Hormonal Therapy for Breast Cancer: We Teach You

hormonal therapy is essential for

estrogen sensitive breast cancers we

will teach you all about it


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


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


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