Side Effects Of Hormone Blockers For Breast Cancer

How Is Hormone Therapy Given

Hormone therapy is most often used to treat breast and prostate cancers. Research is being done to see if hormonal therapy could be used to treat other cancer types. Hormone therapy can be given in a few ways:

• Oral medication Taken by mouth.
• Injection Given by an injection under the skin or in the muscle .
• Surgical intervention Removal of the ovaries in women, or testicles in men, causes lower levels of hormones being made.

Hormone therapy is a “systemic” therapy, meaning that it travels throughout the body. Surgery and radiation therapy are “local” treatments.

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:

Drugs That Block Estrogen

Some drugs work by blocking estrogen from causing cancer cells to grow.

Tamoxifen is a drug that prevents estrogen from telling cancer cells to grow. It has a number of benefits:

• Taking Tamoxifen for 5 years after breast cancer surgery cuts the chance of cancer coming back by half. Some studies show that taking it for 10 years may work even better.
• It reduces the risk that cancer will grow in the other breast.
• It slows the growth and shrinks cancer that has spread.
• It reduces the risk of getting cancer in women who are at high risk.

Other drugs that work in a similar way are used to treat advanced cancer that has spread:

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Managing The Side Effects Of Hormone Therapy

Before hormone therapy begins, talk with your doctor about what side effects could happen and how they can be managed. Ask questions about anything that is unclear to you. This will help you feel more prepared if you start experiencing those side effects. Let your health care team know about any new or worsening medical problems you have as soon as possible. This is important to do even if you do not think your symptoms are serious or related to your hormone therapy. Tracking your side effects can make getting the relief you need easier. One way to track side effects is using the free Cancer.Net Mobile app. You can securely record when side effects occur and their severity, and you can easily share these details with your health care team to describe your experience.

Some people may need to take hormone therapy for a long time. Working with your health care team to manage side effects can help maintain quality of life while on this kind of extended cancer treatment.

Hormonal Therapy For Endometrial Cancer

Cancer of the uterus or its lining, the endometrium, may respond to hormone therapy with progestins. Other types of hormone therapy for endometrial cancer include:

• Aromatase inhibitors

When and why theyre used: Hormone therapy is typically reserved for advanced uterine or endometrial cancer, or for cancer that has returned after treatment. Its often combined with chemotherapy.

Risks: Side effects are similar to those seen with hormone treatment for other types of cancer.

Expert cancer care

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Muscle And Bone Changes

You might develop pains in your joints. This often settles down after a few weeks. You can take a mild painkiller to help control aches and pains.

Some hormone therapies such as aromatase inhibitors can cause thinning of your bones. Tamoxifen can cause bone thinning in pre menopausal women. Tamoxifen doesnt cause bone thinning in post menopausal women, and it can help to maintain the strength of your bones.

Weight bearing exercise can help to build up the bones and protect them. This means any exercise where you are carrying your own weight, such as walking, running, cycling or exercise in the gym.

Swimming is not weight bearing exercise. So, although it is good for you in other ways, it won’t help with bone thinning. Check with your doctor before starting any new type of exercise, especially if you have not exercised for a while.

Bone thinning can lead to osteoporosis and bone fractures if it continues for a few years. So, your doctor may treat you with a drug to strengthen your bones.

• Get more information on osteoporosis risk and hormone therapy

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Side Effects After Stopping Anastrozole

Side effects caused by anastrozole will be different for each person. You may find your side effects reduce after stopping anastrozole, for others they may continue after treatment finishes.

You may also experience side effects caused by other treatments or individual circumstance, such as the menopause. If you’re worried about any long term side effects after stopping anastrozole, speak to your treatment team or GP.

If you have any worries or questions about taking or stopping anastrozole, you can to talk through your concerns.

Common Questions About Anastrozole

Anastrozole belongs to a group of medicines called aromatase inhibitors.

Aromatase inhibitor medicines are used to treat certain types of breast cancer, where the cancer cells need oestrogen to grow.

After the menopause your ovaries stop producing oestrogen. Instead your body makes oestrogen from an enzyme called aromatase.

Aromatase inhibitors reduce the amount of aromatase in your body and this in turn stops your body producing oestrogen. This helps prevent cancer cells growing, as they no longer have anything to feed on.

Anastrozole helps stop your breast cancer coming back after having treatment for cancer.

Your specialist will be able to explain the benefits and risks of taking anastrozole.

They can also calculate how well anastrozole is likely to work for you. This is done by comparing your details with those of more than 20,000 other people who have had treatment for breast cancer.

The exact benefits and how well itâs likely to work for you depend on a combination of different things.

This varies for each person and includes factors like your age when the breast cancer was found, how it was found and whether youâve had chemotherapy or not.

Anastrozole will immediately start to reduce the amount of oestrogen in your body. However, it takes several weeks or months for the medicine to work fully.

Most people who take anastrozole will have had surgery, radiotherapy or sometimes chemotherapy to treat their breast cancer first.

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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.

How To Switch To A Tamoxifen Alternative

Hormone therapy for breast cancer is typically started after surgery. Switching to a tamoxifen alternative may depend on the response to treatment. The timeline for hormone therapy may look like one of the following:

• Start an aromatase inhibitor two to three years after treatment with tamoxifen. Continue taking the aromatase inhibitor for two to three years for a total of five years of treatment with tamoxifen and the aromatase inhibitor. This treatment timeline is appropriate for postmenopausal women.
• Start an aromatase inhibitor two to three years after treatment with tamoxifen. Continue taking the aromatase inhibitor for five years for a total of seven to eight years of treatment with tamoxifen and the aromatase inhibitor. This treatment timeline is appropriate for postmenopausal women.
• Start an aromatase inhibitor five years after treatment with tamoxifen and ovarian suppression therapy. Continue taking the aromatase inhibitor for five years for a total of 10 years of treatment with tamoxifen and the aromatase inhibitor. This treatment timeline is appropriate for women who are premenopausal at the time of diagnosis.

An oncologist will recommend follow-up care every few months to assess the effects after treatment with hormone therapy. They will also assess the risk of recurrence of cancer and determine the next steps for treatment as needed.

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Side Effects Of Aromatase Inhibitors Versus Side Effects Of Tamoxifen

Although both aromatase inhibitors and tamoxifen can cause menopausal symptoms such as hot flashes, many of their side effects differ .

Your health care provider can treat many of these side effects.

Learn more about the side effects of tamoxifen.

Why Does Hormone Therapy Cause Side Effects

Hormones are chemicals made by the body that move through your bloodstream. They control the activity of certain cells or organs. Changes to the amount of a hormone in your body can interfere with a specific activity in the body and cause side effects. Some hormones affect several body functions, so hormone therapy can cause many different side effects.

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What Is A Breast Tumor That Has Estrogen And/or Progesterone Receptors Called

Breast tumors that contain estrogen and/or progesterone receptors are sometimes called hormone receptor positive . Most ER-positive breast cancers are also PR positive. Breast cancers that lack ERs are called ER negative, and if they lack both ER and PR they may be called HR negative. Approximately 67%80% of breast cancers in women

What Is Hormonal Therapy

Hormones help control how cells grow and what they do in the body. The hormones oestrogen and progesterone, particularly oestrogen, can encourage some breast cancers to grow.

Hormonal therapies reduce the amount of oestrogen in the body or stop it attaching to the cancer cells. They only work for women with oestrogen-receptor positive cancers.

Your cancer doctor will advise you to take hormonal therapy to reduce the risk of the breast cancer coming back. It also helps reduce the risk of getting a new breast cancer in your other breast. Sometimes hormonal therapy drugs are given before surgery to shrink a cancer and avoid a mastectomy.

You usually take hormonal therapy drugs for a number of years. For some women, this could be up to 10 years. You usually start taking them after surgery or chemotherapy.

The type of hormonal therapy you have depends on:

• whether you have been through the menopause or not
• the risk of the cancer coming back
• how the side effects are likely to affect you.

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Does Arimidex Work For Breast Cancer

They only work in women who are past menopause, though. Anastrozole , exemestane , and l etrozole are aromatase inhibitors. Doctors prescribe them to treat ER-positive breast cancer, either following tamoxifen treatment or by themselves. There are other hormone therapy drugs used to treat breast cancer, too.

Other Serms Such As Evista And Fareston

Raloxifene and toremifene are other SERMs that act similarly to tamoxifen. They stop cancer growth by binding to estrogen receptors and blocking the ability of estrogen to bind to these receptors. However, SERMs can also mimic the effects of estrogen in other parts of the body, such as the uterus, which can increase the risk of certain cancers. These drugs are not usually recommended if previous treatment with tamoxifen has not been successful. Toremifene is only approved for the treatment of metastatic breast cancer in postmenopausal women, so its uses are more limited than those of tamoxifen.

Some healthcare providers may prescribe raloxifene over tamoxifen due to its lower risk of serious side effects, such as uterine cancer. Raloxifene may be prescribed to postmenopausal women with osteoporosis who are at a high risk of invasive breast cancer. However, raloxifene may be less effective at preventing breast cancer than tamoxifen and has only been tested in postmenopausal women. On the other hand, tamoxifen is an option to prevent breast cancer in premenopausal women.

SERMs are generally taken by mouth. Side effects may include hot flashes, muscle or joint pain, and leg cramps. Serious side effects may include an increased risk of uterine or endometrial cancer and blood clots in the legs or lungs.

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Anastrozole May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:

• joint, bone, or muscle pain
• difficulty falling asleep or staying asleep

• difficulty swallowing or breathing
• swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles, or lower legs

Anastrozole may cause or worsen osteoporosis. It can decrease the density of your bones and increase the chance of broken bones and fractures. Talk to your doctor about the risks of taking this medication and to find out what you can do to decrease these risks.

Anastrozole may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .

Are There Risks To Taking Tamoxifen

Yes. The risks include:

• Fertility. Tamoxifen can increase your fertility for a short time. But it might harm a growing baby, so itâs important to use some form of barrier birth control while youâre taking it, like condoms or a diaphragm. Donât use birth control pills. They can change how the drug works and affect the breast cancer. Tell your doctor right away if you think youâve become pregnant while youâre taking tamoxifen.
• Blood clots. Women who take tamoxifen may have a slightly higher risk of blood clots in their lungs or large veins. Itâs an even bigger risk for smokers.
• Uterine cancer or sarcoma. The drug may make a woman more likely to get these diseases. But this risk is small, and it may be outweighed by the benefits of tamoxifen for breast cancer treatment. Talk to your doctor to know for sure.
• Cataracts. Tamoxifen seems to give some women a higher chance of having this condition, which clouds the lens inside the eye. People have also reported eye problems such as corneal scarring or retinal changes.
• Medications. Tamoxifen may affect how other drugs work in your body.

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Hormone Therapy Has A Bigger Impact Than Chemotherapy On Womens Quality Of Life

Cellules cancéreuses. Expression de la protéine PML en rouge et du gène ZNF703 en vert dans des cellules de la lignée de cancer du sein MCF7. ©Inserm/Ginestier, Christophe

Analysis of the CANTO cohort published in the journal Annals of Oncology will upset received wisdom on the effects that hormone therapy and chemotherapy have on the quality of life in women with breast cancer. Contrary to the commonly held view, 2 years after diagnosis, hormone therapy, a highly effective breast cancer treatment worsens quality of life to a greater extent and for a longer time, especially in menopausal patients. The deleterious effects of chemotherapy are more transient. Given that current international guidelines recommend the prescription of hormone therapy for 5 to 10 years, it is important to offer treatment to women who develop severe symptoms due to hormone antagonist medication and to identify those who might benefit from less prolonged or intensive treatment strategies.

This work was directed by Dr Inès Vaz-Luis, specialist breast cancer oncologist and researcher at Gustave Roussy in the lab Predictive Biomarkers and Novel Therapeutic Strategies in Oncology .

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Questions To Ask The Health Care Team

• What side effects are common from the hormone therapy treatment you are recommending for me?

• When is it likely that side effects will occur? How often?

• How long will side effects last? Could any of them be permanent?

• Is there anything I can do to prepare for these side effects?

• What can the health care team do to prevent or relieve side effects?

• Who should I tell if I begin experiencing side effects from hormone therapy? How soon?

• What side effects are considered emergencies? What should I do if I experience an urgent side effect?

• Who do I contact if I have questions about specifci side effects?

• How can I reach them during regular business hours? After hours?

• Are there any support groups you can recommend to help cope with the fear of side effects?

• Are there other ways I can cope with my fears about the effects of treatment?

• Can you recommend a social worker, counselor, or supportive or palliative care specialist for me to talk with?

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