Breast Cancer and Hormonal Therapy: What You Need to Know
Over two million new breast cancer cases are identified yearly, making it the most prevalent cancer in women worldwide. The good news is that the survival percentage is high with early discovery and successful treatment. Hormonal therapy is one of the primary treatments for breast cancer and is effective in treating certain types of breast cancer. However, many women have questions about hormonal therapy and its side effects. This blog will provide an overview of breast cancer and hormonal therapy, including the types, how they work, side effects, and frequently asked questions.
Breast Cancer: An Overview
An instance of cancer that affects breast tissue is breast cancer. It may begin in the ducts, lobules, or connective tissue of the breast, among other breast structures. There are various forms of breast cancer, each with its specific traits. Invasive lobular carcinoma (ILC) and Invasive ductal carcinoma (IDC) are the two most prevalent kinds of breast cancer.
Breast cancer is a complex disease whose causes are not entirely understood. However, certain risk factors have been identified, such as age, family history of breast cancer, genetic mutations, and exposure to estrogen. The most typical sign of breast cancer is a mass or lump in the breast or armpit, though other symptoms can also be. Nipple discharge, breast soreness, and modifications to the breast’s size or form are further symptoms.
Hormonal Therapy for Breast Cancer
Hormonal therapy is a type of treatment for breast cancer that works by blocking or reducing the amount of estrogen in the body. Estrogen is a hormone that can promote the growth of certain types of breast cancer. Breast cancer that is hormone receptor-positive (HR+), meaning that the tumour cells have oestrogen or progesterone receptors, is treated with hormone treatment.
There are different types of hormonal therapy, including:
– Selective estrogen receptor modulators (SERMs): SERMs block the estrogen receptors in the breast tissue, preventing estrogen from binding to the receptors and promoting the growth of cancer cells. Tamoxifen is the most commonly used SERM.
– Aromatase inhibitors (AIs): AIs block the enzyme aromatase, which converts androgens (male hormones) into estrogen. Postmenopausal women with HR+ breast cancer are treated with AIs. The most commonly used AIs are letrozole, anastrozole, and exemestane.
– Luteinizing hormone-releasing hormone (LHRH) agonists: LHRH agonists work by suppressing estrogen production in the ovaries. They are used to treat premenopausal women with HR+ breast cancer. The most commonly used LHRH agonists are goserelin and leuprolide.
– Selective estrogen receptor degraders (SERDs): SERDs work by blocking and degrading the estrogen receptors. Fulvestrant is the only SERD currently available.
Hormonal therapy is often given for some years, depending on the patient’s circumstances and the type of breast cancer they have.
Side Effects of Hormonal Therapy
Hormonal therapy can cause side effects, depending on the type of therapy and the individual’s response to treatment. The most common side effects seen are:
– Hot flashes
– Vaginal dryness
– Mood changes
– Joint pain
– Bone thinning
– Increased risk of blood clots
– Increased risk of uterine cancer (with tamoxifen)
– Increased risk of osteoporosis (with aromatase inhibitors)
Most of these adverse effects range from mild to moderate and can be managed with medications or lifestyle changes. However, some side effects, such as blood clots and uterine cancer, can be serious and require close monitoring by a healthcare provider.
How Hormonal Therapy Works
Hormonal therapy works by blocking or reducing the amount of estrogen in the body. Estrogen is a hormone that promotes the growth of breast cancer cells. Hormonal therapy is designed to target hormone receptor-positive (HR+) breast cancer, a type of breast cancer with receptors for estrogen or progesterone on the surface of the cancer cells. Hormonal therapy can be given in different forms, including pills, injections, or implants.
Types of Hormonal Therapy
There are several types of hormonal therapy used to treat breast cancer, including:
– Selective estrogen receptor modulators (SERMs): SERMs like blocking the breast tissue’s estrogen receptors.
– Aromatase inhibitors (AIs): AIs block the enzyme aromatase, which converts androgens (male hormones) into estrogen.
– Fulvestrant: An oestrogen receptor antagonist called fulvestrant functions by attaching to and inhibiting oestrogen receptors in breast tissue.
– Luteinizing hormone-releasing hormone (LHRH) agonists: LHRH agonists, such as goserelin, work by suppressing estrogen production in the ovaries.
Who Can Benefit from Hormonal Therapy
Hormonal therapy is generally used to treat women with HR+ breast cancer. It is also used to reduce the chances of breast cancer, mainly in women at high risk of developing the disease. Hormonal therapy is usually given after surgery to remove the tumour. However, it can also be administered before surgery to reduce the tumour’s size and facilitate removal.
Hormonal Therapy Side Effects Management
Although hormonal therapy is generally well-tolerated, it can cause side effects. The most common side effects include hot flashes, vaginal dryness, mood changes, joint pain, fatigue, nausea, bone thinning, increased risk of blood clots, increased risk of uterine cancer (tamoxifen), and increased risk of osteoporosis (with aromatase inhibitors). There are ways to manage these side effects, including medications and lifestyle changes.
The Importance of Compliance with Hormonal Therapy
Hormonal therapy is typically given for several years, and it is essential to comply with the treatment regimen to maximize its effectiveness. Missing doses or stopping treatment prematurely can increase the risk of breast cancer recurrence. Healthcare providers can work with patients to address any concerns or challenges they may have with complying with hormonal therapy.
Hormonal Therapy and Fertility Preservation
Hormonal therapy can affect fertility, so women of childbearing age must discuss fertility preservation options with their healthcare provider before starting treatment. Options may include freezing eggs or embryos for future use or using ovarian suppression to protect the ovaries during treatment.
Hormonal Therapy in Men with Breast Cancer
Men can also develop breast cancer, and hormonal therapy can treat HR+ breast cancer in men. The treatment options and side effects may differ for men, so discussing these with a healthcare provider is important.
Hormonal Therapy and Quality of Life
Hormonal therapy can significantly impact a patient’s quality of life, particularly regarding side effects. Healthcare providers must address these concerns and provide support and resources to help patients manage any issues.
Combination Therapy with Chemotherapy
Hormonal therapy is often used in combination with chemotherapy to treat breast cancer. The combination of treatments can improve outcomes and reduce the risk of recurrence.
Hormonal Therapy Resistance
While hormonal therapy can be highly effective in treating HR+ breast cancer, some patients may develop resistance to the treatment. Research is ongoing to understand the mechanisms behind this resistance better and develop new therapies to overcome it.
Frequently Asked Questions
What is hormone receptor-positive (HR+) breast cancer?
HR+ breast cancer is a type of breast cancer that has receptors for estrogen or progesterone on the surface of the cancer cells. These receptors are proteins that can bind to hormones and promote the growth of cancer cells.
How is HR+ breast cancer treated?
HR+ breast cancer is treated with hormonal therapy, which works by blocking or reducing the amount of estrogen in the body. Depending on the stage and type of breast cancer, chemotherapy, radiation therapy, and surgery may also be used.
What is the difference between tamoxifen and aromatase inhibitors?
Tamoxifen is a selective estrogen receptor modulator (SERM) that blocks the estrogen receptors in the breast tissue. Aromatase inhibitors (AIs) block the enzyme aromatase, which converts androgens (male hormones) into estrogen. Tamoxifen treats premenopausal and postmenopausal women with HR+ breast cancer, while AIs treat postmenopausal women.
How long do I need to take hormonal therapy?
The duration of hormonal therapy depends on the type of breast cancer and the individual’s circumstances. In general, hormonal therapy is given for several years, but your healthcare provider will discuss the best treatment for you.
What adverse effects can hormonal therapy cause?
Hot flashes, vaginal dryness, mood swings, joint pain, exhaustion, nausea, bone thinning, an increased risk of blood clots, an increased risk of uterine cancer (with tamoxifen), and an increased risk of osteoporosis (with aromatase inhibitors) are the most frequent side effects of hormone therapy.
Can hormonal therapy cure breast cancer?
Hormonal therapy can effectively treat breast cancer but is not a cure. It is used to prevent breast cancer recurrence and reduce the risk of metastasis.
Can I get pregnant while on hormonal therapy?
Hormonal therapy can affect fertility, and premenopausal women should use contraception while on hormonal therapy. Pregnancy is not recommended while on hormonal therapy.
Can I drink alcohol while on hormonal therapy?
Moderate alcohol consumption is generally safe while on hormonal therapy, but you should discuss your alcohol intake with your healthcare provider.
What should I do if I experience side effects?
Talk to your healthcare provider if you experience side effects from hormonal therapy. They may be able to adjust your medication or recommend ways to manage your symptoms.
How often should I have follow-up appointments while on hormonal therapy?
Your healthcare provider will schedule follow-up appointments to monitor your response to treatment and check for any side effects. The frequency of these appointments will depend on your circumstances.
In conclusion, hormonal therapy treats hormone receptor-positive (HR+) breast cancer effectively. There are different types of hormonal therapy, each with its unique side effects. If you have breast cancer, discussing your treatment options with your healthcare provider and asking any questions you may have is essential. Early detection and effective treatment are critical for successfully managing breast cancer.
Dr Ghazia Dua