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| 1. What is hormone receptor-positive breast cancer? |
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| | Certain types of breast cancer are fueled by the hormones estrogen and progesterone. On the surface of cells, there are receptors, which when turned on, tell the cells how to behave. Because some receptors have a particular affinity for estrogen and progesterone, the hormones may attach to these receptors and then tell the cells to grow and divide. These receptors are found in tissues all over the body in both healthy cells and certain cancer cells. In women with hormone receptor-positive breast cancer, hormones can spur the growth of breast tumors. About two-thirds of breast cancers are hormone receptor-positive. A tumor’s hormone-receptor status is determined when a pathologist analyzes a sample of tissue from the tumor following a biopsy, or surgery to remove the tumor. |
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| How you can prepare for this discussion |
- Learn your receptor status
- Keep a record of all treatments received for your breast cancer
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| 2. What are the treatment options for hormone receptor-positive breast cancer? |
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| | After surgery for breast cancer, treatment plans often continue with adjuvant therapy—chemotherapy, radiation therapy, hormonal treatment—used alone or in combination. The goal of adjuvant therapy is to prevent cancer recurrence in the breast or elsewhere in the body (metastasis). In women with hormone receptor-positive breast cancers, hormonal treatments, sometimes called anti-estrogens, can be given to prevent estrogen from reaching the receptors. Hormonal treatment options will depend on your menopausal status and tumor stage. In premenopausal women, the primary source of estrogen production is the ovaries and they are sometimes surgically removed or suppressed with medication. After menopause, estrogen is produced by fat cells and the adrenal glands. The standard of care for pre- and postmenopausal women with hormone receptor-positive breast cancer is typically tamoxifen, a drug known as a selective estrogen-receptor modulator, or SERM. In postmenopausal women, a class of drugs called aromatase inhibitors may be used as adjuvant treatment, instead of tamoxifen, or when tamoxifen is not producing a desirable effect.
The following are types of hormonal therapy:
- Selective estrogen-receptor modulators (SERMs)—Block estrogen from attaching to the cell's hormone receptor
- Aromatase inhibitors—Reduce the amount of estrogen circulating in the blood by preventing another hormone, androgen, from being converted to estrogen.
- Estrogen receptor down-regulators—Block and reduce the number of available receptors
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| How you can prepare for this discussion |
- Know your menopausal status
- Speak to other women with breast cancer about their experiences during therapy
- Talk to friends and family about dealing with treatment needs and appointment schedules
- Make a list of all treatments you have had for your breast cancer
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| 3. What are the side effects of hormonal treatments? |
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| | Side effects from hormonal therapy are not the same as those with chemotherapy. Because hormonal therapies decrease estrogen levels, women receiving these treatments have symptoms similar to those experienced during menopause, including hot flashes, fatigue, vaginal dryness and changes in appetite. In some cases, these symptoms will diminish over time. People taking tamoxifen may experience vaginal bleeding and discharge, fluid retention, mood changes and visual disturbances. There is also a slight risk for blood clots, ovarian cysts and uterine cancer. Women who take aromatase inhibitors also experience menopausal symptoms but to a much lesser degree. They may however develop osteoporosis, a bone-thinning condition. Medications may be needed to offset this side effect. Other less common side effects may also be experienced. |
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| How you can prepare for this discussion |
- Determine your support system at home and at work and what aspects might be affected by treatment side effects
- Learn if you have a family history of osteoporosis or if you have low bone mineral density
- Note your history of any diseases of the uterus or ovaries
- List all vitamins, herbals, dietary supplements, and other prescription and over-the-counter medications, especially blood thinners and aspirin
- Record all current and past medications and their side effects
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| 4. How long will I need to take hormonal treatments? |
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| | Hormonal treatments can be given following surgery to help prevent breast cancer recurrence. Tamoxifen can be taken for varying lengths of time, depending on how well the cancer is responding to this treatment. Although the ideal length of treatment with tamoxifen is not known, tamoxifen is generally prescribed for five years. Tamoxifen is the most common treatment but other hormonal treatments may be equally effective. The optimal duration for adjuvant aromatase inhibitor therapy is not known. |
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| How you can prepare for this discussion |
- Note any side effects you experienced from any of your treatments for breast cancer
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| 5. What can I do after treatment with tamoxifen? |
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| | Treatment with tamoxifen is very successful in staving off breast cancer recurrence, but it can only be given for a period of five years. New studies show that aromatase inhibitors may be a treatment option when the five-year period is up. More studies are needed to see how long aromatase inhibitors can be given. |
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| How you can prepare for this discussion |
- Keep a record of all your breast cancer treatments and how long you have been taking them
- Keep records of all your breast cancer follow-up tests, including mammogram results and biopsy reports
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| Supported through an unrestricted educational grant from Novartis Oncology |
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