What Are The Alternatives To Traditional Radiation Therapy For Breast Cancer
Dana Casciotti, PhD, Anna E. Mazzucco, PhD, and Danielle Shapiro, MD, MPH, Cancer Prevention and Treatment Fund
Almost all women with early-stage breast cancer will live just as long if they choose lumpectomy instead of mastectomy. However, traditional radiation treatment is recommended for lumpectomy patients because it lowers their chances of the cancer returning.
Traditional radiation therapy is given on an outpatient basis 5 days each week for 6-8 weeks, and that is a difficult schedule for many patients. Many women living in rural areas or far from the hospital choose to get a mastectomy because daily radiation is so inconvenient.
For some women, radiation to a smaller area of the breast over a shorter period of time may be a useful alternative. These options are called partial breast irradiation .
PBI can be given with just 5-10 treatments over about a weeks time, and researchers are testing if treatments can be shortened to 2 days. According to experts, PBI can reduce the chances of a tumor coming back in the area around the lumpectomy from 10-25% to 3-4%.
Based on a comprehensive 2016 research review, women who had PBI were more likely to have their tumor come back or to have a new tumor form in the same breast than women who had whole breast radiation treatment . However, women who had PBI were not more likely to die any sooner or to later need a mastectomy.
Who Should Consider Pbi
The American Society of Therapeutic Radiology and Oncology provides the following recommendations:
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Side Effects Of Estrogen Blockers
Side effects of estrogen blockers can vary depending on the drug. The most commonly reported symptoms are:
- vaginal dryness
- menstrual cycle changes
More serious but less common side effects of estrogen blockers can include blood clots or increased risk of developing uterine cancer. Postmenopausal women face an even higher chance of a uterine cancer diagnosis.
A very rare but potential side effect of antiestrogen therapy is a stroke, so its essential not to ignore any sudden feelings of confusion, headaches, or trouble moving or speaking.
Youll want to call 911 immediately if any of these issues arise while taking estrogen blockers.
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Can Other Drugs Interfere With Hormone Therapy
Certain drugs, including several commonly prescribed antidepressants , inhibit an enzyme called CYP2D6. This enzyme plays a critical role in the body’s use of tamoxifen because CYP2D6 metabolizes, or breaks down, tamoxifen into molecules, or metabolites, that are much more active than tamoxifen itself.
The possibility that SSRIs might, by inhibiting CYP2D6, slow the metabolism of tamoxifen and reduce its effectiveness is a concern given that as many as one-fourth of breast cancer patients experience clinical depression and may be treated with SSRIs. In addition, SSRIs are sometimes used to treat hot flashes caused by hormone therapy.
Many experts suggest that patients who are taking antidepressants along with tamoxifen should discuss treatment options with their doctors, such as switching from an SSRI that is a potent inhibitor of CYP2D6, such as paroxetine hydrochloride , to one that is a weaker inhibitor, such as sertraline or citalopram , or to an antidepressant that does not inhibit CYP2D6, such as venlafaxine . Or doctors may suggest that their postmenopausal patients take an aromatase inhibitor instead of tamoxifen.
Other medications that inhibit CYP2D6 include the following:
- quinidine, which is used to treat abnormal heart rhythms
Possible Side Effects Of Ais
The most common side effects of AIs are:
- Bone and joint pain
AIs tend to have side effects different from tamoxifen. They don’t cause uterine cancers and very rarely cause blood clots. They can, however, cause muscle pain and joint stiffness and/or pain. The joint pain may be similar to a feeling of having arthritis in many different joints at one time. Options for treating this side effect include, stopping the AI and then switching to a different AI, taking a medicine called duloxetine , or routine exercise with nonsteroidal anti-inflammatory drugs . But the muscle and joint pain has led some women to stop treatment. If this happens, most doctors recommend using tamoxifen to complete 5 to 10 years of hormone treatment.
Because AIs drastically lower the estrogen level in women after menopause, they can also cause bone thinning, sometimes leading to osteoporosis and even fractures. If you are taking an AI, your bone density may be tested regularly and you may also be given bisphosphonates or denosumab , to strengthen your bones.
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Estrogen Exposure Over Time Is Linked To Breast Cancer
The longer your body is exposed to estrogen throughout your life, the more it appears to increase your risk for estrogen-related breast cancer. This helps explain why most breast cancer diagnoses occur later in life, after a lifetime of exposure to estrogen.
But it gets more interesting. Even though breast cancer risk generally increases as you get older, if you start your period later in life , your risk goes down simply because you had a few extra years without estrogen. The opposite seems true for women who go through menopause later, as more years of estrogen exposure may actually increase the risk for breast cancer.
See the connection? More estrogen equals more risk, according to current research.
Will The Nhs Fund An Unlicensed Medicine
Its possible for your doctor to prescribe a medicine outside the uses its licensed for if theyre willing to take personal responsibility for this off-licence use of treatment.
Your local clinical commissioning group may need to be involved, as it would have to decide whether to support your doctors decision and pay for the medicine from NHS budgets.
Page last reviewed: 28 October 2019 Next review due: 28 October 2022
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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.
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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Breast Cancer Is One Of The Most Common Cancers In The World And Affects More Than Two Million Women A Year
Breast cancer is one of the most common cancers in the world. Each year in the UK there are more than 55,000 new cases, and the disease claims the lives of 11,500 women. In the US, it strikes 266,000 each year and kills 40,000. But what causes it and how can it be treated?
What is breast cancer?
Breast cancer develops from a cancerous cell which develops in the lining of a duct or lobule in one of the breasts.
When the breast cancer has spread into surrounding breast tissue it is called an ‘invasive’ breast cancer. Some people are diagnosed with ‘carcinoma in situ’, where no cancer cells have grown beyond the duct or lobule.
Most cases develop in women over the age of 50 but younger women are sometimes affected. Breast cancer can develop in men though this is rare.
Staging means how big the cancer is and whether it has spread. Stage 1 is the earliest stage and stage 4 means the cancer has spread to another part of the body.
The cancerous cells are graded from low, which means a slow growth, to high, which is fast growing. High grade cancers are more likely to come back after they have first been treated.
What causes breast cancer?
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply ‘out of control’.
What are the symptoms of breast cancer?
How is breast cancer diagnosed?
How is breast cancer treated?
Combined Hrt And Breast Cancer
Combined estrogen and progesterone may have the highest risk factor of any type of HRT. According to BreastCancer.org, the risk of developing breast cancer increases by 75% for those taking combined HRT.
The organization also noted that combined HRT increases the chance that a healthcare professional may diagnose a persons breast cancer at a more advanced stage, which increases the likelihood of mortality.
According to the , the risk of breast cancer increases the longer a person takes HRT. However, it also decreases significantly after a person discontinues HRT.
The American Cancer Society states that the risk of breast cancer returns to average 3 years after a person discontinues combined HRT.
However, the researchers for the 2020 study found that risk reduced after 5 years for medroxyprogesterone, and 10 years for levonorgestrel, which are types of progesterone.
Combined HRT is also linked to breast density, which can make it harder to locate cancer on a mammogram. Breast density is a term to describe the amount of dense tissue compared to fatty tissue in a persons breast. Dense tissue is more fibrous than fatty tissue.
HRT containing estrogen alone can also increase the risk of a person developing breast cancer. However, it may only increase the risk after 10 years of continued use.
A person who has had or has breast cancer should not take HRT. Instead, they should speak with a doctor about alternative options.
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Vitamins And Minerals In Supplements
Your doctor may recommend certain vitamins and supplements to help you stay healthy after treatment.
Calcium.Chemotherapy can weaken your bones. A calcium supplement with vitamin D, which helps your body absorb calcium, may protect your bones from changes due to treatment.
Multivitamin. A regular multivitamin may help you get essential vitamins and minerals to improve your overall health.
Probiotics. Probiotics help boost immunity, says Tara Scott, MD, a womens health specialist in Akron, OH. This may help you stay healthy after your treatment. Probiotics have anti-inflammatory effects, which may help protect against cancer. But there isnt enough research yet to know for sure.
Vitamin D. Experts say theres a link between low levels of vitamin D and breast cancer. Theres no evidence a vitamin D supplement will lower your risk of recurrence, but your doctor may recommend it for your overall health.
Continued
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Should A Person Take Hrt
The benefits of taking HRT can vary from person to person. Some people decide that the benefits outweigh the risks.
HRT can help relieve the symptoms of menopause. It can also help reduce the risk of developing osteoporosis.
A person should discuss the benefits and risks with a healthcare professional before deciding whether HRT is right for them.
If a person decides to take HRT, they should attend all their breast cancer screening appointments.
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What Are Hormones And Hormone Receptors
Hormones are substances that function as chemical messengers in the body. They affect the actions of cells and tissues at various locations in the body, often reaching their targets through the bloodstream.
The hormones estrogen and progesterone are produced by the ovaries in premenopausal women and by some other tissues, including fat and skin, in both premenopausal and postmenopausal women and in men. Estrogen promotes the development and maintenance of female sex characteristics and the growth of long bones. Progesterone plays a role in the menstrual cycle and pregnancy.
Estrogen and progesterone also promote the growth of some breast cancers, which are called hormone-sensitive breast cancers. Hormone-sensitive breast cancer cells contain proteins called hormone receptors that become activated when hormones bind to them. The activated receptors cause changes in the expression of specific genes, which can stimulate cell growth.
Breast cancers that lack ERs are called ER negative, and if they lack both ER and PR they may be called HR negative.
Approximately 67%80% of breast cancers in women are ER positive . Approximately 90% of breast cancers in men are ER positive and approximately 80% are PR positive .
What Do Estrogen Blockers Do For Females
Estrogen blockers are chemicals that essentially prevent cancer cells in females from getting the hormones they need to grow, like estrogen.
Many breast cancers are sensitive to hormones like estrogen and respond to this type of treatment. This accounts for 70 to 80 percent of all breast cancers, or 2 out of 3.
When breast cancers sensitive to hormones cant get estrogen they need to grow, they may shrink in size or be unable to grow much at all.
However, a smaller number of breast cancers are insensitive to hormones, meaning they dont benefit from antiestrogen therapy and require different treatments.
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Estrogen Balance For Reduced Breast Cancer Risk
Theres a strong association between estrogen and breast cancer. While there are no guarantees when it comes to cancer, keeping your estrogen balanced through smart lifestyle changes like those Ive listed above can reduce your risk and benefit your overall hormone health.
If you’re looking for a comprehensive approach that can help you achieve optimal hormonal balance, my free Hormone Starter Kit includes a 7 day meal plan, recipes, and other helpful info to get you on the right track.
Chemotherapy For Breast Cancer
Chemotherapy uses anti-cancer drugs that may be given intravenously or by mouth. The drugs travel through the bloodstream to reach cancer cells in most parts of the body. Sometimes, if cancer spreads to the spinal fluid, which surrounds and cushions the brain and spinal cord, chemo may be given directly into in this area .
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Can Breast Cancer Spread While On Chemo
While chemotherapy is one of the oldest and most successful ways of treating cancer, it doesnt always work. So, yes, cancer can spread during chemotherapy. Spreading could mean the tumor keeps growing, or that the original tumor shrinks, but cancer metastasizes, forming tumors in other areas of the body.
What Types Of Hormone Therapy Are Used For Breast Cancer
Several strategies are used to treat hormone-sensitive breast cancer:
Blocking ovarian function: Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. Blocking ovarian function is called ovarian ablation.
Ovarian ablation can be done surgically in an operation to remove the ovaries or by treatment with radiation. This type of ovarian ablation is usually permanent.
Alternatively, ovarian function can be suppressed temporarily by treatment with drugs called gonadotropin-releasing hormone agonists, which are also known as luteinizing hormone-releasing hormone agonists. By mimicking GnRH, these medicines interfere with signals that stimulate the ovaries to produce estrogen.
Estrogen and progesterone production in premenopausal women. Drawing shows that in premenopausal women, estrogen and progesterone production by the ovaries is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which then causes the pituitary gland to make and secrete LH and follicle-stimulating hormone . LH and FSH cause the ovaries to make estrogen and progesterone, which act on the endometrium .
Examples of ovarian suppression drugs are goserelin and leuprolide .
Blocking estrogens effects: Several types of drugs interfere with estrogens ability to stimulate the growth of breast cancer cells:
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Unprecedented Results Seen In Preclinical Models Indicate Cooperation With The Immune System To Attack Cancer
- Date:
- University of Pennsylvania School of Medicine
- Summary:
- A small molecule inhibitor that attacks the difficult to target, cancer-causing gene mutation KRAS, found in nearly 30 percent of all human tumors, successfully shrunk tumors or stopped cancer growth in preclinical models of pancreatic cancer, researchers showed.
A small molecule inhibitor that attacks the difficult to target, cancer-causing gene mutation KRAS, found in nearly 30 percent of all human tumors, successfully shrunk tumors or stopped cancer growth in preclinical models of pancreatic cancer, researchers from Penn Medicine’s Abramson Cancer Center showed, suggesting the drug is a strong candidate for clinical trials. The study was published today in Cancer Discovery, a journal of the American Association for Cancer Research.
“The results of this study are in stark contrast to anything we’ve seen before in pancreatic cancer,” said co-corresponding senior author Ben Stanger, MD, PhD, the Hanna Wise Professor in Cancer Research in the Perelman School of Medicine at the University of Pennsylvania and director of the Penn Pancreatic Cancer Research Center. “Even in preclinical research models for this cancer type, most drugs tested within the last decade — including novel immunotherapies — have had limited impact.”
The study was supported by the National Institutes of Health , the Cancer Research Institute , the Parker Institute for Cancer
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