Hormone therapy

If your breast cancer was found to be hormone-receptor positive when it was diagnosed, you may be able to have hormone therapy to further minimise the risk of your breast cancer recurring.

Breast cancers that are hormone-receptor positive are stimulated to grow by the hormones oestrogen or progesterone, which are found naturally in your body. Hormone therapy works by lowering the levels of hormones in your body or by stopping their effects. It may be used as the only treatment for breast cancer if your general health prevents you from having surgery, chemotherapy or radiotherapy.

If hormone therapy is suitable for you, your treatment will probably be given after surgery or chemotherapy. In some cases, it may be given before surgery to shrink a large tumour. There are several different hormone therapy medicines, including tamoxifen, aromatase inhibitors and pituitary downregulators. In most cases, you will need to take hormone therapy for up to five years after your breast cancer surgery.

Tamoxifen

Tamoxifen is the most common type of hormone therapy. It is most effective for treating cancers that are oestrogen-receptor positive, although you may be prescribed tamoxifen if your cancer is progesterone-receptor positive. If you are prescribed taxmoxifen, you will need to take it every day by mouth (orally) as either a tablet or a liquid. Tamoxifen can cause several side effects, including:

• tiredness,
• changes to your periods,
• nausea and vomiting,
• hot flushes,
• aching joints,
• headaches, and
• weight gain.

Aromatase inhibitors

Aromatase inhibitors come in brands called Arimidex, Aromasin and Femara. They are only suitable for women who have been through the menopause because they block the oestrogen that is made after the menopause by the adrenal glands. Aromatase inhibitors are taken as a tablet once a day. Aromatase inhibitors can cause side effects, including:

• hot flushes and sweats,
• loss of interest in sex,
• nausea and vomiting,
• tiredness,
• aching joints,
• headaches, and
• skin rashes.

Pituitary downregulators

The most commonly used pituitary downregulator in the treatment of breast cancer is goserelin (Zoladex). It is prescribed to women who are still having periods as it stops the ovaries from producing hormones.

If you are prescribed a pituitary downregulator, your periods will stop while you are taking it. They should start again once your treatment is complete. However, if you are approaching menopause (around the age of 50), you may find that your periods do not start again once you stop taking the pituitary downregulator.

This type of hormone therapy is taken as an injection once a month and can cause menopausal side effects, including:

• hot flushes and sweats,
• mood swings, and
• trouble sleeping.

Biological therapy

If your breast cancer was found to be HER2 positive at the time of diagnosis, you may be able to have biological therapy to further minimise the risk of your breast cancer recurring. Biological therapy can also increase the effects of chemotherapy on breast cancer cells.

Breast cancers that are HER2 positive are stimulated to grow by the protein HER2. Biological therapy works by stopping the effects of HER2 and by helping your immune system to fight off cancer cells.

Trastuzumab (Herceptin)

If you are able to have biological therapy, you will probably be prescribed a medicine called trastuzumab (Herceptin). Trastuzumab is usually used after chemotherapy.

Trastuzumab is a type of biological therapy known as a monoclonal antibody. Antibodies occur naturally in your body and are made by your immune system to destroy harmful cells, such as viruses and bacteria. Trastuzumab targets and destroys cancer cells that are HER2 positive.

If you are prescribed trastuzumab, you will need to have your treatment in hospital as it is given intravenously (an injection directly into your vein). Each treatment session takes up to one hour and the number of sessions you need will depend on whether you have early breast cancer or cancer that is more advanced. On average, you will need one session every three weeks for early breast cancer and weekly sessions if your cancer is more advanced.

Trastuzumab can cause side effects, including heart problems. This means that it is not suitable if you have existing heart problems, such as angina, uncontrolled high blood pressure (hypertension) or heart valve disease. If you need to take trastuzumab, you will have regular tests on your heart to make sure the medication is not causing any problems. Other side effects of trastuzumab include:

• an initial allergic reaction that can cause nausea, wheezing, chills and fever,
• diarrhoea,
• tiredness, and
• aches and pains.

Related Articles:

1. Tests to determine specific types of breast cancer treatment
2. Treating breast cancer — part 1
3. Symptoms of breast cancer
4. Cervical Cancer – Knowing is saving a life!
5. Introduction 1: Improve your knowledge of cancer

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