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 Am I a candidate for hormonal treatments?

Hormone therapy is beneficial only to breast cancer patients who have hormone (ER+ or PR+) receptor cancer. This will be indicated on a pathology report. Receiving hormone therapy is not dependent upon age, or stage of cancer although the type of hormonal agent may be.

 What are hormonal treatments?

Hormonal treatments target the hormones (or hormone receptors) that can effect the growth of breast cancer cells. Most of the hormonal therapies target estrogen which is known to promote the growth of breast cancer cells in tumors that are estrogen receptor positive (ER+). Hormone therapy is given either as an individual treatment or in conjunction with other treatments i.e. surgery, radiation, and chemotherapy. These treatments can be helpful in a number of ways: before surgery to shrink cancer, after treatment to prevent recurrence, or after a recurrence to again shrink cancer or keep it under control.

 How long do hormonal treatments last?

As stated above there are different reasons for receiving hormonal treatments and each of these have a different time frame. Hormonal treatments given before surgery (neoadjuvant) can last from 3-6 months as long as it is working to shrink the cancer. Treatment after surgery/chemotherapy/radiation (adjuvant) will normally last anywhere from 5 to 10 years. Finally treatment given for metastatic disease will be continued as long as it is working to shrink the cancer or keep it under control.

  What does menopausal status mean?

Women can be in three different stages of menopause; pre-menopausal (regular period), peri-menopausal (irregular period), or post-menopausal (no longer having periods). Some treatments, such as chemotherapy, may bring about early menopause, especially in women close to the average menopausal age. However, this early menopause is sometimes temporary and so it is important, especially for younger women, to be sure of your menopausal status before deciding on further treatments. A doctor will determine whether you have gone into permanent menopause by testing the levels of the following hormones; estrogen, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). Some treatments, such as aromatase inhibitors, can only be given to post-menopausal women.

 What are Aromatase Inhibitors?

Aromatase inhibitors are the standard of care in hormone receptor positive post-menopausal women. Some women who experience early menopause may be temporarily put on tamoxifen for a year or two until it is certain that menopause was not temporary before swtiching to an aromatase inhibitor. Some women choose to go into surgical or medically induced menopause so they can take aromatase inhibitors.

 What is tamoxifen?

Tamoxifen is the most commonly prescribed hormonal treatment. It is prescribed for newly diagnosed women, patients with metastatic disease, and sometimes, for women at high risk for contracting breast cancer. The usual dosage is 20 mg per day for five years taken in pill form once or twice daily. Tamoxifen blocks the effects of estrogen on breast tissue without changing your body's production of estrogen.

 What are the side effects of tamoxifen?

The side effects vary from individual to individual, but can include hot flashes, mood swings, vaginal discharge, inability to concentrate and, less frequently, endometrial cancer, blood clots, weight gain and visual problems. Tamoxifen should not be taken if pregnant because it can cause harmful damage to developing embryos. Furthermore, women should not get pregnant during treatment. Tamoxifen can increase fertility so it is important to use some form of contraception during treatment. Women should discuss with their doctors if they plan on becoming pregnant fewer than five years after treatment to determine the risks and see if other options are available.

  Is tamoxifen an effective treatment for premenopausal women?

Studies show that tamoxifen is an effective treatment for young women, and is currently the standard care for pre-menopausal women. It is important to discuss with your doctor whether tamoxifen is right for you and to be aware of other options. 

 Will hormone treatments affect bone density?

Tamoxifen may have a positive effect on bone mineral density. This can help to prevent such conditions as osteoporosis. However, it has also been found that the treatments are only effective if continued and that short-term treatments may not produce long-term bone density improvement. Hormonal treatment for breast cancer that lowers estrogen levels can also make bones weaker. Research is ongoing as to which treatments increase the chances of bone loss and this is something which should be discussed with your doctor.

 What are ovarian suppression and ovarian ablation?

Ovarian suppression and oblation refer to the cessation of the production of natural hormones by the ovaries to block those hormones (estrogen and progesterone) from reaching cancer cells and causing them to grow.

· Ovarian suppression: A pharmaceutically induced menopause. Women will experience a gradual change which is close to the effects of natural menopause. The long term risks and benefits of ovarian suppression drugs, taken in combination with drugs like tamoxifen and chemotherapy, are currently being researched. There are currently three trials (SOFT, PERCHE, and TEXT) which you can get information about by visiting the Clinical Trials section of our website.

· Ovarian ablation: Achieved through the surgical removal of the ovaries (oophrectomy). Young women who experience ovarian oblation experience menopause immediately and the side effects are likely to be more severe than the effects of natural menopause.

 What questions should I ask my doctor about hormonal treatments?

• Am I a candidate for hormonal therapy?
• Will I benefit from hormonal therapy?
• How much will I benefit?
• What hormonal therapies do I qualify for?
• Which will work best for me and why?
• Will hormone treatments affect my bone density?
• What are the side effects of this treatment?
• Will these treatments affect my ability to get pregnant?
• What is the likelihood that I will go into early menopause?
• As a younger woman, do the current statistics apply to me?
• Are there any clinical trials which I can take part in?
• How long will I be taking this treatment?
• When should I start?
• Will the costs be covered by my insurance?