How Does Hormone Therapy Work
About 2 out of 3 breast cancers are hormone receptor-positive. Their cells have receptors for estrogen and/or progesterone which help the cancer cells grow and spread.
There are several types of hormone therapy for breast cancer. Most types of hormone therapy either lower estrogen levels in the body or stop estrogen from helping breast cancer cells grow.
Clinical Trials Are A Promising Treatment Option
For people with advanced stages of cancer, clinical trials can be considered the gold standard of treatment. I recommend clinical trials highly, says Rosen. You get access to medication and treatment that you normally wouldnt have.
A clinical trial could even have positive results on your cancer. We are living in an exciting time for cancer treatment, says Kimmick. There are myriad new drugs coming out that will improve the lives of all women with breast cancer, both metastatic and early stage.
However, its important to be realistic about the potential outcome of your trial. Rosen was recently enrolled in a clinical trial in which the medication proved toxic for her. But she has no regrets about participating. It feels like Im helping researchers who are working on cures for cancer, she says. When I had a bad reaction to the drug, they were able to put my side effects in their study. I feel like I did help, and that makes me happy.
People interested in joining a clinical trial for treatment should talk to their doctor about options that might be good for them.
What Are The Stages Of Breast Cancer And Their Treatment Options
Compared to most other cancers, staging breast cancer is more complex and that has to do with the number of breast cancer stages and differences in how breast cancer can develop.
How many stages of breast cancer are there? There are five stages, beginning at Stage 0 and going up to Stage 4. Within some stages there are additional categories based on the location and formation of the cancer.
So when it comes to treating breast cancer, there isnt a one-size-fits-all approach. Your treatment plan should be created especially for you and be coordinated across specialists and thats where your cancer care team comes in.
At HealthPartners, we believe cancer treatment and care is best managed by a group of doctors and specialists in whats known as multidisciplinary conferences. This is where breast surgeons, oncologists, radiologists, pathologists and other members of your care team gather to discuss the best treatment sequence for you.
Below we dive into the treatment options your care team might recommend at various breast cancer stages.
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How Is Hormone Therapy Used To Treat Breast Cancer
There are three main ways that hormone therapy is used to treat hormone-sensitive breast cancer:
Adjuvant therapy for early-stage breast cancer:Tamoxifen is FDA approved for adjuvant hormone treatment of premenopausal and postmenopausal women with ER-positive early-stage breast cancer, and the aromatase inhibitorsanastrozole, letrozole, and exemestane are approved for this use in postmenopausal women.
Research has shown that women who receive at least 5 years of adjuvant therapy with tamoxifen after having surgery for early-stage ER-positive breast cancer have reduced risks of breast cancer recurrence, including a new breast cancer in the other breast, and reduced risk of death at 15 years .
Until recently, most women who received adjuvant hormone therapy to reduce the chance of a breast cancer recurrence took tamoxifen every day for 5 years. However, with the introduction of newer hormone therapies , some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common .
Some premenopausal women with early-stage ER-positive breast cancer may have ovarian suppression plus an aromatase inhibitor, which was found to have higher rates of freedom from recurrence than ovarian suppression plus tamoxifen or tamoxifen alone .
Men with early-stage ER-positive breast cancer who receive adjuvant therapy are usually treated first with tamoxifen. Those treated with an aromatase inhibitor usually also take a GnRH agonist.
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Hormone Therapy For Breast Cancer
Some types of breast cancer are affected by hormones, like estrogen and progesterone. The breast cancer cells have receptors that attach to estrogen and progesterone, which helps them grow. Treatments that stop these hormones from attaching to these receptors are called hormone or endocrine therapy.
Hormone therapy can reach cancer cells almost anywhere in the body and not just in the breast. It’s recommended for women with tumors that are hormone receptor-positive. It does not help women whose tumors don’t have hormone receptors .
Systemic Treatments For Stage Iv Breast Cancer
Treatment often continues until the cancer starts growing again or until side effects become unacceptable. If this happens, other drugs might be tried. The types of drugs used for stage IV breast cancer depend on the hormone receptor status, the HER2 status of the cancer, and sometimes gene mutations that might be found.
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Treatment Of Breast Cancer Stages I
The stage of your breast cancer is an important factor in making decisions about your treatment.
Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of systemic drug therapy . In general, the more the breast cancer has spread, the more treatment you will likely need. But your treatment options are affected by your personal preferences and other information about your breast cancer, such as:
- If the cancer cells have hormone receptors. That is, if the cancer is estrogen receptor -positive or progesterone receptor -positive.
- If the cancer cells have large amounts of the HER2 protein
- How fast the cancer is growing
- Your overall health
- If you have gone through menopause or not
Talk with your doctor about how these factors can affect your treatment options.
Summary Of Treatment Options For Metastatic Breast Cancer
Hormone receptor-positive, HER2-negative breast cancer
Hormonal therapy is considered the standard initial treatment for HER2-negative metastatic breast cancer that is also hormone receptor-positive. It is often given in combination with targeted therapy. However, chemotherapy may also be given. A clinical trial may also be an option for treatment at any stage.
Hormone receptor-negative, HER2-negative breast cancer
In general, chemotherapy or targeted therapy is given for treatment of triple-negative breast cancer. A clinical trial may also be an option for treatment at any stage.
HER2-positive breast cancer that has spread to parts of the body other than the brain
In general, HER2-targeted therapy is regularly added to treatment for HER2-positive breast cancer that has spread. The drugs used depend on the treatments already given and whether the cancer is hormone receptor-positive. The treatment recommendations for first-line, second-line, and third-line or higher treatment are described below. A clinical trial may also be an option for treatment at any stage.
For people with advanced breast cancer that has grown during or after first-line treatment with a HER2-targeted therapy, ASCO recommends trastuzumab deruxtecan as a second-line treatment.
Third-line or higher treatment
HER2-positive breast cancer that has spread to the brain
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Genetic Testing For Inherited Gene Mutations
The National Comprehensive Cancer Network recommends everyone diagnosed with metastatic breast cancer get genetic testing for BRCA1 and BRCA2 inherited gene mutations . If you have a mutation in one of these genes, a PARP inhibitor may be included in your treatment plan.
Metastatic breast cancer can respond to many different drug therapies. This means the drugs can shrink the tumors.
However, over time, tumors can become resistant to drugs used to treat metastatic breast cancer.
Learn how your metastatic breast cancer will be monitored, including blood tests for tumor markers, and when drug therapies are likely to change. Also learn about scan anxiety .
Talk about quality of life issues with your health care providers and your family. This can help you decide what treatments are best for you.
Keep in mind how each treatment option fits in with your values and beliefs, your family situation, your finances and anything else that may be important to you at this stage of your life.
Joining a support group may also help you think through these issues.
How Can I Prevent Breast Cancer Recurrence
Healthcare providers dont know why some people experience breast cancer recurrence. A recurrence isnt your fault. You didnt do anything wrong to cause it or fail to do something more to prevent it.
Certain medications may reduce the risk of breast cancer recurrence in people who have early stage breast cancer. For estrogen-receptive breast cancer, hormonal therapies including tamoxifen or aromatase inhibitors block either the activity of estrogen or the bodys production of estrogen. Chemotherapy may also be recommended to reduce risk of breast cancer recurrence.
Early diagnosis may make it easier to treat a recurrence. Follow your healthcare providers recommendations for mammograms and other screenings. You should also perform regular breast self-exams. Get familiar with how your breasts look and feel so you can see your provider quickly if you notice changes. And remember that most breast changes occur for reasons other than cancer.
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Coping With Advanced Breast Cancer
Being told that you have advanced or metastatic breast cancer may be very confronting or overwhelming. Some women also find the news that their cancer has spread or come back is more devastating than their original diagnosis.
There are many resources available online to help you further understand the meaning of your diagnosis and how to manage the emotional, physical and practical issues arising from metastatic breast cancer. Below are some links where these resources can be accessed:
Although support groups can provide a safe place for people to express their feelings amongst others who share a similar experience, some people are more comfortable talking one-on-one, such as with a counsellor, therapist or trained volunteer . Your GP can also refer you to a psychologist, social worker or other trained therapist. Every person is different and it is important to find a healthy support system that works for you.
Chance Of Remission And Recurrence
When cancer goes into remission, tests that look for cancer cannot detect it. A doctor may refer to this pathological complete response.
Treatment may also cause partial remission. This means that treatment has destroyed a portion of the cancer but that tests can still find the cancer.
Stage 4 breast cancer will not go away completely. However, Breastcancer.org notes that treatment can help control the cancer for years. It notes that the cancer can be active at times and go into remission at other times.
Because stage 4 breast cancer is not curable, it will not disappear and then recur.
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Ovarian Ablation Or Suppression
In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.
Ovarian ablation or suppression stops the ovaries working and producing oestrogen.
Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means you’ll experience the menopause early.
Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist .
Your periods will stop while you’re taking it, although they should start again once your treatment is complete.
If you’re approaching the menopause , your periods may not start again after you stop taking goserelin.
Goserelin comes as an injection you have once a month.
Cancers Treated With Hormone Therapy
Hormone therapy is used to treat prostate and breast cancers that use hormones to grow. Hormone therapy is most often used along with other cancer treatments. The types of treatment that you need depend on the type of cancer, if it has spread and how far, if it uses hormones to grow, and if you have other health problems.
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How Is Breast Cancer Stage Determined
The breast cancer staging process helps doctors determine how much cancer there is and where its located. The higher the breast cancer stage number, the more advanced the disease.
Breast cancer staging is so important because it provides cancer care teams which include breast surgeons, oncologists, pathologists, radiologists and many others an agreed upon way to talk about the disease. This makes it easier for them to understand diagnoses and collaborate on treatment plans.
What This Means For You
Its important to know that this study only looked at women who were diagnosed de novo, meaning the breast cancer was stage IV at first diagnosis. So the results only apply to that type of breast cancer. Its not clear if surgery would improve survival for women diagnosed with a metastatic recurrence or breast cancer that has spread to other parts of the body away from the breast during treatment for early-stage disease.
Its also important to know that this study is a retrospective cohort study. A cohort study means the researchers compared the outcomes of two or more groups of people exposed to different things. In this case, the researchers compared groups of women diagnosed with de novo breast cancer who had different treatments. In a retrospective study, the outcome 5-year survival had already happened. So the researchers looked at the treatments the women received to figure out what may have caused any difference in outcomes.
So even though the study had good results, these weaknesses mean most people diagnosed with stage IV breast cancer are likely to continue receiving treatments other than surgery.
After a diagnosis of stage IV disease, you and your doctor have a number of treatment options to consider, including chemotherapy, hormonal therapy, targeted therapy, immunotherapy, radiation, and surgery. Your treatment plan depends on the characteristics of the cancer, as well as any other health conditions you may have and your personal preferences.
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What Questions Should I Ask My Healthcare Provider
You may want to ask your provider:
- What type of breast cancer recurrence do I have?
- Has the cancer spread outside the breast?
- What stage is the breast cancer?
- What is the best treatment for this type of breast cancer?
- What are the treatment risks and side effects?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.
Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.
Is Breast Cancer Curable
When caught early, breast cancer is extremely treatable. Currently, the average five-year relative survival rate for invasive breast cancer is 90%. But when the cancer is localized, meaning theres no sign the cancer has spread outside of the breast, that rate is 99%.
Relative survival rate compares people with the same type and stage of cancer to the overall population. This is what the American Cancer Society uses to talk about survival rates.
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Plans Have To Be Flexible
My energy is unpredictable, says Sendelbach. I literally never know how Im going to feel from one day to the next. Its so hard to make plans because if I say yes to something thats two weeks away, the day of, I could wake up and feel absolutely horrible.
When someone with metastatic breast cancer declines an invitation or cancels at the last minute, its most likely not because they dont want to be there. Says Sendelbach, We physically cant do it.
Silberman agrees. Ive been going through for a long time, she says, and Ive had friends drop away. Because of MBC and my treatments, its hard for me to be reliable.
When Is Hormone Therapy Used For Breast Cancer
Hormone therapy is often used after surgery to help reduce the risk of the cancer coming back. Sometimes it is started before surgery .
It is usually taken for at least 5 years. Treatment longer than 5 years might be offered to women whose cancers have a higher chance of coming back. A test called the Breast Cancer Index might be used to help decide if a woman will benefit from more than 5 years of hormone therapy.
Hormone therapy can also be used to treat cancer that has come back after treatment or that has spread to other parts of the body.
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How The Breast Cancer Staging Process Starts
The breast cancer staging process begins with diagnostic testing. Depending on previous screening results, if any breast cancer symptoms are present, and other factors, your doctor may recommend one of the following tests:
- Diagnostic mammogram A mammogram involves using an X-ray to take photos of your breast tissue at different angles. To do this, your breasts are gently compressed between two plates so the X-ray can be taken.
- Ultrasound An ultrasound is a non-invasive imaging test that bounces soundwaves of your breast tissue to create a picture of the inside of your breast.
- MRI An MRI is another non-invasive imaging test that uses radio waves and a magnetic field to create an image of your breast tissue. This can help doctors determine the size and placement of tumors.
- Biopsy A biopsy removes small masses and growths from your breast so they can be examined under a microscope by a pathologist and determine if theyre cancerous.
If cancer is detected, a CT scan may be ordered to look for any distant metastasis or local invasion to other organs. And youll likely be connected with a breast surgeon right away, either through a nurse navigator or your doctor.