Still on Breast Cancer therapy

The piece last week on Neoadjuvant therapy for breast cancer generated a lot of interest. It is obvious that the misconceptions surrounding therapy for breast cancers are still so deep.

It is important to accept the therapy advised by your health care provider once you have been diagnosed with breast cancer. There is nothing wrong with you seeking a second opinion from another health care provider on what you have been advised to do by your health care provider.

This must be done with dispatch because breast cancer will not wait for you while you are making your decision. Some of the tumours can be so aggressive that any delay could change the dynamics of therapy.

Medications given after breast cancer surgery are referred to as adjuvant therapy. This could be either chemotherapy of hormonal therapy.

There was one particular feedback that sought to find out how hormones affected the growth of breast cancer. A relation had been informed that her breast cancer was estrogen/progesterone receptor positive.

She has since had a breast surgery and chemotherapy,and subsequently been put on Tamoxifen. The relation is 38 years old.Breast cancers that have many cells with hormone receptors are hormone receptor-positive (estrogen receptor-positive (ER-positive) and/or progesterone receptor-positive (PR-positive)).

Breast cancers that have few or no cells with hormone receptors are hormone receptor-negative (estrogen receptor-negative (ER-negative) and/or progesterone receptor-negative (PR-negative)). Hormones such as oestrogen and progesterone are chemicals produced by glands in the body.

Under normal circumstances, these hormones help to regulate the body’s cycles such as menstruation. These same hormones can fuel the growth of the breast cancer cells.

If the breast cancer cells have been found to be oestrogen positive it means the cells have receptors that feed on estrogen and thereby stimulate their growth.

In such situations your health care provider may put you on hormone therapy medications such as blockers or inhibitors. These medications help to destroy the cancer cells by cutting off their supply of hormones.

The most common hormone therapy medication is Tamoxifen. It blocks the eostrogen-shaped openings (receptors) in the cells, and prevents the oestrogen-fueled cancers from growing. Tamoxifen is in a class of drugs called “SERMs” – selective estrogen-receptor modifiers.

Tamoxifen’s action is to occupy an estrogen receptor on a cell, thus paralysing the receptor and preventing it from triggering the events that result in cell division.  It does not kill cancer cells; rather it disables them or puts them to sleep.

Tamoxifen targets not only the estrogen receptors in breast tissue, but also all of the other cells in the body that have estrogen receptors.Tamoxifen can be taken as a pill on a daily basis up to five years after breast cancer surgery.

Hormone inhibitors (e.g. Aromatase inhibitors) also target breast cancer cells with hormone receptors but unlike hormone blockers (such as Tamoxifen) reduce the hormone production by the body. The breast cancer cells are gradually starved of fuel and die.

It is important to stress that a combination of hormone therapy and chemotherapy have been found to be greater than using either therapy alone.

So your health care provider is likely to combine both chemotherapy and hormone therapy after breast surgery if your breast cancer is positive for hormone receptors.

If you have not gone through menopause (that is premenopausal) such as the case mentioned above then your health care provider may put you on Tamoxifen after the completion of the acute treatment (surgery, chemotherapy and radiation).

The medication can prevent the original breast cancer from returning and also helps to prevent the development of new cancers in the other breast or even from growing elsewhere in the body in future. Tamoxifen is a tablet that must be taken every day, usually for 5 years.

The side effects of Tamoxifen are similar to some of the symptoms of menopause. E.g. hot flushes, vaginal discharge, irregular menstrual periods and thinning of the bones. Other sideeffects are headaches, fatigue, nausea/vomiting and vaginal dryness or itching.

There could be serious ones such as blood clots and strokes. There are interventions for these side effects and therefore the need for regular reviews even when your health care provider puts you on this medication.

Tamoxifen is currently the “gold standard” treatment recommended for all women with hormone driven breast cancer, regardless of the stage.

Taking the medication for 5 years after a breast cancer diagnosis can supposedly reduce the risk of recurrence by up to 50 per cent.

By Edward O. Amporful

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