Breast cancer is the most common form of cancer in women. Fortunately, the treatment methods for this nasty disease are becoming increasingly user-friendly and effective. In addition to the fairly aggressive chemotherapy with various unpleasant side effects, there is now an alternative: hormone therapy. Hormone therapy inhibits the growth of the tumor in the breast tissue by blocking the production of the female hormone estrogen. Hormone therapy is especially suitable for women who have already gone through menopause. Hormone therapy can cause menopause to start (early). However, there are medications on the market that can reverse this unpleasant side effect. Hormone therapy is less known than chemotherapy, despite the fact that hormone therapy has appeared on the market earlier. Hormone therapy is only suitable for a limited number of cancers, chemotherapy for several types of cancer.
Breast cancer
- 30% of women with cancer are diagnosed with breast cancer
- There is a 1 in 10 chance that a woman will develop breast cancer in her lifetime
- In the Netherlands, approximately 10,000 women are diagnosed with breast cancer every year
- 75% of women with breast cancer are 50 years or older
Risk factors
It is currently unknown what causes breast cancer. It has been discovered that there are some risk factors that increase the risk of breast cancer. Long-term pill use, long-term hormone therapy for menopausal symptoms, previous diagnosis of cancer, being 30 years or older at the birth of the first child, being 11 years or younger at the first menstruation and being older than 55 at the start of menopause are some risk factors. Please note that these factors increase the risk of breast cancer, but they are absolutely no guarantee of whether or not you will develop breast cancer.
Discovering breast cancer
Most women discover that they have breast cancer because they go to the doctor with a strange swelling on a lump in the breast and then undergo an examination. In most cases, such a breast lump is benign. Mammography, an X-ray, can be used to determine whether there are any abnormalities in the tissue structure of the breast.
Stage of breast cancer
When research shows that a lump in the breast contains malignant cells, one must find out what stage the breast cancer has reached. This includes examining to what extent the lymph nodes in the armpit are affected and whether metastases can be found elsewhere in the body. Only with such an accurate examination can one give a prognosis; a statement about the further course and treatment of breast cancer.
Breast cancer can be broadly divided into two groups: carcinoma in situ and invasive cancer. Carcinoma is in situ are abnormal cells in the breast that have not yet formed into a lump and have not yet affected adjacent tissue. Invasive cancer has four substages:
- Early disease with small tumor in the breast, the lymph nodes are not affected
- Larger tumor with or without affected lymph nodes
- Extensive tumor and/or extensive metastases to the axillary lymph nodes
- Disease that has spread to other places in the body
Breast cancer treatment
In the early stages of breast cancer, people try to prevent the disease from coming back or delay it. The chance of healing in the first two stages is considerable.
At a later stage, the chance of definitive healing is much smaller. The aim of the treatment is mainly aimed at increasing life expectancy and maintaining a high quality of life. The emphasis is on symptom suppression and suppression of cancer progression.
In general, three types of breast cancer treatment can be distinguished:
- A surgical procedure in which the cancer cells are removed
- Radiation, which destroys cancer cells in a specific location
- Hormone therapy, the modification of the female hormones estrogen and/or progesterone
Hormone therapy
George Beatson
George Beatson accidentally discovered the usefulness of hormone therapy in 1896 when he removed the ovaries of a woman in advanced stages of breast cancer. He suspected that the growth of the cancer cells had something to do with the function of the ovaries. And he was right about that.
Hormone-sensitive tumors
Chemotherapy is the treatment of choice for tumors that are not hormone sensitive. Some tumors, especially breast, uterine and some forms of lymphatic cancer, are so-called hormone-sensitive tumors. This means that sex hormones negatively influence the growth of tumors. Laboratory tests can be used to investigate whether a tumor is hormone sensitive. In this test, a piece of tumor tissue is taken from the woman and a search is made for proteins that can bind estrogen and/or progesterone.
When to take hormone therapy?
Hormone therapy is used when the growth of certain breast cancer cells is stimulated by the female sex hormones estrogen and progesterone. Hormone therapy reduces the availability of these female hormones using surgery, radiation or medication.
Hormone therapy and menopause
Menopause is a period in a woman’s life when menstruation becomes more irregular and gradually stops. Menopause usually occurs between the ages of 45 and 55 of a woman’s life. If a woman’s still active ovaries are removed or modified in connection with cancer treatment, the woman may go through menopause.
The different hormone treatments for breast cancer
Various hormone treatments are possible. The choice of a particular hormone treatment is influenced, among other things, by the age of the patient, the stage of the disease, the progression (speed) of the disease and the location of any metastases.
Stages I and II
Firstly, a surgical procedure, irradiation of the ovaries or treatment with medications that reduce the production of sex hormones will be chosen. If this is not sufficient, treatment with anti-estrogens will be used. It is often combined with chemotherapy. The treatment is primarily aimed at healing. Women who have already gone through menopause are often given a different type of medication, aromatase inhibitors; medications that aim to inhibit estrogen production outside the ovaries.
Stages III and IV
In the later stages of breast cancer, treatment consists of surgery, radiation or medication. The primary goal is to inhibit sex hormone production to combat symptoms and improve quality of life. If there are metastases, anti-estrogens, aromatase inhibitors or progestogens are used.
What do the medicines do?
The different medications can affect hormone production in several ways. This can be done via the brain, the receptors, enzymes and progestins. Progestins are substances that are very similar in effect to the pregnancy hormone progesterone.
Hormone therapy is especially suitable for women who have already gone through menopause. Hormone therapy can cause menopause to start (early). The drug tamoxifen, one of the forms of medication used in hormone therapy, does not cause this. Tamoxifen tackles tumor growth, but the structure of the endometrium remains intact, resulting in active ovaries again after stopping treatment with tamoxifen.