Hormone Therapy for ER/PR+ Breast Cancer:
Hormone therapy (also called endocrine therapy) is a pill-based treatment for estrogen receptor-positive (ER+) or progesterone receptor-positive (PR+) breast cancers. It blocks or lowers estrogen to prevent cancer growth and recurrence.
Who Needs Hormone Therapy?
- ER+ and/or PR+ breast cancer (~70% of cases).
- Given after surgery (adjuvant) or for metastatic cancer.
- Typically taken for 5-10 years (sometimes longer).
Not for:
Hormone receptor-negative (ER-/PR-) cancers.
HER2+ cancers (unless also ER+).
Types of Hormone Therapy
1. For Premenopausal Women
A. Tamoxifen (SERM - Selective Estrogen Receptor Modulator)
- How it works: Blocks estrogen receptors in breast cells.
- Duration: 5-10 years.
- Side Effects: Hot flashes, vaginal dryness, blood clot risk (rare).
- Bonus: May preserve fertility (unlike ovarian suppression).
B. Ovarian Suppression (OFS) + Aromatase Inhibitor (AI)
- For high-risk cases (young age, large tumors, node involvement).
- OFS options:
- Monthly injections (Goserelin/Leuprolide).
- Oophorectomy (surgical removal of ovaries).
- AI added (Anastrozole/Letrozole/Exemestane) for stronger protection.
2. For Postmenopausal Women
A. Aromatase Inhibitors (AIs)
- How it works: Blocks estrogen production in fat/adrenal glands.
- Types:
- Anastrozole (Arimidex)
- Letrozole (Femara) – More potent.
- Exemestane (Aromasin) – Slightly different mechanism.
- Side Effects: Joint pain, bone thinning (osteoporosis), cholesterol changes.
B. Tamoxifen (Alternative for Some)
- Used if AIs cause intolerable side effects.
How Long to Take Hormone Therapy?
- Standard: 5 years (Tamoxifen or AI).
- Extended Therapy: Up to 10 years for high-risk cases.
- Switching Drugs: Some switch from Tamoxifen to AI after 2-5 years.
(Decision depends on recurrence risk and side effects.)
FAQs
Q: Can I get pregnant on hormone therapy?
→ No. Tamoxifen can harm a fetus. Discuss fertility preservation before starting.
Q: Do AIs cause weight gain?
→ Some women gain weight, but diet/exercise can help.
Q: What if I miss a dose?
→ Take it ASAP, but don’t double up. Consistency is key!
Key Takeaways
✔ Hormone therapy is a long-term treatment (5-10 years).
✔ Tamoxifen for premenopausal, AIs for postmenopausal (usually).
✔ Side effects are manageable—don’t stop without talking to your doctor!
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