HORMONAL THERAPY BREAST CANCER
Hormones influence the growth of cells and how they behave in the body. Estrogen and progesterone are particularly relevant here especially estrogen – the hormone that seems to affect the most common of all breast cancers across the world for black or white women.
If breast cancer feeds off estrogen, hormonal therapies are designed to reduce the amount of estrogen in the body or stop estrogen from latching onto the cancer cells.
This only applies to Luminal ‘A’ or estrogen positive (ER+) breast cancers. Estrogen positive means it is a cancer with a receptor sitting on top of the cancer cells.
Please see : Estrogen Related Breast Cancer
Hormonal therapy is the last part of the chemical breast cancer journey (Hopefully). It comes when you’ve completed your surgery, chemotherapy and radiotherapy. At least, that’s when it was given to me, but it can be given earlier to help try and shrink a tumor. Your oncologist (cancer doctor) will advise you about this medication – normally a pill. I take it once a day. The whole idea is to prevent your cancer from coming back.
Hormonal therapy drugs are given for a period between 5 – 10 years.
The problem with hormonal medication is the side effects. I really struggled and was not consistent in taking them for a long time. The beginning is the worse and I changed tablets 3 times because I couldn’t get along with them. Now I have learned to stick with it, it has got a lot better and accept the medication as a part of my life. This is because I have seen 3 black women stop the medication and have breast cancer return.
If you are still having problems after this, then your cancer doctor may suggest changing to a different type of hormonal therapy.
BLACK WOMEN AND HORMONAL THERAPY
A 2017 study by the American Cancer Society, found that Black Women were particularly challenged in sticking with hormonal therapy after breast cancer.
The researchers found that about 14 per cent of Black women reported not taking hormonal therapy as prescribed compared to about 5 per cent of white women.
BLACK WOMEN (compared to white women), were also more likely to report:
Apparently, we’re (of African heritage), also least likely to believe breast cancer would return if the hormonal tablet was not taken. We didn’t believe it would change anything.
Lower income young women were less likely to take hormonal therapy
While breast cancer mortality rates have declined over the last few decades, Black women are still twice as likely to die from breast cancer compared to other ethnic groups.
TYPES OF HORMONAL THERAPY
Tamoxifen is the most well-known and established hormonal therapy first introduced in 1998. As an anti-estrogen drug it stops oestrogen attaching to breast cancer cells and making them grow.
Tamoxifen is taken daily as a tablet though I couldn’t stand it. My hot flashes were so frequent and so intense, I could not bear it. I changed to Letrozole…which I also could not stand.
Tamoxifen is usually given to women who have not been through the menopause. Some women take it for a few years and then take another type of hormonal therapy drug called an aromatase inhibitor – Letrozole for example.
Your oncologist / cancer doctor will help and advise you. If you are close to menopause when you start taking it, your doctor may change you to an aromatase inhibitor after a few years of taking tamoxifen. Get them to check your hormone levels first. It’s a blood test.
AROMATASE INHIBITORS (ALS)
Aromatase inhibitors (ALS) are the main hormonal therapies used for women who have been through the menopause.
The main source of estrogen is no longer the ovaries but found in the adrenal glands, fat, the brain and our muscles.
ALS stops oestrogen being made in the fatty tissue. Plus, the breast is its own supply of estrogen.
Unlike Tamoxifen, ALS has much less estrogenic effects but there are a whole new set of side-effects experienced from ALS including:
Sorry but I found these worse and somehow more aggressive than Tamoxifen so yes, I did change my medication for the third time but from Letrozole to Exemestane.
Your cancer doctor may prescribe an aromatase inhibitor such as,
I’m only 2 years in of a 10-year period for Exemestane, but I’ve adjusted now and in truth, the intensity of my symptoms has calmed down.
Nevertheless, since taking this medication I have developed osteoarthritis which I suspect is due to Exemestane against the belief of my doctors.
I am only telling you this in case you already have weak bones because you might find Tamoxifen is more suitable for you.
Before you start an ALS, you could ask for a scan called a DEXA (dual-energy x-ray absorptiometry), to check your bone health (density).
Your doctor may advise you to take calcium and vitamin D supplements to help strengthen your bones. Which is what I do. There are things you can do to look after your bones including eating healthily and doing regular exercise such as walking.
Recent studies show that after five years 92.8 per cent of women who had taken exemestane had no signs of breast cancer recurrence, compared 88.8 per cent of women who had been on Tamoxifen.