When to start tamoxifen after chemotherapy
Hormonal Therapy for Breast Cancer: We Teach You
hormonal therapy is essential for
estrogen sensitive breast cancers we
will teach you all about it
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if you've been diagnosed with breast
cancer there's an 80% chance that your
tumor is estrogen receptor-positive this
means that you will benefit from
estrogen blocking medications usually
pills for up to 10 years but when I
mentioned benefit
I mean improve your survival decrease
the chance of your cancer coming back in
assets lessening the chance that you
could die of your estrogen
receptor-positive cancer so having an
estrogen receptor-positive cancer does
not entirely mean that you will not need
or benefit from chemotherapy in addition
to hormonal therapy and a leap forward
in breast cancer care over the last
decade our genomic assays which help us
better determine whether you'll need
hormonal therapy alone or hormonal
therapy and chemotherapy in this lesson
I'm going to tell you exactly what
hormonal therapy is and the different
medications that we use I'm going to go
over what tumor receptor patterns with
suggest hormonal therapy I'm going to go
over the benefits and the side-effects
of hormonal therapy and I'm also going
to go over genomic assays and how they
can play a role in your care so let's
get started so what is hormonal therapy
for estrogen receptor positive breast
cancers these estrogen blocking or anti
estrogen medications usually pills but
there's some other forms are incredibly
effective at killing cancer cells or
suppressing cancer cells from growing
there generally are two types that are
used the most one is called tamoxifen
and there's some other variations as
happened we've been using this drug to
great effect for the last 30 or 40 years
there's another class of drugs called
aromatase inhibitors and there are three
or four versions of those they're
generally used more for postmenopausal
women they work almost as effectively
and they have some different advantages
and disadvantages the way to think about
hormonal
therapy for estrogen receptor-positive
cancer you got to think about the
estrogen receptor let me tell you so
let's pretend we have a one cancer cell
and it has estrogen receptors on it s
estrogen receptor positive if it's
negative it doesn't have any of these
growth light switches so to speak and
when these estrogen receptors interact
with estrogen it turns the growth switch
to on telling that cell and encouraging
that cell to grow or shall we say
divided to 1 to 2 2 to 4 tumor grows and
spreads it's a problem these medications
hormonal therapy do one of several
things but they can take that growth
switch and turn it from on to off
sometimes killing the seller keeping it
from growing or there are other
situations where it can deprive the
tumor of estrogen and so the on switch
is always in the off position it's much
more complicated than that by the threat
to your life is that when you walked
into your surgeon's office before you've
had surgery and treated your cancer that
might have been cancer cells elsewhere
in your body your bone your brain your
liver that over time although we remove
the cancer can grow and threaten your
life that's what people die off of
breast cancer so hormonal therapy is so
effective because it can interact with
any of those cells that may or may not
be there for up to 10 years suppressing
them or killing them
and increasing the chance of us curing
your cancer there are many different
other more new hormonal therapies they
work in even more sophisticated ways
beyond the scope of this discussion but
let me tell you your medical oncologist
is such a key part of your breast cancer
team medical oncologist prescribed
hormonal therapy prescribed the more
sophisticated drugs and your medical
oncologist can help determine whether or
not you will benefit from chemotherapy
in addition to hormonal therapy next I'm
going to tell you a little bit more
about tumor receptors so what are grass
tumour receptors that suggest I might
need hormonal therapy well your tumor
receptors are key information in guiding
you and your doctors especially your
medical oncologist determining how we
treat your cancer with medication so
it's one of many factors including the
size of your tumor whether you have
cancer in your lymph nodes or elsewhere
in your body but let me walk you through
some principles if you have an estrogen
receptor positive breast cancer
invariably you are going to benefit from
hormonal therapy now the three different
receptors are estrogen receptor
progesterone receptor which plays a much
smaller role and her2 receptors which
plays a very strong role for suggesting
chemotherapy and immunotherapy so let me
walk you through this you can take our
tumor receptor video lesson at the
breast cancer school for patients to
learn more about tumor receptors and
dive more into the details but estrogen
receptor positive tumor benefits from
hormonal therapy if you're a Sturgeon
receptor positive and your progesterone
receptor which is sort of a hormone
therapy type of receptor if it's
positive or negative you're still going
to benefit from hormonal therapy her2
and it's only positive in 20% of
patients suggests that you will benefit
from chemotherapy and targeted immuno
therapy but even if you have a her2
positive breast cancer and it's estrogen
receptor-positive you do chemotherapy
targeted immunotherapy and then you take
hormonal therapy for ten years so all of
this is quite complicated the take-home
message is know what your receptors are
know if your estrogen receptor positive
or negative know if your her2 positive
or negative engage your breast surgeon
early on about whether they think that
you might need chemotherapy already even
before surgery and engage your medical
oncologist when you see them about the
benefits of hormonal therapy and
possibly chemotherapy if it's needed so
what are the benefits and side-effects
of hormonal therapy well the benefits
are tremendous
it's an incredible cancer treating
medication and therapy for hormone
positive cancer and if you think about
it if you're taking these medications
for five to ten years they're protecting
you they're suppressing any cancer cells
from growing back in recurrent one way
to think about hormonal therapy is that
in many different situations it lessens
the chance of cancer growing back by
about 50% so let me give you an example
let's say you have a hormone only
positive breast cancer and that's all
you need but you don't take the
medication and the chance of the cancer
is of coming back and threatening your
life is 20% without
if you take these medications it can cut
in half that number twenty to ten
percent of the chance of your cancer
coming back and threatening your life so
in general it lessens the chance of
things recurring the lessens the chance
the cancer threatening you versus not
taking it by half which is a powerful
effective cancer I want to cover the
side effects and if you cover everyone
about 30 or 40 percent of people really
have little to no side effects at all
from these hormonal therapy but let me
cover the two tamoxifen aroma taste
inhibitors and those are the two main
classes let's cover tamoxifen get the
first you can have hot flashes with
tamoxifen one of the positive side
effects is that it tends to strengthen
your bones or offset some of the normal
bone walls so that's a positive side
effect it can increase the chance of you
developing a rare cancer called in the
material or uterine cancer slightly so
we follow you for that and also as you
get older the chance of developing blood
clots increases while you're on
tamoxifen and you can't take it if
you're trying to have children let's
pivot to aroma taste in heathers which
we use for postmenopausal women you can
get hot flashes it also can cause muscle
aches and joint pains in some women and
we have a number of remedies that your
view and your medical oncologists if you
have those symptoms can work to remedy
them it can also tend to increase bone
loss su age and we have some
countermeasures and medications to
offset that so in the end benefits risks
benefits are tremendous from a cancer
perspective side-effects are there or
not insignificant
but the benefits are dramatically strong
the side effects are generally there but
tolerable and so that's why we strongly
recommend taking hormonal therapy for an
estrogen receptor-positive cancer next
I'm going to tell you about genomic
abscess what are genomic assays in
breast cancer well we already know if
your estrogen receptor-positive you're
going to benefit from hormonal therapy
but they're still in many situations
some unanswered questions that we might
want more information we might otherwise
think you'll just benefit from hormonal
therapy but you might have a higher risk
cancer we don't know about and might
benefit from chemotherapy in addition to
it there are some situations where how
long do you need to take hormonal
therapy five years what's the benefit
from five years to 10 years is a
significant what if I'm having side
effects from five years of hormonal
therapy and I really don't want to take
your six seven eight nine and ten how
much benefit versus how much side
effects all of these questions are
evolving and we're finding better ways
to answer them let me tell you about
genomic assays genomic assays look
inside your cancer cells a little deeper
than receptors and other aspects of it
to tell us whether or not your cancer is
more aggressive than we otherwise would
think or less aggressive or as
aggressive as we otherwise think and the
concept here is sometimes we can look
into your cancer cells with these
advanced sophisticated tests and
determine that someone that we otherwise
would give hormonal therapy is someone
that really has a high-risk tumor and
will really benefit from chemotherapy
and additional
that otherwise wouldn't get it and
otherwise have a higher chance of dying
from their cancer so the 2's assays that
are the most used the predominant one of
the United States is an Oncotype DX
assay
there's also another asset called a
mammoth print and you can go and take
our free video genomic assay lesson at
the breast cancer school for patients to
learn more but most of these assays
apply to hormonal II sensitive breast
cancers so research this more engage
your doctors to determine whether or not
in your unique situation you might
benefit from a genomic asset most breast
cancers are estrogen receptor-positive
and really benefit from hormonal therapy
to lessen cancer recurrence and quite
simply reduce the chance of you dying of
a estrogen receptor-positive breast
cancer hormonal therapy is today usually
recommended for 10 years and generally
well tolerated but it is essential that
you work closely with your medical
oncologists to navigate any side-effects
you may experience without altogether
stopping hormonal therapy chemotherapy
is sometimes needed in addition to
hormonal therapy and in some genomic
assays can play a role in this difficult
decision to learn more about hormonal
therapy for breast cancer visit the
breast cancer school for patients where
we teach you everything you need to know
we're here to help you get the best
possible breast cancer care in your
community register on our website to get
our list of questions to prepare you for
your next doctor visit
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