Refusing Hormone Therapy For Breast Cancer Postmenopausal

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What Types Of Hormone Therapy Are Used For Breast Cancer

Several strategies are used to treat hormone-sensitive breast cancer:

Blocking ovarian function: Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. Blocking ovarian function is called ovarian ablation.

Ovarian ablation can be done surgically in an operation to remove the ovaries or by treatment with radiation. This type of ovarian ablation is usually permanent.

Alternatively, ovarian function can be suppressed temporarily by treatment with drugs called gonadotropin-releasing hormone agonists, which are also known as luteinizing hormone-releasing hormone agonists. By mimicking GnRH, these medicines interfere with signals that stimulate the ovaries to produce estrogen.

Estrogen and progesterone production in premenopausal women. Drawing shows that in premenopausal women, estrogen and progesterone production by the ovaries is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which then causes the pituitary gland to make and secrete LH and follicle-stimulating hormone . LH and FSH cause the ovaries to make estrogen and progesterone, which act on the endometrium .

Examples of ovarian suppression drugs are goserelin and leuprolide .

Blocking estrogens effects: Several types of drugs interfere with estrogens ability to stimulate the growth of breast cancer cells:

What If Hormones Arent Fuel For The Fire After All

Its no wonder that breast cancer ranks highest among womens health concerns. Over 235,000 cases of breast cancer are diagnosed annually in the United States, with almost 40,000 deaths attributable to the disease. Although the leading cause of death in women is heart disease, cancer ranks second with breast, lung, and colorectal cancer being most common, according to the CDC.

Breast cancer is diagnosed more often in older, usually postmenopausal, women. Breast cancer treatments include anti-estrogen therapy, such as taking aromatase inhibitors, but the serious side effects lead many women to discontinue use. However, some research indicates that hormone replacement therapy using natural hormones may actually be a key component in the treatment of breast cancer.

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Standard Forms Of Treatment

You will likely receive multiple forms of treatment for your breast cancer. These are the most commonly used for all women, regardless of if they are pre- or post-menopausal.

• Surgery: Most breast cancer patients will have some type of surgery to try to remove the cancer. This may involve removing the tumor itself and any affected lymph nodes, or it may require a mastectomyremoval of one or both breasts.

• Chemotherapy: Chemotherapy uses powerful medication to destroy cancer cells, but it can also destroy normal cells in the process. It can be injected directly into your veins or given as a pill that you take by mouth. It may be given prior to surgery to help shrink the tumor or afterwards in an attempt to kill the remaining cancer cells.

• Radiation: This is often recommended for women after they undergo a lumpectomy to remove the tumor. High-energy x-rays are directed at the tissue to destroy cancer cells and keep them from returning.

Preventing Breast Cancer In The Opposite Breast

About 1 in 20 women diagnosed with breast cancer will develop breast cancer in the opposite breast within the 10 years after first breast cancer diagnosis. A 2017 study in the prestigious medical journal JAMA found that taking tamoxifen can reduce the percentage of those women from developing cancer in the opposite breast within 10 years, from about 5% to 2%. Unfortunately, the study authors did not report on breast cancer deaths or deaths for any other reason. Therefore, we do not know whether tamoxifens reduction of cancer in the opposite breast had any impact on the womens longevity.

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What Are The Types Of Hormone Therapy

There are two main types of hormone therapy :

• Estrogen Therapy: Estrogen is taken alone. Doctors most often prescribe a low dose of estrogen to be taken as a pill or patch every day. Estrogen may also be prescribed as a cream, vaginal ring, gel or spray. You should take the lowest dose of estrogen needed to relieve menopause symptoms and/or to prevent osteoporosis.
• Estrogen Progesterone/Progestin Hormone Therapy : Also called combination therapy, this form of HT combines doses of estrogen and progesterone .

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.

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Can I Take Menopausal Hormone Therapy After Breast Cancer

When women reach menopause, some choose to take PHT, which is made up of female hormones to help reduce menopause symptoms. But there have been concerns about women who have had breast cancer using PHT, because of the known link between estrogen levels and breast cancer growth.

A well-designed clinical trial found that breast cancer survivors taking PHT were much more likely to develop a new or recurrent breast cancer than women who were not taking these hormones. Because of this, doctors generally do not recommend PHT if a woman was previously treated for breast cancer.

Effects On Memory And Concentration

During or after cancer treatment some people find it difficult to concentrate, or feel more forgetful. This is known as cognitive impairment.

Many women who are menopausal also find it harder to remember and recall things as well as they did before.

Tiredness, anxiety and changes to your sleep pattern can also cause you to become forgetful and stop you feeling mentally sharp.

It can be difficult to be sure what is causing these memory problems and this can be hard to cope with when you are trying to get back to normal.

If you are concerned, talk to your GP or treatment team.

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Can Some Postmenopausal Women With Breast Cancer Skip Chemotherapy

• By T. Salewa Oseni, MD, Contributor

Breast cancer remains the most common cancer among women. In the last two decades, the treatment of breast cancers has become personalized. This has been possible due to the subtyping of breast cancers. Breast cancers have been subtyped based on the receptors on the breast cancer cell. The most clinically significant receptors those that have targeted therapies are the estrogen and progesterone receptors and the human epidermal growth factor receptor 2 . Cancers that have the estrogen and progesterone receptors are termed hormone receptor -positive cancers.

The development of hormone therapy for HR-positive breast cancers means that some women, for whom the risks of chemotherapy outweigh the benefits, may be able to forego chemotherapy. The development of genomic assays, tests that analyze genes expressed in cancer, have provided a way to help doctors and women decide who will obtain the most benefit from chemotherapy.

Aromatase Inhibitors Such As Arimidex Femara And Aromasin

Aromatase inhibitors work by blocking the production of estrogen in the body. They are generally reserved for postmenopausal women with breast cancer whose estrogen is primarily produced by the aromatase enzyme. Aromatase inhibitors may be used in premenopausal women if ovarian suppression treatments are also used.

Unlike tamoxifen, aromatase inhibitors have a low risk of causing uterine cancer or blood clots. However, aromatase inhibitors can cause muscle and joint pain, which can lead to some women discontinuing treatment. Because they block the production of estrogen, aromatase inhibitors can cause bone loss in women after menopause.

Common side effects of aromatase inhibitors include vaginal dryness, muscle pain, joint aches, and hot flashes or night sweats.

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How Do The Hormones Used In Mht Differ From The Hormones Produced By A Womans Body

The hormones used in MHT come from a variety of plants and animals, or they can be made in a laboratory. The chemical structure of these hormones is similar, although usually not identical, to those of hormones produced by womens bodies.

Non-FDA-approved hormone products, sometimes referred to as bio-identical hormones, are widely promoted and sold without a prescription on the Internet. Claims that these products are safer or more natural than FDA-approved hormonal products are not supported by credible scientific evidence. The FDA provides more information about these products on its Menopause page.

How To Choose The Best Kind Of Hormone Therapy

There are many hormone therapy types to cure breast cancer such as

Selective Estrogen Receptor Modulators

Even known as SERMs, these medications obstruct breast cancer cells from getting attached to estrogen. SERMs impede the effects of estrogen merely in breast tissue but not in other tissues within the body.

These drugs are traditionally only used in premenopausal women.

The commonly used SERMs consist

Tamoxifen

This medication stops estrogen from attaching to cells and thereby disables cancer from growing and dividing. People who have tamoxifen for a decade after breast cancer treatment are less supposed to see the cancer recurrence and more supposed to live longer in comparison to the ones who take the medicine for just 5 years.

Toremifene

This medication is approved only to cure breast cancer that has extended to other body parts and might not be useful in persons who have seen less success with tamoxifen.

Fulvestrant

This is an injected estrogen receptor-blocking medication that is usually used to cure advanced breast cancers. Different from other SERMs, it obstructs the effect of estrogen all through the total body.

Aromatase Inhibitors

AIs obstruct estrogen production from fat tissue, however, have no consequence on the estrogen made by the ovaries.

Common AIs consist

Ovarian Ablation or Suppression

Surgical ablation is carried on by the removal of ovaries. Without the manufacturing of estrogen from the ovaries, one will move into permanent menopause.

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What Can I Take In Place Of Tamoxifen

Other options to treat hormone receptor-positive breast cancer are available. The most popular alternative to tamoxifen is an aromatase inhibitor, such as Arimidex and Aromasin . Other SERMs, such as Evista , and estrogen-receptor antagonists, such as Faslodex , may also be prescribed instead of tamoxifen. These treatment options may be preferred because they are effective and tend to carry a lower risk of severe side effects associated with tamoxifen. Most breast cancer drugs are used as adjuvant therapy or treatments that are given after surgery.

What Is Hormone Replacement Therapy

Hormone replacement therapy is one way to help treat the symptoms of menopause. Menopause is a natural process that happens when the body stops releasing eggs and, in turn, decreases production of the hormones estrogen and progesterone. The age that menopause starts varies, though it typically begins around age 50. There is also a period of several years before menopause called perimenopause when some symptoms of menopause can start appearing.

Some people do not experience any symptoms of menopause beyond irregular menstrual cycles that eventually stop altogether, but most will experience other menopause symptoms. To help manage these symptoms, your doctor may recommend hormone replacement therapy. Hormone replacement therapy is also sometimes called hormone therapy, although it is important to note that it is not the same as the hormone therapy used to treat some types of cancer, including breast cancer. It can also be called HRT.

There are different types of hormone replacement therapy.

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Overall Survival And The Role Of Soft/text In The Contemporary Era

In the SOFT and TEXT trials, no improvement in overall survival was seen with the addition of OS. However, given the few events observed in this cohort, the overall excellent prognosis , and the long natural history of HR+ breast cancer, the absence of an overall survival difference is likely due to insufficient follow up and long-term results are eagerly awaited. The worse overall survival with AI plus OS in ABCSG-12 has not yet been replicated in SOFT/TEXT follow-up is ongoing.

What Is Known About Hormone Therapy And The Risk Of Heart Disease

Scientists continue to learn about the effects of HT on the heart and blood vessels. Many large clinical trials have attempted to answer questions about HT and heart disease. Some have shown positive effects in women who started HT within 10 years of menopause some have shown negative effects when started greater than 10 years of menopause. Some studies have raised more questions about the potential benefits of HT.

Based on the data, the American Heart Association issued a statement for use of HT. They say:

• Hormone therapy for the sole purpose of preventing heart disease is not recommended.

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Ovarian Ablation Or Suppression

Two basic strategies exist to abrogate ovarian function. Ovarian suppression refers to the use of temporary means to suppress ovarian function, generally with LHRH analogues, whereas ovarian ablationa refers to permanent strategies using either oophorectomy or ovarian radiation. The latter is used rarely in the United States, however, due to concerns about efficacy of this approach.2â4 It should be noted that adjuvant chemotherapy can function indirectly as a form of OS or OA depending on the patient, the type of chemotherapy, and the duration of chemotherapy.

Ovarian ablation via oophorectomy is one of the oldest recorded treatments for breast cancer5 and remains an excellent strategy to eliminate ovarian estrogen production. Before the advent of newer, less invasive surgical techniques, perioperative mortality was up to 5% in women with metastatic breast cancer,6 although currently the operative risk is minimal. Surgical oophorectomy is irreversible as are the subsequent consequences of menopause, such as infertility and increased risk of osteoporosis and coronary artery disease. Potential benefits of this approach include the reduction of the risk of ovarian cancer in women who may be at increased risk for ovarian cancer as well as the cost savings over LHRH agonists for any length of time.

Talking With Your Doctor About Hormone Replacement Therapy

Hormone replacement therapy, like any medication, has benefits and risks. Choosing hormone replacement therapy is a personal decision. Be sure to talk with your doctor about the risks and benefits of taking hormone replacement therapy, as well as alternatives for managing the symptoms of menopause. This discussion can help you determine the best plan for you.

If you are considering taking hormone replacement therapy, you can start the conversation with your doctor by asking the following questions:

• What are the risks for cancer with taking this medication?

• What are the protections from cancer by taking this medication?

• What other benefits or risks does this hormone replacement therapy have?

• Are there other medications that have fewer risks or greater benefits?

• How does my family history or genetics affect my choices?

• Should my personal medical history affect my choices?

• Do you think the benefits of hormone replacement therapy outweigh the risks, based on my age and health history?

If you are taking hormone replacement therapy, it is important to keep up with your recommended cancer screenings, including mammograms for breast cancer. Always tell your doctor about any unexpected symptoms you experience, too, including vaginal bleeding, spotting, or discharge, which could be a sign of uterine cancer.

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When Is Hormone Therapy Used For Breast Cancer

Hormone therapy is often used after surgery to help reduce the risk of the cancer coming back. Sometimes it is started before surgery .

It is usually taken for at least 5 years. Treatment longer than 5 years might be offered to women whose cancers have a higher chance of coming back. A test called the Breast Cancer Index might be used to help decide if a woman will benefit from more than 5 years of hormone therapy.

Hormone therapy can also be used to treat cancer that has come back after treatment or that has spread to other parts of the body.

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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