Florida Breast Health Specialists Hormone Therapy Information and Questions to Ask Your Doctor

Transcription

1 What is Hormone Therapy? Hormonal therapy medicines are whole-body (systemic) treatment for hormone-receptorpositive breast cancers. Hormone receptors are like ears on breast cells that listen to signals from hormones. These signals "turn on" growth in cells that have receptors. Most breast cancers are hormone-receptor-positive. About 80% of breast cancers are estrogen-receptor positive. About 65% of estrogen-receptor-positive breast cancers are also progesteronereceptor-positive. About 13% of breast cancers are estrogen-receptor-positive and progesteronereceptor-negative. About 2% of breast cancers are estrogen-receptor-negative and progesteronereceptor-positive. If a cancer has receptors for either estrogen or progesterone, it's considered hormonereceptor-positive. There are three different types of hormonal therapy medicines: aromatase inhibitors: Arimidex (chemical name: anastrozole) Aromasin (chemical name: exemestane) Femara (chemical name: letrozole) SERMs (Selective Estrogen Receptor Modulators): tamoxifen Evista (chemical name: raloxifene) Fareston (chemical name: toremifene) ERDs (Estrogen Receptor Downregulators): Faslodex (chemical name: fulvestrant) Hormonal therapy medicines can be used to: lower the risk of early-stage hormone-receptor-positive breast cancer coming back

2 lower the risk of hormone-receptor-positive breast cancer in women who are at high risk but haven't been diagnosed with breast cancer help shrink or slow the growth of advanced-stage or metastatic hormone-receptorpositive breast cancers Hormone Therapy At a Glance How Your Body Makes Estrogen after Menopause If you are post-menopausal, most of your estrogen is produced in two steps: Your adrenal glands (two small glands that sit on top of your kidneys) make a hormone called androgen. Androgens are mostly male hormones, but women have them too. Then a special protein found in muscle and fat cells throughout your body makes an enzyme called aromatase, which changes androgen into estrogen. Hormonal therapy medicines treat hormone-receptor-positive breast cancers in two ways: by lowering the amount of the hormone estrogen in the body by blocking the action of estrogen in the body Because it targets estrogen, hormonal therapy is also known as anti-estrogen therapy. Estrogen has many different roles in your body, including keeping your bones strong and cholesterol low, as well as improving your sense of well-being. Before menopause, most of the estrogen in a woman's body is made by the ovaries. After menopause, the ovaries stop producing estrogen, but smaller amounts of estrogen are still made in the body; a steroid produced by the adrenal glands is made into estrogen in fat tissue. After a breast cancer is removed, the cells are tested to see if they have receptors for two hormones: estrogen and progesterone. If a breast cancer is hormone-receptor-positive, it means that it has these hormone receptors, which act like ears or antennae. When estrogen in the body attaches to the receptors, the breast cancer cells respond to signals from the estrogen that tell the cells to grow and multiply. By reducing the amount of estrogen in the

3 body or blocking the effects of estrogen, hormonal therapy medicines can slow the growth of or shrink advanced-stage/metastatic estrogen-receptor-positive breast cancers. Lowering the amount of estrogen or blocking its effects also can reduce the risk of an earlystage, estrogen-receptor-positive breast cancer coming back after surgery. Since hormonal therapy affects the action of estrogen but not progesterone in breast cancer cells, the value of hormonal therapy is less clear if your cancer is progesterone-receptor-positive and estrogen-receptor-negative. In this situation, you should discuss the value of hormonal therapy with your doctor. In addition to taking a hormonal therapy medicine, premenopausal women diagnosed with hormone-receptor-positive breast cancer or who are at high risk for breast cancer also may want to consider temporary ovarian shutdown using medication or permanent ovarian shutdown by surgically removing the ovaries. The ovaries are the main source of estrogen before menopause, so ovarian shutdown or removal stops them from producing estrogen. Hormonal therapy WON'T work on hormone-receptor-negative breast cancers. Hormonereceptor-negative breast cancers don't respond to estrogen, so reducing the amount of estrogen in the body doesn't affect hormone-receptor-negative cancers.

4 Questions to ask your Doctor about Hormone Therapy: Questions for people who just have been diagnosed with hormone-receptor-positive breast cancer: 1. For my situation, what are the benefits and risks of aromatase inhibitors? 2. For my situation, what are the benefits and risks of tamoxifen? 3. Do you think an aromatase inhibitor or tamoxifen makes more sense for me? 4. Can you compare the side effects of tamoxifen with the side effects of aromatase inhibitors? 5. How many years will I take hormonal therapy? 6. Do I need any tests to determine if I am pre- or postmenopausal? 7. Do I need a bone density test? Questions for people who have taken tamoxifen for 2 to 3 years: 1. Do you think I should switch to an aromatase inhibitor? Why? 2. How much longer would I take tamoxifen if I didn't switch to an aromatase inhibitor? 3. How long would I take an aromatase inhibitor if I did switch? 4. Will I have different side effects if I switch to an aromatase inhibitor?

5 Questions for people who have finished 5 years of tamoxifen or an aromatase inhibitor: 1. Are there any reasons I should now take a different type of hormonal therapy for an additional 5 years? (Tamoxifen for women who have finished 5 years of an aromatase inhibitor; an aromatase inhibitor for women who have finished 5 years of tamoxifen.) 2. Are there any reasons why I should keep taking my current hormonal therapy medicine for longer than 5 years? 3. How many years would I take an aromatase inhibitor? 4. How many years would I take tamoxifen? 5. What side effects might I have with an aromatase inhibitor? With tamoxifen?