Can Other Drugs Interfere With Hormone Therapy
Certain drugs, including several commonly prescribed antidepressants , inhibit an enzyme called CYP2D6. This enzyme plays a critical role in the body’s use of tamoxifen because CYP2D6 metabolizes, or breaks down, tamoxifen into molecules, or metabolites, that are much more active than tamoxifen itself.
The possibility that SSRIs might, by inhibiting CYP2D6, slow the metabolism of tamoxifen and reduce its effectiveness is a concern given that as many as one-fourth of breast cancer patients experience clinical depression and may be treated with SSRIs. In addition, SSRIs are sometimes used to treat hot flashes caused by hormone therapy.
Many experts suggest that patients who are taking antidepressants along with tamoxifen should discuss treatment options with their doctors, such as switching from an SSRI that is a potent inhibitor of CYP2D6, such as paroxetine hydrochloride , to one that is a weaker inhibitor, such as sertraline or citalopram , or to an antidepressant that does not inhibit CYP2D6, such as venlafaxine . Or doctors may suggest that their postmenopausal patients take an aromatase inhibitor instead of tamoxifen.
Other medications that inhibit CYP2D6 include the following:
- Quinidine, which is used to treat abnormal heart rhythms
Weight Loss After Menopause Tied To Lower Breast Cancer Risk
Older women who lose weight may have a lower risk of developing invasive breast cancer than those who maintain or gain weight, a large U.S. study from the City of Hope National Medical Center in Duarte, California suggests.
While obesity has long been linked to an increased risk of breast cancer, previous research is not clear on the potential for losing weight to help reduce the risk.
For the current study, researchers assessed weight and height to calculate body mass index for more than 61,000 women twice, three years apart.
Then, the researchers followed these women for an average of 11.4 more years. During this time 3,061 women developed invasive breast cancer.
What Are The Types Of Breast Cancer
The most common types of breast cancer are:
- Infiltrating ductal carcinoma. This cancer starts in the milk ducts of the breast. It then breaks through the wall of the duct and invades the surrounding tissue in the breast. This is the most common form of breast cancer, accounting for 80% of cases.
- Ductal carcinoma in situ is ductal carcinoma in its earliest stage, or precancerous . In situ refers to the fact that the cancer hasn’t spread beyond its point of origin. In this case, the disease is confined to the milk ducts and has not invaded nearby breast tissue. If untreated, ductal carcinoma in situ may become invasive cancer. It is almost always curable.
- Infiltrating lobular carcinoma. This cancer begins in the lobules of the breast where breast milk is produced, but has spread to surrounding tissues in the breast. It accounts for 10 to 15% of breast cancers. This cancer can be more difficult to diagnose with mammograms.
- Lobular carcinoma in situ is a marker for cancer that is only in the lobules of the breast. It isn’t a true cancer, but serves as a marker for the increased risk of developing breast cancer later, possibly in both or either breasts. Thus, it is important for women with lobular carcinoma in situ to have regular clinical breast exams and mammograms.
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Breast Cancer In Postmenopausal Women
Breast cancer is most common in postmenopausal women, and most breast cancers in postmenopausal women are hormone receptor positive. As women age, the fat cells in their breasts tend to produce greater and greater amounts of an enzyme called aromatase. Aromatase promotes the production of oestrogen. Consequently, with age, the levels of oestrogen present in women’s breasts increases. This locally produced oestrogen plays a role in both the development and growth of breast cancer in postmenopausal women. Once established, the tumour acts to increase oestrogen levels to help it grow, with immune cells appearing to boost oestrogen production. Recent studies have also identified a link between obesity and oestrogen production. Data demonstrating that obesity carries a two-fold increased risk of developing breast cancer in older women supports these findings. This makes sense considering that obese women have more of the fat cells responsible for producing oestrogens.
Is Breast Cancer Less Threatening After Menopause
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Hormone Therapy After Menopause
Hormone therapy with estrogen has been used for many years to help relieve symptoms of menopause and help prevent osteoporosis . This treatment goes by many names, such as post-menopausal hormone therapy , hormone replacement therapy , and menopausal hormone therapy .
There are 2 main types of hormone therapy. For women who still have a uterus , doctors generally prescribe estrogen and progesterone . Progesterone is needed because estrogen alone can increase the risk of cancer of the uterus. For women whove had a hysterectomy , estrogen alone can be used. This is known as estrogen replacement therapy or just estrogen therapy .
Combined hormone therapy : Use of combined hormone therapy after menopause increases the risk of breast cancer. This increase in risk is typically seen after about 4 years of use. Combined HT also increases the likelihood that the cancer may be found at a more advanced stage.
The increased risk from combined HT appears to apply mainly to current and recent users. A womans breast cancer risk seems to go back down within 5 years of stopping treatment.
Estrogen therapy : Studies of the use of estrogen alone after menopause have had mixed results, with some finding a slightly higher risk and some finding no increase. If ET does increase the risk of breast cancer, it is not by much.
To learn more, see Menopausal Hormone Therapy and Cancer Risk.
How Can I Protect Myself From Breast Cancer
Follow these three steps for early detection:
- Get a mammogram. The American Cancer Society recommends having a baseline mammogram at age 35, and a screening mammogram every year after age 40. Mammograms are an important part of your health history. Recently, the US Preventive Services Task Force came out with new recommendations regarding when and how often one should have mammograms. These include starting at age 50 and having them every two years. We do not agree with this, but we are in agreement with the American Cancer Society and have not changed our guidelines, which recommend yearly mammograms starting at age 40.
- Examine your breasts each month after age 20. You will become familiar with the contours and feel of your breasts and will be more alert to changes.
- Have your breast examined by a healthcare provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can detect lumps that may not be detected by mammogram.
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How Much Do Anastrozole And Exemestane Lower The Risk Of Breast Cancer
Studies have shown that both anastrozole and exemestane can lower the risk of breast cancer in postmenopausal women who are at increased risk of the disease.
In one large study, taking anastrozole for five years lowered the risk of developing estrogen receptor-positive breast cancer by 53 percent. In another study, taking exemestane for three years lowered the risk of developing estrogen receptor-positive breast cancer by 65 percent.
The most common side effects seen with anastrazole and exemestane are joint pains, decreased bone density, and symptoms of menopause .
Last reviewed by a Cleveland Clinic medical professional on 12/31/2018.
Previous Breast Cancer Or Lump
If you have previously had breast cancer or early non-invasive cancer cell changes in breast ducts, you have a higher risk of developing it again, either in your other breast or in the same breast.
A benign breast lump does not mean you have breast cancer, but certain types of breast lumps may slightly increase your risk of developing cancer.
Some benign changes in your breast tissue, such as cells growing abnormally in ducts , or abnormal cells inside your breast lobes , can make getting breast cancer more likely.
Can Exercise Help Reduce My Risk Of Developing Breast Cancer
Exercise is a big part of a healthy lifestyle. It can also be a useful way to reduce your risk of developing breast cancer in your postmenopausal years. Women often gain weight and body fat during menopause. People with higher amounts of body fat can be at a higher risk of breast cancer. However, by reducing your body fat through exercise, you may be able to lower your risk of developing breast cancer.
The general recommendation for regular exercise is about 150 minutes each week. This would mean that you work out for about 30 minutes, five days each week. However, doubling the amount of weekly exercise to 300 minutes can greatly benefit postmenopausal women. The longer duration of exercise allows for you to burn more fat and improve your heart and lung function.
The type of exercise you do can vary the main goal is get your heart rate up as you exercise. Its recommended that your heart rate is raised about 65 to 75% of your maximum heart rate during exercise. You can figure out your maximum heart rate by subtracting your current age from 220. If you are 65, for example, your maximum heart rate is 155.
Aerobic exercise is a great way to improve your heart and lung function, as well as burn fat. Some aerobic exercises you can try include:
Remember, there are many benefits to working more exercise into your weekly routine. Some benefits of aerobic exercise can include:
Estimation Of The Population
To quantify the attributable proportion of cancer cases, we estimated the population-attributable fraction associated with specific behaviors with the assumption of a causal relationship on a particular set of risk factors, all others remaining unchanged. Point estimates and 95% CIs were evaluated using a method for the estimation of PAFs in cohort studies, described by Spiegelman et al. The estimation of PAFs took into account exposure prevalence throughout follow-up, based on person-years in the E3N cohort, and HRs of cancer risk associated with exposure and potential effect modifiers.
PAFs were estimated separately for each factor included in the model and expressed as the percentage of cancer cases attributed to a hypothetical scenario in which all women would be in the reference category . In addition, we estimated the combined PAFs of the non-behavioral factors, the behavioral factors and all of them simultaneously, including all factors considered in the individual PAFs, whatever their significance.
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Mammograms May Not Always Be Recommended
Women who are not at an elevated risk of breast cancer should receive mammograms annually or every two years after age 50. However, the age to stop mammograms is less clear. Older women with other serious medical issues should discuss the benefits of mammography with their physician, as it may make sense to stop mammography at some point and monitor risk through physical exams. Patients should develop a personalized plan for screening and surveillance with their doctors based on their current health and medical history.
Does A Mammogram Detect All Breast Cancer If Not Are There Any Other Tests You Can Do Via The Nhs Or Privately
A mammogram does not detect all breast cancer, but the chance of detecting an underlying cancer increases with age, as the breast becomes less dense. In postmenopausal women presenting with symptoms, mammography will pick up more than 80% of all breast cancers.
Mammography is the only validated screening test for detecting breast cancer in asymptomatic women and, this is available in the private sector . Women deemed to be at high risk of breast cancer are also offered MRI screening. Breast ultrasound is not a valid test for breast screening.
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Gaining Weight Over Time Linked To Aggressive Breast Cancer
Weight gain of 5 percent or more was not associated with an increased risk of breast cancer overall. But this amount of weight gain was associated with a 54 percent higher risk of developing triple negative breast cancer, an aggressive and difficult to treat type of cancer.
The study wasnt a controlled experiment designed to prove whether or how weight changes over time impact a womens risk of developing or dying from breast cancer.
For most people, weight creeps up over time, so, the first realistic goal is to work to stop gaining weight. There are health benefits to that, even if youre overweight, Colditz said by email.
All research on this web site is the property of Leslie Beck Nutrition Consulting Inc. and is protected by copyright. Keep in mind that research on these matters continues daily and is subject to change. The information presented is not intended as a substitute for medical treatment. It is intended to provide ongoing support of your healthy lifestyle practices.
Ascertainment Of Cancer Cases
All questionnaires enquired about any cancer occurrence, type of cancer, addresses of physicians and permission to contact them. Only invasive breast cancers were considered, and in situ tumors with no concomitant invasive tumor were censored at the date of diagnosis. Invasive breast cancer cases were confirmed by pathology reports, obtained for 91.5% of cases. Information on oestrogen-receptor status and on the expression of the human epidermal growth factor receptor 2 were extracted from pathology reports. Invasive premenopausal breast cancers were classified accordingly into two categories, ER+ and ER, and invasive postmenopausal breast cancer into eight non-exclusive categories: HER2+, HER2, ER+, ER and their combinations.
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What Are The Warning Signs Of Breast Cancer
- A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
- A mass or lump, which may feel as small as a pea.
- A change in the size, shape, or contour of the breast.
- A blood-stained or clear fluid discharge from the nipple.
- A change in the look or feel of the skin on the breast or nipple .
- Redness of the skin on the breast or nipple.
- An area that is distinctly different from any other area on either breast.
- A marble-like hardened area under the skin.
These changes may be found when performing monthly breast self-exams. By performing breast self-exams, you can become familiar with the normal monthly changes in your breasts.
Breast self-examination should be performed at the same time each month, three to five days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month.
Treatments To Stop Ovarian Function In Premenopausal Women
Women who havenât undergone menopause may opt for treatment to stop their ovaries from producing hormones. These strategies are generally used with young women with the BRCA mutation or those with aggressive breast cancer. Treatments to stop ovarian function may allow premenopausal women to take medications only available to postmenopausal women. Options may include:
- Surgery to remove the ovaries may offer some women additional protection against recurrence and secondary cancers such as ovarian cancer.
- Treatment with Goserelin and Lupron: These are Luteinising Hormone Releasing Hormone agonists that stop the ovaries from producing estrogen. They can be used to suppress the ovaries long term.
- Radiation therapy aimed at the ovaries.
Side effects of hormone therapy for breast cancer include: Hot flashes, vaginal discharge, vaginal dryness or irritation, fatigue, nausea, joint and muscle pain, menopause, impotence in men with breast cancer. Less common, more-serious side effects of hormone therapy may include: Blood clots in veins, endometrial cancer or uterine cancer, cataracts, stroke, osteoporosis, and heart disease.
Your oncologist will discuss the most appropriate hormonal therapy regimen based on your breast cancer pathology and age. It is very important to take these pills every day adhering to the daily schedule and dosage as planned, otherwise you may reduce the benefit of these drugs.
Information on Tamoxifen and Aromatase Inhibitors:
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Can I Prevent Breast Cancer
While there is no definitive way to prevent breast cancer, there are steps you can take to reduce your risk:
- Maintain a healthy weight.
- Be physically active and get at least 30 minutes of moderate to vigorous exercise five or more days per week.
- Eat a healthy diet with at least five servings of fruits and vegetables daily limit the amount of processed meat and red meat eaten.
- Women should drink no more than one alcoholic beverage daily .
Postmenopausal Hormones Linked To More Aggressive And Deadly Breast Cancers Study Finds
Back in 2002, the Womens Health Initiative randomized trial found that not only did taking postmenopausal hormone therapy have a deleterious effect on womens cardiovascular systems (more heart at
Back in 2002, the Womens Health Initiative randomized trial found that not only did taking postmenopausal hormone therapy have a deleterious effect on womens cardiovascular systems , it also raised their risk of developing breast cancer.
Within 12 months, sales of the hormones had plummeted 32 percent. Bad news for HT manufacturers. But what also dropped over the next few years was the incidence of breast cancer in the United States. Terrific news for women.
Then came the pushback. HT supporters have been parsing and picking away at the WHI data, trying to discredit its overall findings. Claims were made that women would be OK if they took the hormones for just four or five years. Or if they just took different kinds of hormones . New observational studies were launched, and several suggested that the breast cancers associated with HT werent that bad . The cancers tended to be less advanced, these studies suggested, and had more favorable prognoses .
Gosh. I guess that means that the trade-off is worth it for women.
The HT users also had a higher death rate from all causes 0.05 percent per year versus 0.03 percent per year in the placebo group. Again, in absolute numbers that meant 5.3 deaths versus 3.4 deaths per 10,000 women per year.