part of our patient-centered care model, which is designed to help you keep strong during treatment, your multidisciplinary care team may recommend various evidence-informed supportive therapies, such as naturopathic support, psychosocial support, nutritional support, physical and occupational therapy and pain management. The entire team works together with a whole-person focus, which is at the heart of our centers dedication to personalized and comprehensive care.
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More Precise Radiation Treatments
Similarly, radiation treatments have improved. Newer technology allows radiation oncologists to plan therapy that targets the breast but avoids the heart.
We can outline areas at risk slice by slice on a CT scan, and then we can outline what we want to miss, like the heart, says Reshma Jagsi, M.D., D.Phil., professor and deputy chair of radiation oncology at U-M.
Add to that a surprising low-tech solution: Have the patient hold her breath. This pushes the lung up, which moves the heart farther away from the breastbone, adding another layer of protection.
An analysis of more than 1,000 breast cancer patients treated with radiation at U-M found these approaches led to excellent outcomes in terms of both preventing recurrence and reducing cardiac events.
Radiation courses are getting shorter, too. Instead of coming for daily treatments for six weeks, some patients now come for only three weeks. They get higher daily doses of radiation but less dose overall. And that has also translated into fewer side effects.
Common Breast Cancers In Older Adults
The most common cancer diagnosed in this age group is invasive ductal carcinoma, or IDC , followed by invasive lobular carcinoma . These cancers arise in different tissues of the breast, but are treated in similar ways.
Most invasive cancers in this age group are hormone receptor positive. Hormone-positive breast cancers are considered slow-growing tumors, which can mean a good overall prognosis.
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Invasive Breast Cancer Symptoms
Most breast cancers start in the ducts, or the tubes that carry milk to the nipple, or in the lobules, the little clusters of sacs where breast milk is made. Invasive breast cancer refers to breast cancer that spreads from the original site to other areas of the breast, the lymph nodes or elsewhere in the body. In these cancers that form in the ducts or lobules, invasive ductal carcinoma or invasive lobular carcinoma , the cancer spreads from the ducts or lobules to other tissue. Depending on the stage, you may notice symptoms.
Invasive breast cancer symptoms may include:
- A lump or mass in the breast
- Swelling of all or part of the breast, even if no lump is felt
- Skin irritation or dimpling
- A lump or swelling in the underarm lymph nodes
Getting Used To Changes
Research has shown that the sooner you confront the physical changes to your body, the easier you may find it to gain confidence in the way you look. However, some people wont have had the chance or courage to do this early on.
If you have a partner, letting them see the surgical scars and changes to your body sooner may also make being intimate easier in the long term.
The first few times you look at yourself might make you feel unhappy and shocked, and you may want to avoid looking at yourself again. However, the initial intense feelings you may have will lessen over time as you get more used to how you look now.
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Studies On Time To Surgery And Survival
Several studies have been done, but there are some differences in how these were conducted that can affect the results. For example, some studies have looked at the time between a definitive diagnosis and surgery, and others have looked at the time between the onset of symptoms and the time of surgery. Some have looked at averages of all people, whereas others have separated out people based on age, tumor type, and receptor status. Studies can also be skewed, as doctors may recommend surgery sooner for women who have more aggressive tumors. Let’s look at time to surgery and survival rates in different groups of people.
A Team Approach To Breast Cancer Treatment
Tran says older patients or anyone diagnosed with breast cancer can benefit from getting care at a comprehensive center, such as the one where she performs surgery: the Sullivan Breast Center at Sibley Memorial Hospital in Washington, D.C.
Our team meets weekly to discuss individual patients cases, and that helps us bring the best thinking to each persons treatment plan, Tran says. Our combined experience supports every patient.
Breast Health Services
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Coping With Late Effects
There are many things that can be done to manage or treat late effects. It is important that you do not feel you have to cope with them without getting help.
Late effects may be minor and not affect your daily life much. Or, they may be more difficult to live with and affect your daily life more. There are usually a lot of things that can help you cope with them to live life as well as you can. Some late effects improve over time and may eventually go away on their own.
If side effects do not go away after treatment, or if you develop late effects, always let your cancer doctor or specialist nurse know. You can contact your specialist nurse even if you no longer have follow-up appointments with a doctor. You can also contact your GP.
The breast care team can assess your symptoms. They will explain whether they could be caused by treatment and how to manage them.
Some late effects may be similar to the symptoms you had when you were first diagnosed. This can be scary, and you may worry the cancer has come back.
Sometimes symptoms are caused by other conditions not related to the cancer or its treatment. Your doctor may arrange tests to find out more about the cause of your symptoms.If you are unable to work because of late effects, you may be entitled to some benefits.
Are Exercises Beneficial In The Healing Process After The Breast Cancer Surgery
Once the patient recovers from the breast cancer surgery procedure, the doctor may recommend some stretching exercises that may be beneficial to regulate and gain mobility. It is important to talk to the surgeon before starting with the exercises.
Arm Lift Exercises: Arms lifts are seen to be beneficial after the breast cancer surgery. While standing or sitting on the edge of the chair, both of the arms may be lifted over the head with elbows close to the ears. The position should be held for five counts and then repeated.
Arm Swing Exercises: Arm swings are another form of exercise helping in mobility. As the patient stands straight, she may swing both arms forward and backward from the shoulder like a pendulum keeping the elbow straight.
Wall Climbing Exercises: Wall climbing may be recommended for patients at times. In this, the patient has to stand facing the wall with hands on the wall. The fingertips of both the hands may be used to climb up the wall until the arms are stretched over the head. Again, the patient has to climb the fingers down the wall.
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How Long Does It Take To Treat Breast Cancer
There are many factors to consider when determining how long breast cancer takes to treat. Even your doctor will only be able to give estimates based on how far your cancer has spread through the breast tissue and where it has metastasized if it has metastasized at all.
Their estimates are based on decades of experience and medical research. However, you should still ask your doctor to give you two estimates, one that imagines everything going to plan and one that factors in common complications. Taking all factors into consideration, the Mayo Clinic suggests that the average treatment length for breast cancer can be divided into two categories: early-stage breast cancer and advanced breast cancer. When trying to figure out how long breast cancer takes to treat, its important to start here.
If youre lucky and catch your condition early on, then your breast cancer treatment will generally last between three and six months. This assumes there is no further growth while you are undergoing treatment. In more advanced cases, you should typically expect a minimum of six months of treatment. How far it goes beyond that depends on how many surgeries you need and how far the cancer has spread.
Local Or Regional Treatments
The systemic therapies described above are the main treatments for metastatic breast cancer.
However, local and regional treatments, including radiation, surgery, and chemotherapy can also be used to help treat metastatic cancer in a specific part of the body, but theyre unlikely to completely eradicate it.
Usually, these therapies are used to treat symptoms or complications of the cancer.
For example, radiation and surgery may be used in these situations:
- when a breast tumor causes an open wound in the breast
- to treat a small number of metastases in a specific area, such as the brain
- to help prevent bone fractures
- when a tumor is pressing on the spinal cord
- to treat a blood vessel blockage in the liver
- to provide pain relief or to relieve other symptoms
Chemotherapy can also be delivered directly to a certain area , to help relieve symptoms or complications.
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Internal Breast Cancer Radiation
Internal breast cancer radiation is also known as brachytherapy. You doctor will place a device that contains radioactive seeds in the area of the breast where the cancer was found. For a short time, internal radiation targets only the area where breast cancer is most likely to return. This causes fewer side effects. The treatment takes a week to complete.
If youve had breast-saving surgery, a doctor may treat you with both internal and external radiation to increase the boost of radiation. Doctors may only perform internal radiation as a form of accelerated partial breast radiation to speed up treatment.
Potential side effects of internal radiation include:
Targeting Cancer Stem Cells
Researchers at the U-M Rogel Cancer Center discovered in 2003 that a small number of cells within a tumor are responsible for fueling its growth and spread. These cancer stem cells do not respond to traditional chemotherapies, which kill the bulk tumor cells only.
Clinical trials at U-M are testing drugs designed to target the cancer stem cells, using them in combination with other treatments to try to improve outcomes.
Women with advanced disease treated with Herceptin or other anti-HER2 therapies do well for a while, but eventually, they all become resistant to the HER2 blockade. Why is that? Our laboratory showed the stem cells activate the inflammatory pathway IL6. That drives the stem cells and allows them to overrule Herceptin, Wicha says.
This led to a clinical trial using tocilizumab, a drug approved for arthritis, which works by blocking IL6. In another trial, patients are randomized to receive chemotherapy or chemotherapy plus reparixin, a drug designed to target cancer stem cells through another inflammatory pathway.
Research suggests that cancer stem cells may be especially potent in triple-negative breast cancer, which represents about 15 percent of diagnoses. Because this subtype does not express receptors to estrogen, progesterone or HER2, the targeted therapies that work so well in those types are not effective in triple-negative tumors.
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What Are The Stages Of Breast Cancer
There are two different staging systems for breast cancer. One is called anatomic staging while the other is prognostic staging. The anatomic staging is defined by the areas of the body where the breast cancer is found and helps to define appropriate treatment. The prognostic staging helps medical professionals communicate how likely a patient is to be cured of the cancer assuming that all appropriate treatment is given.
The anatomic staging system is as follows:
Stage 0 breast disease is when the disease is localized to the milk ducts .
Stage I breast cancer is smaller than 2 cm across and hasn’t spread anywhere including no involvement in the lymph nodes.
Stage II breast cancer is one of the following:
- The tumor is less than 2 cm across but has spread to the underarm lymph nodes .
- The tumor is between 2 and 5 cm .
- The tumor is larger than 5 cm and has not spread to the lymph nodes under the arm .
Stage III breast cancer is also called “locally advanced breast cancer.” The tumor is any size with cancerous lymph nodes that adhere to one another or to surrounding tissue . Stage IIIB breast cancer is a tumor of any size that has spread to the skin, chest wall, or internal mammary lymph nodes .
Stage IV breast cancer is defined as a tumor, regardless of size, that has spread to areas away from the breast, such as bones, lungs, liver or brain.