Male Breast Cancer Hormone Therapy

Tamoxifen And Breast Cancer Prevention

A large study by the National Cancer Institute looked at whether tamoxifen lowered cases of breast cancer in healthy women who were known to be likely to get the disease. The results of the trial showed a 50% reduction in breast cancer in the women who took the drug.

Studies have also shown that tamoxifen lessens the risk of breast cancer returning in women who have had the earliest form of the disease, ductal carcinoma in situ .

After Breast Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Breast Or To Other Parts Of The Body

After breast cancer has been diagnosed, tests are done to find out if cancercells have spread within the breast or to other parts of the body. This process is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Breast cancer in men is staged the same as it is in women. The spread of cancer from the breast tolymph nodes and other parts of the body appears to be similar in men and women.

The following tests and procedures may be used in the staging process:

Your Body After Surgery

After surgery, there’ll be a straight scar across your chest where your nipple used to be and possibly a dent where the breast tissue was removed.

The scar will be raised and red at first, but it should flatten and fade with time. The area will also be bruised and swollen for a few weeks.

It may be possible to have further surgery at some point to improve the appearance of your breast and create a replacement nipple. Other options include tattooing a new nipple on to your chest.

Talk to your care team about how your chest will look after surgery and what options you have for improving its appearance if necessary.

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Breast Cancer And Tamoxifen

Tamoxifen is a pill that doctors have prescribed for more than 30 years to treat breast cancer. It works by keeping estrogen from attaching to the cancer cells.

Doctors first used tamoxifen to treat women whose breast cancer had spread in their bodies because it slowed or stopped the growth of the disease. The drug also lowers the chance that some early stage breast cancers will come back. And it can lower the risk that a woman will get cancer in the other breast later on.

Women who are at high risk for breast cancer can take tamoxifen to try to lower their chances of getting the disease. Itâs an alternative to watchful waiting or having surgery to remove a breast, called a mastectomy, before they get the disease.

Tamoxifen is an option for:

• Treatment of the earliest form of breast cancer, ductal carcinoma in situ , along with surgery
• Treatment of abnormal cells in the glands that make milk, called lobular carcinoma in situ , to lessen the chance that theyâll become more advanced breast cancer
• Treatment of breast cancer in men and women whose cancers use estrogen
• Treatment of breast cancer that has spread to other parts of the body or that comes back after treatment
• To prevent breast cancer in women at high risk for the disease

Some people should not use tamoxifen:

• Women planning to get pregnant
• Men or women whoâve had blood clots or a stroke

Talk to your doctor to see if tamoxifen is right for you.

• Sexual side effects like erectile dysfunction or a lower sex drive

What Is Intermittent Adt

Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.

Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .

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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.

When To Contact Your Team

Your doctor, nurse, or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects
• your side effects arent getting any better
• your side effects are getting worse

We haven’t listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

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Possible Side Effects Of Ais

The most common side effects of AIs are:

• Bone and joint pain

AIs tend to have side effects different from tamoxifen. They don’t cause uterine cancers and very rarely cause blood clots. They can, however, cause muscle pain and joint stiffness and/or pain. The joint pain may be similar to a feeling of having arthritis in many different joints at one time. Options for treating this side effect include, stopping the AI and then switching to a different AI, taking a medicine called duloxetine , or routine exercise with nonsteroidal anti-inflammatory drugs . But the muscle and joint pain has led some women to stop treatment. If this happens, most doctors recommend using tamoxifen to complete 5 to 10 years of hormone treatment.

Because AIs drastically lower the estrogen level in women after menopause, they can also cause bone thinning, sometimes leading to osteoporosis and even fractures. If you are taking an AI, your bone density may be tested regularly and you may also be given bisphosphonates or denosumab , to strengthen your bones.

Men And Breast Cancer: Statistics

According to the American Cancer Society:

• Breast cancer in men is rare less than 1 percent of all breast cancer occurs in men.

• About 2,350 new cases of invasive breast cancer were diagnosed in men in the U.S in 2015.

• Breast cancer is about 100 times more common in women.

• About 440 men in the U.S. died from breast cancer in 2015.

Some people use statistics to figure out their chances of getting cancer. Or they use them to try to figure out their chance of being cured. Because no two people are alike, statistics cant be used to predict what will happen to one person. These statistics describe large groups of people. They dont take into account a person’s own risk factors, such as family history, behaviors, or cancer screenings. If you have questions, talk with your healthcare provider.

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How Ovarian Ablation Is Done

If you have not gone through menopause, your ovaries are your main source of estrogen. Estrogen causes some breast cancers to grow, and treatment plans for these cancers may include stopping the ovaries from making estrogen. This is called ovarian ablation or ovarian suppression. Ovarian ablation is most often done to treat breast cancer that has spread to other parts of the body. It can be done in these ways:

• Surgery. The ovaries may be taken out by surgery. This surgery is called oophorectomy or ovariectomy. You will get general anesthesia before the surgery so that youll be in a deep sleep and wont feel anything. The surgeon may do open surgery, which means youll have a large cut . Or you may be able to have laparoscopic surgery, which means smaller incisions are used. The side effects of surgery and your recovery time depend on which procedure you have done.

• Radiation. Another way to stop the ovaries from making estrogen is to use radiation to damage them.

• Medicines. Most often, medicines called luteinizing hormone-releasing hormone analogs, such as goserelin or leuprolide, are used to stop the signals the body sends to the ovaries to tell them to make estrogen. These medicines can be used alone. More often, theyre used with other hormone therapy medicines in people who have not been through menopause.

If Cancer Comes Back Or Has Spread

AIs, tamoxifen, and fulvestrant can be used to treat more advanced hormone-positive breast cancers, especially in post-menopausal women. They are often continued for as long as they are helpful. Pre-menopausal women might be offered tamoxifen alone or an AI in combination with an LHRH agonist for advanced disease.

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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

Side Effects Of Tamoxifen And Toremifene

The most common side effects of tamoxifen and toremifene are:

• Vaginal dryness or discharge
• Changes in the menstrual cycle

When tamoxifen treatment starts, a small number of women with cancer that has spread to the bones might have a tumor flare which can cause bone pain. This usually decreases quickly, but in some rare cases a woman may also develop a high calcium level in the blood that is hard to control. If this happens, the treatment may need to be stopped for a time.

Rare, but more serious side effects are also possible:

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What Are The Stages Of Male Breast Cancer

After diagnosing breast cancer, providers classify the disease using a process called staging. Providers measure the tumor and look at its location. They determine whether the tumor has spread to lymph nodes, surrounding breast tissue or other parts of your body. Lymph nodes are small organs that move fluid through the body and help protect you from illness.

To gather this information, your provider may order tests such as a sentinel node biopsy, PET scan or CT scan. These tests allow your cancer care team to determine the disease stage.

The stages of male breast cancer are:

Stage 0: Cancer cells are only in the ducts. Cancer has not spread to other breast tissue.

Stage I: The tumor is small and hasnt spread to the lymph nodes.

Stage II: One of these is true:

• The tumor is smaller than 20 millimeters and has spread to a few axillary lymph nodes. Axillary nodes are lymph nodes in the armpit.
• The tumor is 20 mm to 50 mm across and has not spread to the axillary lymph nodes . Or the tumor is 20 mm to 50 mm and has spread to the axillary lymph nodes .
• The tumor is larger than 50 mm and has not spread to a few axillary lymph nodes.

Stage III: Cancer has spread typically to several lymph nodes. Cancer cells may also be in the chest wall or skin. It has not spread to other areas of the body away from the breast.

Stage IV: Cancer cells have spread to other parts of the body away from the breast. Cancer can spread to all areas of the body, including the lungs, bones, liver or brain.

Medicine Therapy With Aromatase Inhibitors

If you have not gone through menopause, your ovaries still make most of your estrogen. After menopause, your ovaries no longer make large amounts of estrogen. But cells in your muscles and fat still make some estrogen from male hormones called androgens.

Aromatase inhibitors interfere with the enzyme called aromatase. Its role is to convert androgens into estrogen. By affecting how much estrogen is made, aromatase inhibitors reduce estrogen in the body. This helps slow or stop the growth of breast tumors that are sensitive to estrogen. Sometimes it even shrinks them. Researchers have found that the medicines cant lower estrogen levels enough to affect tumor growth in younger people who have not gone through menopause. Thats because younger peoples ovaries still make high levels of estrogen. For this reason, these medicines are used only in people who have gone through menopause.

There are 3 aromatase inhibitors used for breast cancer, all taken as pills:

Many studies have compared aromatase inhibitors with tamoxifen as adjuvant hormone therapy in postmenopausal people. Using these medicines, either alone or after tamoxifen, has been shown to better reduce the risk for cancer recurrence than using only tamoxifen for 5 years.

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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.

Symptoms Of Breast Cancer In Men

The most common symptom for men with breast cancer include:

• lump in the breast that is nearly always painless
• oozing from the nipple that may be blood stained
• a nipple that is pulled into the breast
• swelling of the breast
• a sore in the skin of the breast
• lump or swelling under the arm
• a rash on or around the nipple

If you have any of these symptoms it is important to go to your GP straight away. Finding a cancer early gives the best chance of successful treatment.

• Find out about stages, types and grades

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How Hormone Therapy Is Used Against Cancer

Hormone therapy is used for two main reasons.

• Treat cancer. Hormone therapy can stop or slow cancer’s growth and reduce the chance it will return.
• Ease cancer symptoms. Hormone therapy may be used to reduce or prevent symptoms in men with prostate cancer who are not able to have surgery or radiation therapy.

What Are The Types Of Male Breast Cancer

Breast cancer in men usually begins in the breast ducts. Ducts are tubes that carry milk to the nipple. Although men have milk ducts and glands that create milk, they dont work like the ducts and milk-producing glands in women.

The types of male breast cancer include:

• Invasive ductal carcinoma: Cancer begins in the breast ducts and spreads to other parts of the breast. Cancer cells may also spread to other areas of the body. Invasive ductal carcinoma is the most common type of breast cancer in people regardless of gender.
• Invasive lobular carcinoma: Cancer begins in the lobules . Lobular breast cancer can also spread to other parts of the body.
• Ductal carcinoma in situ : Cancer cells grow in the lining of the breast ducts. They have not spread to other parts of the breast or the rest of the body. Ductal carcinoma in situ is uncommon in men.
• Inflammatory breast cancer: Usually a type of invasive ductal carcinoma, inflammatory breast cancer is very rare in men. The breast tissue is swollen and red. It feels warm to the touch, and the skin may be dimpled, but there is no lump.
• Pagets disease of the nipple: Cancer cells grow in the ducts and spread to the nipple and the area around the nipple. Pagets disease of the nipple is also called Pagets disease of the breast or mammary Paget disease.

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Treatment Of Locally Advanced Male Breast Cancer

In This Section

Treatment options for men with locally advanced breast cancer include the following:

• Neoadjuvant chemotherapy.
• Surgical excision.
• Radiation therapy and endocrine therapy.

The decisions regarding the order and choice of treatments in men are guided by the same principles used for the treatment of breast cancer in women .

For more information, see the Treatment of Locoregional Recurrent Breast Cancer section in Breast Cancer Treatment.

What Are The Treatments For Male Breast Cancer

Male breast cancer treatment depends on the type and stage of the disease. Your team of providers will discuss your options with you. Your medical history will help guide what treatment is best for you. Treatments include:

• Surgery: During breast cancer surgery, your provider removes as much of the tumor as possible. You may need a lumpectomy or a mastectomy . Because men have limited breast tissue, mastectomy is more commonly done. You may also need surgery to remove lymph nodes.
• Radiation: Your provider uses targeted radiation therapy to kill cancer cells. Radiation for breast cancer usually follows surgery .
• Chemotherapy : Your provider delivers chemotherapy drugs into a vein, usually through an infusion. You might also take oral chemotherapy pills . These medications kill cancer cells and stop them from multiplying. You may receive chemo treatments over several weeks or months.
• Hormone therapy : Your provider prescribes medications that affect your hormones. These drugs may lower levels of estrogen or block the effects of estrogen. Providers usually use hormone therapy to treat women with breast cancer, but it can be an effective treatment for men, too. These medications treat breast cancers that use hormones to grow. Hormone therapy can be given in the form of pills and/or injections.
• Medications: Several medications kill cancer cells or stop them from growing. Your provider will discuss these medications with you. These may include medications called targeted therapy.

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