How Do Tamoxifen Raloxifene Anastrozole And Exemestane Reduce The Risk Of Breast Cancer
If you are at increased risk for developing breast cancer, four medications tamoxifen , raloxifene , anastrozole , and exemestane may help reduce your risk of developing this disease. These medications act only to reduce the risk of a specific type of breast cancer called estrogen receptor-positive breast cancer. This type of breast cancer accounts for about two-thirds of all breast cancers.
Tamoxifen and raloxifene are in a class of drugs called selective estrogen receptor modulators . These drugs work by blocking the effects of estrogen in breast tissue by attaching to estrogen receptors in breast cells. Because SERMs bind to receptors, estrogen is blocked from binding. Estrogen is the fuel that makes most breast cancer cells grow. Blocking estrogen prevents estrogen from triggering the development of estrogen-receptor-positive breast cancer.
Anastrozole and exemestane are in a class of drugs called aromatase inhibitors . These drugs work by blocking the production of estrogen. Aromatase inhibitors do this by blocking the activity of an enzyme called aromatase, which is needed to make estrogen.
Who Gets Breast Cancer
Breast cancer is the most common cancer among women other than skin cancer. Increasing age is the most common risk factor for developing breast cancer, with 66% of breast cancer patients being diagnosed after the age of 55.
In the US, breast cancer is the second-leading cause of cancer death in women after lung cancer, and it’s the leading cause of cancer death among women ages 35 to 54. Only 5 to 10% of breast cancers occur in women with a clearly defined genetic predisposition for the disease. The majority of breast cancer cases are “sporadic, meaning there is no definitive gene mutation.
A New Blood Test For Breast Cancer Detection
We were curious about the new blood test available to women in Alberta and Ontario and coming across Canada and so we did some research. This research is not exhaustive and we found there are unanswered questions. The main one being, how accurate is the test? We would be thrilled if this blood test could help women who are not well served by current imaging or who are too young for imaging. Can it do that? Perhaps, it is too early to know since the test is still being studied while it has gone to market.
WHAT IS IT?
- Syantra DX is a blood test for breast cancer now available in Canada.
- While Syantra DX is still being studied, it has also been released commercially.
WHERE IS IT AVAILABLE?
- Currently, the test is available in one location in Calgary and one location in Ottawa.
- There are more locations to come in Ontario this winter and then plans are for a roll out across Canada, so this information about availability may be out of date soon.
HOW DOES IT WORK
- Syantra detects the presence of breast cancer by evaluating the expression of 12 novel genes through a custom qPCR process with proprietary software that includes machine learning-derived algorithms.
- If something is detected then there is follow up with imaging
WHAT DOES IT COST?
- Syantra recommends a cost of $499 but clinics offering the test are free to charge what they like and the Ottawa location is charging $799. Some private insurance plans may cover part .
WHY DOES THIS MATTER
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What Are The Symptoms Of Inflammatory Breast Cancer
Symptoms of inflammatory breast cancer include swelling and redness that affect a third or more of the breast. The skin of the breast may also appear pink, reddish purple, or bruised. In addition, the skin may have ridges or appear pitted, like the skin of an orange . These symptoms are caused by the buildup of fluid in the skin of the breast. This fluid buildup occurs because cancer cells have blocked lymph vessels in the skin, preventing the normal flow of lymph through the tissue. Sometimes the breast may contain a solid tumor that can be felt during a physical exam, but more often a tumor cannot be felt.
Other symptoms of inflammatory breast cancer include a rapid increase in breast size sensations of heaviness, burning, or tenderness in the breast or a nipple that is inverted . Swollen lymph nodes may also be present under the arm, near the collarbone, or both.
It is important to note that these symptoms may also be signs of other diseases or conditions, such as an infection, injury, or another type of breast cancer that is locally advanced. For this reason, women with inflammatory breast cancer often have a delayed diagnosis of their disease.
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The best way to cite this PDQ summary is:
PDQ® Screening and Prevention Editorial Board. PDQ Breast Cancer Screening. Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .
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Can Cancer Form In Other Parts Of The Breast
Cancers can also form in other parts of the breast, but these types of cancer are less common. These can include:
- Angiosarcomas. This type of cancer begins in the cells that make up the lining of blood or lymph vessels. These cancers can start in breast tissue or breast skin. They are rare.
- Inflammatory breast cancer. This type of cancer is rare and different from other types of breast cancer. It is caused by obstructive cancer cells in the skins lymph vessels.
- Paget disease of the breast, also known as Paget disease of the nipple. This cancer affects the skin of the nipple and areola .
- Phyllodes tumors. These are rare, and most of these masses are not cancer. However, some are cancerous. These tumors begin in the breasts connective tissue, which is called the stroma.
Why It Is Done
A BRCA gene test is done to find out if you have BRCA gene changes that increase your risk of breast, ovarian, and some other cancers.
You might consider this test if you or your family have certain health problems or risk factors. Examples include having one or more members of your family who’ve had breast, ovarian, prostate, or pancreatic cancer, being diagnosed with breast cancer before age 50, and having an Ashkenazi Jewish heritage.
You may feel better if the test shows that you don’t have a BRCA mutation. If the test shows that you do have a BRCA mutation, you may be able to make some decisions that could reduce your cancer risk.
If you are concerned that you may have a BRCA gene change, talk with your doctor.
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Tests To Determine Specific Types Of Treatment
You’ll also need tests that show whether the cancer will respond to specific types of treatment.
The results of these tests can give your doctors a more complete picture of the type of cancer you have and how to treat it.
In some cases, breast cancer cells can be stimulated to grow by hormones that occur naturally in your body, such as oestrogen and progesterone.
If this is the case, the cancer may be treated by stopping the effects of the hormones or by lowering the level of these hormones in your body. This is known as hormone therapy.
During a hormone receptor test, a sample of cancer cells will be taken from your breast and tested to see if they respond to either oestrogen or progesterone.
If the hormone is able to attach to the cancer cells using a hormone receptor, they’re known as hormone-receptor positive.
While hormones can encourage the growth of some types of breast cancer, other types are stimulated by a protein called human epidermal growth factor receptor 2 .
These types of cancers can be diagnosed using a HER2 test and are treated with medicine that blocks the effects of HER2. This is known as targeted therapy.
Want to know more?
Molecular Breast Imaging Gives An Inside Look At Cancer Cell Activity
Researchers are also exploring the possibility of using molecular breast imaging to detect breast cancer. It may be used together with a mammogram or ultrasound for women who have dense breast tissue or are at higher risk of developing breast cancer.
This form of imaging works by injecting small amounts of radioactive material into the arm. Then, small cameras record the tracer for about 40 minutes to create images of each breast. Cancer cells absorb the tracer faster than regular cells, so areas that show the most tracer will appear highlighted in the image. This technology may help doctors get a better look at breast tissue to determine whether a biopsy is needed, which can help you avoid unneeded procedures.
Molecular breast imaging is a new technology and is not yet widely available. You can learn more from Mayo Clinic.
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Does A Person Need To Prepare For The Test
There is no need to prepare for a CA 15-3 test, but a person should make their doctor aware of any medications, supplements, or herbal remedies they are taking. A doctor may advise stopping taking some substances a few days before any lab tests.
For instance, according to the Food and Drug Administration , biotin supplements which some people take to promote the growth of hair and nails may interfere with certain lab tests.
The daily recommended biotin allowance for adults, which is 0.03 milligrams , is unlikely to cause any issues. However, the United Kingdoms National Health Service suggests that healthcare professionals wait 8 hours before collecting the sample if a person is taking more than 5 mg per day of biotin.
A normal test result for CA 15-3 levels is usually 30 units per milliliter or less.
Lab Tests Online notes that the levels of CA 15-3 generally increase in line with the advancement of breast cancer. Increased levels of CA 15-3 may, therefore, indicate that the cancer has spread to other areas of the body.
CA 15-3 levels that continue to increase over time may indicate that the:
- treatment is not working effectively
- cancer is continuing to spread
- cancer is recurring
In some cases, a person with normal CA 15-3 levels may still have breast cancer. In the early stages of breast cancer, CA 15-3 levels may not be high enough for a test to detect.
Also, about 2025% of people with advanced breast cancer have tumors that do not release CA 15-3.
What Is The Oncotype Dx Breast Dcis Score
DCIS is the most common form of non-invasive breast cancer. DCIS usually is treated by surgically removing the cancer . After surgery, hormonal therapy may be recommended if the DCIS is hormone-receptor-positive .
Radiation therapy may be recommended for some women. Doctors arent always sure which women will benefit from radiation therapy.
The Oncotype DX Breast DCIS Score is used:
to help doctors figure out a womans risk of DCIS coming back and/or the risk of a new invasive cancer developing in the same breast
how likely a woman is to benefit from radiation therapy after DCIS surgery
The results of the Oncotype DX Breast DCIS Score Test, combined with other features of the DCIS, can help you and your doctor make a more informed decision about whether or not you need radiation therapy.
You may be a candidate for the Oncotype DX Breast DCIS Score Test if:
youve recently been diagnosed with DCIS
youre having lumpectomy to remove the DCIS or have had a core biopsy
The Oncotype DX Breast DCIS Score Test analyzes the activity of 12 genes that can influence how likely the DCIS is to come back, either as another DCIS or as invasive breast cancer.
The Oncotype DX Breast DCIS Score Test assigns a Recurrence Score a number between 0 and 100 to the DCIS. You and your doctor can use the following ranges to interpret your results for DCIS:
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What Is The Test For Breast Cancer Called
- Stage 3A:
- The cancer has spread to 49 axillary lymph nodes or has enlarged the internal mammary lymph nodes, and the primary tumor can be any size.
- Tumors are greater than 5 cm, and the cancer has spread to 13 axillary lymph nodes or any breastbone nodes.
Effective Cancer Screening Tests
Cancer screening tests aim to find cancer early, before it causes symptoms and when it may be easier to treat successfully. Effective screening tests are those that:
- Find cancer early
- Reduce the chance that someone who is screened regularly will die from the cancer
- Have more potential benefits than harms.
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When You Need Themand When You Dont
When you learn that you have breast cancer, its normal to want to do everything you can to treat it and be sure it doesnt come back. But its not always a good idea to get all the tests that are available. You may not need them. And the risks may be greater than the benefits.
The information below explains when cancer experts recommend imaging tests and tumor marker testsand when they dont.
Imaging tests, such as CT, PET, and bone scans, take pictures to help find out if the cancer has spread in your body. Another test, called a tumor marker test, is a kind of blood test. Tumor markers are also called biomarkers or serum markers. They are higher than normal in some cancer patients. The tests you need depends on the stage of your breast cancer.
What Are Genomic Tests
Genomic tests analyze a sample of a cancer tumor to see how active certain genes are. The activity level of these genes affects the behavior of the cancer, including how likely it is to grow and spread. Genomic tests are used to help make decisions about whether more treatments after surgery would be beneficial.
While their names sound similar, genomic testing and genetic testing are very different.
Genetic testing is done on a sample of your blood, saliva, or other tissue and can tell if you have an abnormal change in a gene that is linked to a higher risk of breast cancer. See the Genetic Testing pages for more information.
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How To Check For Breast Cancer
Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.
It’s important that every woman knows how to do a breast self-examination , as it can help in early detection of breast cancer, such as lumps, nipple changes, and more.
Being familiar with what is normal for you will make it easier to recognize any new developments. Furthermore, knowing what’s not normal for anyone can help prompt you to bring such issues to your doctor’s attention, should you notice them during your BSE.
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The Patient Undergoes A Breast Biopsy
Different methods may be used to get a sample of breast tissue to submit to the pathologists for evaluation. These methods include skin punch biopsy, fine needle aspiration , core needle biopsy, and excisional biopsy. The decision of which method to use is influenced by the characteristics of the mass as well as the patientâs breast tissue.
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What Is The Oncotype Dx Breast Recurrence Score Test
The Oncotype DX Breast Recurrence Score Test analyzes the activity of a group of genes that can affect how an early-stage breast cancer is likely to behave and respond to treatment. The Oncotype DX Breast Recurrence Score Test is used in two ways:
to help doctors figure out a persons risk of early-stage, estrogen-receptor-positive breast cancer coming back in a part of the body away from the breast
to help figure out if a person will benefit from chemotherapy
The results of the Oncotype DX Breast Recurrence Score Test, combined with other features of the cancer, can help you make a more informed decision about whether or not to have chemotherapy to treat early-stage, hormone-receptor-positive, HER2-negative breast cancer.
You may be a candidate for the Oncotype DX Breast Recurrence Score Test if:
you and your doctor are making decisions about chemotherapy
Most early-stage, estrogen-receptor-positive, HER2-negative breast cancers are treated with hormonal therapies, such as an aromatase inhibitor or tamoxifen, after surgery to reduce the risk that the cancer will come back in the future. Whether or not chemotherapy is also necessary has been an area of uncertainty for patients and their doctors.
The Oncotype DX Breast Recurrence Score Test analyzes the activity of 21 genes that can influence how likely a cancer is to grow and respond to treatment.
Looking at these 21 genes can provide specific information on:
For women older than 50 years of age: