Hormone therapy for secondary breast cancer
This page tells you about hormone therapy for secondary breast cancer. There is information on
Hormone therapy for secondary breast cancer
Hormones, especially the female sex hormones oestrogen and progesterone, affect the growth of some breast cancer cells. This means that hormones, or drugs that block hormones, can be used to treat some types of secondary breast cancer. They can stop or slow down the development of the cancer cells and can reduce symptoms. Hormone therapy seems to work best with 'oestrogen-receptor positive' cancers, and slow-growing cancers affecting the bones or the skin.
Tamoxifen can help many women with secondary breast cancer, whether or not they have had the menopause. Aromatase inhibitors are currently mainly used for post-menopausal women. We have more information about the side effects of hormone therapy
Progesterone
Artificial progesterone can control the growth of breast cancer cells. If the secondary breast cancer cells stop responding to aromatase inhibitors, your doctor may suggest progesterone treatment instead. You can have it as tablets or by injection.
Switching off your ovaries
If you have not yet had your menopause and have secondary breast cancer, your specialist will probably suggest treatment that stops your ovaries producing any more oestrogen. You may have surgery to remove your ovaries, radiotherapy to the ovaries, or monthly injections with a drug called goserelin (Zoladex). All these treatments give you an early menopause. We have more information about how to cope with menopausal symptoms.
Hormones can stimulate the growth of some breast cancer cells, especially the female sex hormones oestrogen and progesterone. So hormones, or drugs that block hormones, can be used to treat some types of secondary breast cancer. They can stop or slow down the development of the cancer cells and can reduce symptoms.
Hormone therapy seems to work best with
- Women who have 'oestrogen-receptor positive' cancers
- Women with slow-growing cancers affecting the bones or the skin
Oestrogen receptors are areas on the surface of some human cells. They act a bit like a lock that can be opened by oestrogen molecules. When the oestrogen 'key' fits the receptor 'lock', the cell is stimulated to grow into two new cells. Tests can show whether your breast cancer cells are oestrogen receptor positive (ER positive).
Hormones tend not to cause bad side effects. Although side effects may be a problem, they are not often serious. Another advantage is that there are many different hormone treatments. So your doctor may try several until they find one that works and suits you best.
The main types of hormone therapy used for breast cancer are covered below.
If you have advanced ER positive breast cancer, you will probably first be offered hormone treatment with an aromatase inhibitor if
- You have been through your menopause
- You have not had any hormone treatment for breast cancer before OR you have had tamoxifen
Oestrogen is made by a process known as aromatisation in women who have had their menopause. Sex hormones (androgens) produced by the adrenal glands are turned into oestrogen in the fatty tissue of the body. The adrenal glands are small glands just above the kidneys. A chemical called aromatase converts the androgens into female hormones.
Aromatase inhibitors block aromatisation, and reduce the amount of oestrogen in the body. So the hormone receptors are exposed to less oestrogen and the cancer cells receive fewer signals to divide. Aromatase inhibitors are currently mainly used for post-menopausal women. But research is being carried out into using them in pre-menopausal women who have been put into a temporary menopause by using another hormonal therapy called Zoladex.
There are several different aromatase inhibitors used to treat secondary breast cancer
- Anastrozole (or Arimidex) - a once daily tablet
- Letrozole (or Femara) - a once daily tablet
- Exemestane (Aromasin) - a once daily tablet
The most common side effects of these drugs are
- Hot flushes
- Vaginal dryness
- Joint stiffness or pain (arthralgia)
Other side effects can include
- Feeling sick
- Constipation or diarrhoea
- Hair thinning (temporary)
- Tiredness and headaches
- Bone thinning (osteoporosis)
Aminoglutethimide is another aromatase inhibitor that is rarely used now. It switches off natural steroid production as well as oestrogen production. So you have to take steroid replacement tablets all the time you are taking aminoglutethimide.
You should be offered tamoxifen, and treatment to switch off your ovaries, if
- You have advanced ER positive breast cancer
- You have not been through your menopause
- You have not previously been treated with tamoxifen
If you have not had your menopause, you have already had tamoxifen, and your cancer has come back or continued to grow, then you should be offered treatment to switch off your ovaries.
If you are a man with advanced ER positive breast cancer, then you should be offered tamoxifen.
Tamoxifen (also called 'Nolvadex-D' or 'Tamofen') is a common hormone therapy. Many people have taken tamoxifen as treatment for primary breast cancer. It can also help many people with secondary breast cancer.
To find out more about the side effects of tamoxifen look in the CancerHelp UK section about cancer treatments.
Progesterone is another hormone which occurs naturally in women. Artificial progesterone can control the growth of breast cancer cells. You can have it as tablets or by injection. The most common types of progesterone are
- Medroxyprogesterone acetate (Provera)
- Megestrol (Megace)
If the secondary breast cancer cells stop responding to aromatase inhibitors, your doctor may suggest progesterone treatment instead.
If you have not yet had your menopause and have secondary breast cancer, your specialist will probably suggest treatment called ovarian ablation. This stops your ovaries producing any more oestrogen. There are several ways to stop your ovaries working
- Monthly injections with a drug called goserelin (Zoladex)
- Surgery to remove your ovaries
- 3 or 4 treatments with radiotherapy to the ovaries
Goserelin is a hormone treatment. It works on the part of the brain that stimulates the ovaries to produce oestrogen. The drug actually switches the ovaries off. This treatment is reversible. So, if you stop the injections, your ovaries should start working again. But, the closer you are to the age when your menopause will start and the longer you take goserilin, the more likely it is that it too will stop your ovaries working permanently.
Surgery and radiotherapy stop your ovaries working permanently. Chemotherapy may also sometimes permanently stop your ovaries working.
All the ‘ovarian ablation’ treatments give you an early menopause (even though this may be temporary with goserelin). Some women find this very difficult to deal with. You are likely to have symptoms and these will come on very suddenly. There is more information about how to cope with menopausal symptoms in CancerHelp UK’s living with breast cancer section.
Most doctors are sensitive to a woman’s feelings about this type of treatment. You may want time to think about the pros and cons of the treatment and whether to go for permanent or temporary ovarian ablation. You may want to go home and talk it over with your family and friends before deciding to go ahead.
There are books and booklets about hormone treatments, some of which are free. Look at the breast cancer reading list. If you would like to talk to someone outside your own friends and family, some organisations can put you in touch with counselling services. You can find these on our breast cancer organisations page. To find out more about counselling look in what is counselling?
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