Hormone Therapy for Estrogen Receptor Positive Breast Cancer

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What types of hormone therapy are available for the treatment of breast cancer, and how do these work to lower the risk of recurrence?

Hormone Therapy for Breast Cancer

Most cases of breast cancer are fueled by the hormones estrogen and progesterone. If your cancer is hormone-sensitive, then hormone therapy may be part of your treatment plan. Hormone therapy, also called endocrine therapy, is used to remove or block hormones, to stop or slow down the growth of cancer cells.

If your doctor prescribes this for your early stage breast cancer, plan on taking hormonal therapy for five years after completing your primary treatments. The main benefit of this type of therapy is to prevent estrogen from fueling of estrogen responsive cancer cells, thereby reducing your risk of recurrence. For breast cancer that is estrogen-receptor negative, hormonal therapy is not effective.

Hormone Therapy Can Be Either Medications or Surgery

Hormones can be lowered by drugs and/or by surgery. In pre-menopausal women, the ovaries create most of the estrogen, and after primary treatment, taking Tamoxifen will be sufficient to block estrogen from cancer cells. If needed, for young women with estrogen-sensitive breast cancer, ovaries can be temporarily shut down with ovarian suppression injections. For high-risk women, ovaries can be surgically removed (oophorectomy). Oophorectomy is a significant step to take, as you will no longer be fertile, so discuss this issue with your doctor before starting treatment.

Two Classes of Anti-Estrogen Hormone Drugs

Two classes of drugs are used for hormone therapy, and these are given based on your menopausal status and your breast cancer diagnosis.

Common Side Effects of Hormone Therapy

Having your ovaries shut down or removed, or taking hormone therapy can bring on medical menopause.

You may not get all of the symptoms of menopause, but here are some common side effects you may experience from this type of therapy:

  • Hot flashes
  • Night sweats
  • Mood swings
  • Vaginal dryness
  • Fatigue

In Summary

Hormonal therapies are used after surgery and other primary treatments for breast cancer. These help prevent recurrence or disease progression in estrogen-receptor positive breast cancers, preventing estrogen from fueling the growth of estrogen-responsive cancer cells. If your doctor prescribes anti-estrogen drugs for you, it is important to take them regularly and for as long as you need them.

How Hormonal Therapies Are Prescribed for Estrogen Sensitive Breast Cancer

Early-stage breast cancer:
Menopausal
Status
Anti-Estrogen DrugDosage Duration
Pre-Tamoxifen2* - 5 years
Pre-Combination of ovarian suppression drugs, SERMs and AIs5 years (clinical trials)
Post-Aromatase Inhibitor5 years
* Tamoxifen may be given for two years and followed by Aromasin for three years, in some cases
Metastatic disease:
Menopausal
Status
Anti-Estrogen DrugDosage Duration
AnyTamoxifenUntil no longer effective
AnyIntermediate and high-dose estrogensUntil no longer effective
AnyAromatase InhibitorsUntil no longer effective
Post-Faslodex InjectionFor disease no longer responding to Tamoxifen or Fareston
AnyMegaceFor disease no longer responding to other hormonal therapies
AnyAndrogens (male hormones)Used after all other hormonal therapies have become ineffective
Pre-Combination of ovarian suppression drugs, SERMs and AIsUntil no longer effective

Sources:

National Cancer Institute. Hormone Therapy for Breast Cancer. Updated 08/02/12. http://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet

National Cancer Institute. Hormone Therapy for Breast Cancer. Updated 08/02/12. http://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet

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