Estrogen Receptor Positive Breast Cancer
Estrogen receptors are the most common hormone receptor that causes breast cancer. A study by the American Cancer Society reports that 2 out of every 3 breast cancer cases are hormone receptor positive. This is because estrogen is a dominant hormone that is responsible for most female traits. It can be found in the ovaries, adrenal glands, kidneys, and even fat tissues.
Among the common symptoms of ER-positive breast cancer are lumps surrounding the breast area, skin irritation or dimpling, breast swelling, nipple discharge, redness in the nipple or breast skin, and an increase in size of one or both of the breasts. Upon detecting these changes, a doctor may conduct an ultrasound or biopsy to confirm whether it is a form of hormone-receptor breast cancer.
What Does This Mean For Me
National guidelines recommend that all women with a BRCA1 mutation have their ovaries and fallopian tubes removed between the ages of 35-40 to lower their risk for ovarian cancer. If you are a BRCA1 previvor who has had or will have your ovaries removed, this study showed that using hormone replacement therapy for 10 years will not increase your risk of breast cancer.
Although not statistically significant, breast cancer rates were higher in women who took HT that contains progesterone compared with women who took estrogen-only HT. Its important to note that estrogen-only HT can increase the risk for uterine cancer. Progesterone is often given to women who have had risk-reducing ovary removal but who have not removed their uterus. Progesterone can lower the risk for uterine cancer in women who take estrogen. Women who are planning risk-reducing removal of their ovaries should speak with their health care provider about whether or not they should remove their uterus at the time of surgery.
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Posted 9/7/18
Prolonged Tamoxifen Surpasses Oophorectomy In Breast Cancer
Pam Harrison
May 09, 2017
SAN DIEGO For premenopausal women with estrogen receptor -positive breast cancer treated with tamoxifen for 5 years, lifetime outcomes are better with an extra 5 years of tamoxifen than with ovarian ablation followed by aromatase inhibitor therapy or with no additional treatment, new research shows.
“Short-term evidence suggests that aromatase inhibitors have an advantage over tamoxifen, which makes sense because you achieve a greater reduction in estrogen by removing the ovaries and putting women on an aromatase inhibitor,” said investigator Janice Kwon, MD, associate professor of obstetrics and gynecology at the University of British Columbia in Vancouver, Canada.
“But when women undergo oophorectomy, they can’t go on hormone-replacement therapy because of their ER-positive breast cancer, so they are at risk for bone loss and heart attacks and dying of these consequences much later on,” she told Medscape Medical News.
“It’s important for gynecologists to appreciate that ovarian ablation is associated with downstream health risks, particularly in young women who have early-stage disease,” she added.
To determine the optimal endocrine strategy for premenopausal women treated with 5 years of tamoxifen, Dr Kwon and her colleagues compared three regimens: 5 extra years of tamoxifen, ovarian ablation followed by an aromatase inhibitor, and no additional treatment.
They measured effectiveness in years of life expectancy gained.
| Average Outcome |
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What Are Estrogen And Progesterone Receptors
Estrogen and progesterone are two hormones that can help breast cancer grow. These hormones bind to estrogen and progesterone receptors.
Following a breast biopsy, a pathologist will perform a test called an immunohistochemical staining assay on the tissue sample. The test can detect the presence of estrogen and progesterone receptors.
Hormone receptor status provides a lot of information on how the cancer is likely to behave. Its also a key factor in determining the best possible treatment.
HR-positive breast cancer typically responds well to hormone therapy. These therapies block the production of the hormones or interfere with their effects on breast cancer cells. On the other hand, HR-negative breast cancers dont respond to hormone therapy, so other treatment options will be more effective.
Benefits Of A Hysterectomy For Fibroids
For large fibroids, your doctor may suggest a hysterectomy as a way to relieve the symptoms, especially if they are causing a lot of bleeding.
A myomectomy can remove fibroids from the womb andis a good option if you still want to have children. But not all fibroids canbe treated through this procedure.
Even if they can, it is possible they come back again. A hysterectomy is a more permanent way to deal with fibroids. The benefits are that it provides relief for symptoms such as:
- Heavy and long-lasting periods
- Problems with emptying your bladder and frequent urination
- Pelvic or low back pain
- Pain during intercourse
Overall, removing the womb is probably the best way to make sure that fibroids do not develop again in the future.
Read more: When to have a hysterectomy for fibroids?
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What Are The Side Effects Of Hormone Therapy
The side effects of hormone therapy depend largely on the specific drug or the type of treatment . The benefits and harms of taking hormone therapy should be carefully weighed for each person. A common switching strategy used for adjuvant therapy, in which patients take tamoxifen for 2 or 3 years, followed by an aromatase inhibitor for 2 or 3 years, may yield the best balance of benefits and harms of these two types of hormone therapy .
Hot flashes, night sweats, and vaginal dryness are common side effects of all hormone therapies. Hormone therapy also may disrupt the menstrual cycle in premenopausal women.
Less common but serious side effects of hormone therapy drugs are listed below.
Tamoxifen
- breathing problems, including painful breathing, shortness of breath, and cough
- loss of appetite
Is A Salpingo Oophorectomy A Risk Factor For Breast Cancer
Breast cancer risk after hysterectomy with and without salpingo-oophorectomy for benign indications. Women with concurrent bilateral salpingo-oophorectomy for benign indications had a lower risk of breast cancer than those who had hysterectomy alone. However, all-cause mortality was higher in women with oophorectomy.
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Ovarian Suppression Or Ablation
For premenopausal women with estrogen receptor-positive breast tumors, ovarian ablation or suppression may be an option. Since a premenopausal womans ovaries are the main source of estrogen production, temporarily or permanently shutting off their function has been shown to be effective in reducing the chances of a breast cancer recurrence. Studies are now confirming their usefulness when given with tamoxifen instead of chemotherapy or after chemotherapy. This is called ovarian ablation or suppression and can be done through surgery or monthly hormonal injections . The injection of medication will prevent you from ovulating or menstruating and will put you in temporary menopause. Surgery will prevent you from having to undergo monthly injections, but will put you in irreversible menopause. You should speak to your doctor regarding any plans to conceive children so that together you can decide which option is best for you and your family.
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.
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Does Concomitant Benign Breast Resection At The Time Of Hysterectomy Matter
In this population-based study of a diverse cohort of women, we found that concomitant BSO at the time of hysterectomy for benign indications conferred a lower risk of breast cancer than hysterectomy alone. However, all-cause mortality was higher in women who underwent a BSO. Results of the study in the context of what is known
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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Why Is This Study Important
HT alleviates symptoms of menopause associated with removal of the ovaries . Although retrospective review of medical records show that HT does not appear to change the risk of breast cancer for women with BRCA mutations who had their ovaries removed, no prospective study has examined this issue. Knowing how HTs affect breast cancer risk may be helpful for decision making by women with BRCA1
This study followed 872 women with BRCA1 mutations who had risk-reducing oophorectomy. Among these women, 43% chose to use HTs and 57% did not. During the study period, 92 of the participants were diagnosed with breast cancer:
Genetic Risks Offer A Different Set Of Tough Choices
Not all preventative surgeries are the same. Women who elect to have a double mastectomy and/or a hysterectomy when theres no known cancer but a high genetic risk strike a different bargain.
IIn the United States in 2011, more than one-third of women younger than 40 who tested positive for a high-risk BRCA1 mutation chose to have a double mastectomy. Preventative double mastectomy doesnt cut the risk of breast cancer to zero, but it does reduce it by 90 to 95 percent, according to the National Cancer Institute .
The other option is surveillance, which involves examinations and scans once every six months. The watch and wait method is more reliable for catching breast cancers than ovarian cancers.
We present both of these choices to women with BRCA mutations and usually most women know their own mind, Burstein said.
Many patients, including Jolie, say they feel empowered by their decision to take manage their risks proactively.
The things that Im at risk for by going into menopause early are things that to an extent I can prevent in my life, but I cant prevent ovarian cancer, said Megghan Shroyer, a Dayton, Ohio, woman who underwent a double mastectomy and radical hysterectomy in 2012 at the age of 28.
I wouldnt want to know that my body would be a ticking time bomb, and thats what it felt like, Shroyer said.
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Can Ovarian Suppression Preserve Fertility During Chemotherapy
Chemotherapy can affect the ovaries, reducing the number and quality of eggs and make it more difficult to get pregnant.
Some studies have shown that ovarian suppression using hormone therapy drugs may protect the ovaries during chemotherapy as it temporarily shuts down the ovaries. However, the effectiveness of ovarian suppression for preserving fertility is still debated and cannot replace other fertility preservation methods like egg and embryo freezing.
More research is needed looking at the role of ovarian suppression during chemotherapy to preserve fertility.
Your treatment team should discuss what treatment they recommend for you and why.
Database And Patient Selection
Study cohort selection. BSO, bilateral salpingo-oophorectomy ER, estrogen receptor OS, ovarian suppression PR, progesterone receptor.
For bilateral salpingo-oophorectomy, gynecological oncologists were consulted and minimally invasive surgery was the preferred method. Surgical details and complications were extracted from the gynecological oncology surgical database. Complications were recorded and graded on a 15 scale according to a previously published classification system.
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Benefits Of Hysterectomy For Endometriosis
The misery of endometriosis can sometimes be improved, given that all endometrial tissue can be removed. Some of the benefits a hysterectomy for endometriosis may have are:
- Relieve pelvic pain, painful periods and ovulation pain
- End bladder problems
- Improved sex life
- Ends heavy bleeding
As long as all of the endometrial tissue can be successfully removed, hysterectomy can be a solution for endometriosis.
Read more: Hysterectomy for endometriosis – Get all the facts before you decide.
What Is The Life Expectancy For Each Cancer Stage
Your outlook depends on the stage of your cancer when its discovered. Cancer is staged by number, starting with 0 and going to 4. Stage 0 is the very beginning and stage 4 is the last stage, also called the metastatic stage, because its when cancer has spread to other areas in the body.
Each number reflects different characteristics of your breast cancer. These characteristics include the size of the tumor and whether the cancer has moved into lymph nodes or distant organs, like the lungs, bones, or brain.
Research on survival statistics for people with breast cancer tends to separate participants into categories of women and men.
Survival statistics of women with the major subtypes of breast cancer such as ER-positive, HER2-positive, and triple-negative are grouped together. With treatment, most women with very early stage breast cancers of any subtype can expect a normal life span.
Survival rates are based on how many people are still alive years after they were first diagnosed. Five-year and 10-year survival are commonly reported.
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Progesterone Receptor Positive Breast Cancer
On the other hand, a PR-positive breast cancer is induced by cells that are more responsive to progesterone. Progesterone is a steroid hormone found in the ovaries and it is essential in the development of breasts during puberty. It also assists in preparing the body for lactation and breastfeeding. It also shows symptoms that are similar to the ER-positive cancer type.
What Is It Called When You Have A Womans Leg In A Stirrup
This is known as femoral neuropathy and can occur after a vaginal hysterectomy or any gynecological surgery where the womans legs are put in stirrups. These will put the womans hips in an awkward position. Excessive rotation of the hip may cause compression of the nerve that provides sensation to the leg.
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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.
Impact Of Ovary Removal On Subsequent Breast Cancer Prognosis
- Breast Cancer Research and Treatment
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What Is The Most Common Non
breast cancer. hysterectomy. Hysterectomy is the most common nonpregnancy-related major surgical procedure for women in the United States. 1 Of the 600,000 hysterectomies performed yearly, 90% are performed for benign indications. The percentage of bilateral salpingo-oophorectomies performed with hysterectomies increased from 25% in 1965
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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