Do You Need Hormonal Therapy to Treat Breast Cancer?
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- Опубліковано 2 чер 2024
- What is hormonal therapy, why is it used, what to expect from it, and its cost? In this video, Dr. Jennifer Griggs explains everything you need to know about hormonal therapy to treat breast cancer.
If you want to know more about your unique treatment choices, visit www.Yerbba.com to get your personalized report!
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• Hormonal Drugs for Invasive Breast Cancer | Full List 2020 - blog.yerbba.com/hormonal-drug...
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I have DCIS grade 2. I plan on doing radiation therapy. It seems worthwhile because without it, my chance of it coming back is about 20-30%. I do not see taking the hormonal treatment because the percentage that it is supposed to help is very little compared to the side effects and risks. It does increase your chance of losing bone, and heart issues and I am not willing to chance that at age 62. You would think that in 2023 we would have a safer treatment that has more bang for its buck than these hormones. I have to wonder how much money big pharma is making off of this. I am, however, willing and able to improve my diet, avoid estrogen rich foods and increase my intake of berries, mushrooms and green leafy vegetables. Diet is something I have not heard mentioned from any of my doctors. Why is that? I find that the medical profession does not seem to know much about nutrition. I believe God provides us the things we need to keep us healthy. Knowing what those things are is the hard part. I see pills being pushed constantly, but not one word on how important diet can be in treating disease. That is a real shame.
We share many of your concerns. Endocrine therapy for DCIS does not improve survival, so it is what we call a "preference sensitive" decision, in which your preferences play the major role. Tamoxifen does not generate any revenue to speak of for the pharmaceutical companies. Endocrine therapy, despite its flaws, is life saving in invasive disease (not DCIS) and represents a major advance worldwide.
Dear Tonya, I'm so in tune with you on being pushed into taking Anastrozole. ( Which almost killed me. ) Now they have me trying Tamoxifen. I'm in dread my tolerance to this medication of being no better. Like you. I have embraced an anti- cancer anti estrogen diet. Avoiding sugars. I'm 64, stage 3, ER +. I have 2 more infusions of Projetta, Procepton infusions left. Have had a lumpectomy followed with radiation. At my age , my feelings is with quality of life. They already lied about the Tamoxifen hair loss. What else am I being lied to about.? Sister I am with you, and feel as you do. The side effects are horrific for the 10 years they propose you take it. There has got to be a better way of preventing recurrence without living in pain, can't breathe and your hair falling out.....again.
I went with targeted radiation and it was easy and painless. I had minimal side effects - slight sunburn. Stay hydrated and take radiation FACE DOWN. Positioning yourself this way, protects your other organs rather than lying on you back, face up with your arms in an uncomfortable position.
@@juaquiene7726hi. It all depends on why you got cancer. If diet and lifestyle were the culprits than making changes should work against the cancer coming back. If they weren’t then you are back to square one. It’s always a good idea to be healthier because we can fight the diseases better and probably, suffer less from the side effects from the medication. However, even slim, healthy and fit people get cancer.
@@alessia_traversa Alessia, ( pretty name ) your latter comment be hardest of all to accept. Some of us will develop cancer despite 0 predisposing risks. I feel so badly for the very young with small kids at home. Dealing with cancer. What do you tell people? As having cancer brings up the subject no matter what. Everyone wonders why, how, what can you do about it? Just wish it was more known how obesity can lead to cancer. I don't feel it's important public knowledge. It ought to be!
You get “cured” from one terrible thing and get others. There needs to more a lot more done for Breast Cancer.Too many women I know cannot tolerate the AI. They suffer terrible depression , plus the terrible side effects.That’s not quality living, in my opinion.
So important to know that you can switch from one AI to another with a strong possibility of improvement in your symptoms. And you're right, the side effects can be really difficult. It's so important to stay in touch with your medical team. If we know what you're experiencing, we can help.
I’m one of them,depression,no sex drive,hot flashes,night sweats and horrific itching in my arm pits,I’m 66 my tumor literally disappeared yet lymph nodes surgery is still scheduled? My trust in the medical professionals is close to zero,5 yrs of this misery I’m thinking no.
Sorry Yerba, I had severe depression anxiety and panic attacks coming off hormone replacement due to developing breast cancer. Every time I tried to tell my " team " about my symptoms they shut me down or ridiculed me for not being able to tough it out. I learned my lesson and went to an acupuncturist for help . My symptoms were severe enough to need herbal support in addition to acupuncture. Do I discuss the herbs with my doc? Nope. Because of my severe reactions coming off hormone replacement I declined hormone blocking therapy. Since the I have learned that most doctors are NOT trained in menopause management in medical school. That explains a lot. Going to my docs for help was not worth the scorn. Should have gone to the acupuncturists first.i do commend the oncologist for continuing to monitor me even though I refused hormone blockers. I have been lied to also. One doc said " you will have a rough year, then everything will go back to normal." After going bald, having severe insomnia, humiliating brainfog and in one case having dry heaves around the clock for 48 hours my supposedly normal life was proposed Tobe a combo of aromatase inhibitors and CDK4 inhibitors. My new normal life would include a life time of joint pain, fatigue, more memory losss and continued suppression of my immune system. I declined aspolitely as I could. You may find this hard to believe but I personally like my oncologist. He's dedicated doctor and a kind person. Does he truly get what it's like to try and function with these limitations? I don't think so. Also my experience is that docs dont take insomnia seriously.
I do truly appreciate all your videos.
We appreciate you for watching.
I’m watching you from Switzerland and tanks a lot you video is fantastic
Thanks for watching
This is so informative. Thank you.
Glad it was helpful.
I am from Italy. Thank you for your kindness explain.I watched every video.
I am stage one Breast ♋
Thank you so much for watching our videos. We are so glad these have been helpful.
Hello how u doing now
Excellent explanation
Glad it was helpful
Great vid…thank you🙌🏼💗
Glad you enjoyed it.
Thanks for the information and your soft tone of voice. What are your views on the BCI test? Not sure if you are allowed to answer, but I'm deciding with my doctor if the testing is legitimate.
The breast cancer index (BCI) is another test that can help patients and doctors make decisions about treatment. We'll be doing a video on the other genomic tests (in addition to the OncotypeDX, or 21-gene assay).
I am 67. I have read so many horror stories about the side effects, including joint and bone pain so severe women can't maintain any position for more than 20 minutes. The "treatments" they are prescribed to address this pain do little. Women say these effects continue throughout the course of treatment, which would be 10 years of constant pain. That would be the rest of my life. I've also read that when women try to drop hormone therapy, docs just shift them to another type that is no better. In addition, the brain fog lasts throughout treatment. I am a college professor who will never be able to afford to retire. I can't have brain fog. I sincerely doubt I will do hormone therapy.
I chose to decline it as well.
I'm leaning that way too. I have 4 weeks to decide (still undergoing radiation) but I don't want to be in pain for the last 5-10 years of my life because I take AI.
With these concerns, it's understandable that you would be hesitant to take endocrine therapy. It might be worthwhile to "date" the drug. See how you feel. People who tolerate the medications just fine rarely go online to express that. In other words, we tend to read the experiences of people who have a tough time with the medications and not to hear from the majority of people who do fine. Hope that makes sense.
I’m older than you. Brain fog was not an issue for me. I was on Anastrozole for 5 years, 2015 through 2020. It did a number on me though, pain, thinning hair, osteopenia, pelvic floor issues. Last fall I was diagnosed with a new, small, early tumor in the same breast, even though I’d had a mastectomy. It was in the fat layer! So just had a lumpectomy and radiation. So I will be going back on an aromatase inhibitor for the rest of my life. That’s if I decide to follow my oncologists advice. I can probably cope with the downside, maybe in part because I’ve had chronic pain in my back and feet for 30 years, so am used to pushing through. In retrospect, I wish my oncologist had let me stay on it for 7 years first time around, which I offered to do. My osteopenia resolved after I stopped the Anastrozole. This time I plan to do weight bearing exercises to ward off bone loss. Each of us has to make our own decision about the downside of any prescription. Good luck to you!
@@Katsem Wow, my wife is on Letrozole. But your cancer came back? How great can these meds be? They don't sound so great. I hope you stay well.
That was interesting. Thank you.
You're welcome.
I was a fit, active woman diagnosed with severe osteopenia of the spine at 50. I was post-menopausal for five years. I can’t handle hastening my bone loss.
Being concerned about bone health is completely understandable. It's important to remember that there are not major drops in bone density on the aromatase inhibitors. In addition, the bone changes will stop once you're off the aromatase inhibitor. It is also worthwhile discussing this with your medical team and asking about tamoxifen in your case. Tamoxifen strengthens the bones.
Thank you so much for the informative video! Does Tamoxifen affect the skin, hair & nails? I’m trying to let my hair grow so wondering if being in Tamoxifen will affect this…
Tamoxifen can cause hair thinning in some people, and tamoxifen and having had chemotherapy can change our skin and nails. If these changes are from tamoxifen, they will go away afterward stopping the tamoxifen. It is also possible that hair, skin, and nail changes can be the result of other, unrelated issues, such as thyroid problems. Thyroid problems are so common in the general population that they should be considered for anyone with changes in their nails, skin, or hair.
@@yerbba Thank you so much! I really appreciate your response. I lost my hair due to chemotherapy and now I’m letting it grow out. Hopefully I’ll be from the ones who’s hair does not thin out from Tamoxifen.
I wish the video also includes information about injection based drugs that cause chemical menopause, such as Zoladex or Lupron.
We can make a video about these medications. Thank you for the suggestion.
Hello Dr Griggs,
I was diagnosed with invasive carcinoma of no special type (ductal) in my left breast,
It was estrogen positive progesterone positive and HER2 negative and grade 2 of the Nottingham modification of bloom Richardson system.
The tumour was 3cm x 2cm, 1.5cm away from overlying skin and 1.5 cm away from deep skin margin.
I did a single mastectomy of my left breast. Nothing was identified in any of my lymph nodes. pT2N0MX is also stated.
I am 43 years old and premenopausal
I’ve started taking tamoxifen but I want to know if I will need chemotherapy or radiation therapy. Is hormonal therapy is enough for me?
Thank you for watching, and this is a great question. Hormonal therapy is a very reasonable option. For some people with the tumor characteristics you describe, a 21-gene assay (brand name: OncotypeDX) can be done on the tumor that has already been removed to see if there is benefit from chemotherapy. It is likely that chemotherapy is not necessary. There are people who should have radiation therapy after mastectomy, but nothing in the description of your tumor leads us to think that this would be helpful in your case. Please remember that we are not providing advice here...just general guidance. Thanks for watching.
Thank you for this video. Very informative! I’ve just been diagnosed with ER+ /PR+ her- tumor and headed to surgery next. Talk of possible radiation after that and then hormone blocker. I’m not really wanting radiation or the hormone blocker. Surgeon said it’s a very high risk not doing radiation. Can you share what if a person chooses not to do radiation and the hormone blocker?
I have seen instances where cancer still comes back even after having done those things. So trying to find out risk & weigh options. Thank you!!
Radiation therapy reduces the risk of cancer coming back in the breast and neighboring lymph nodes, and hormonal therapy reduces the risk of the cancer coming back both in the breast and throughout the body. The extent of benefit--and of benefit that is foregone, depends on the risk of recurrence after surgery. It may be helpful to ask your doctor specifically about the risk of recurrence. The radiation oncologist can tell you about the extent of benefit from radiation therapy, and the medical oncologist can help you make a decision about endocrine therapy. You are correct that cancer can come back despite all these treatments. The risk is much higher if treatment is not given. We hope this is helpful.
@@yerbba thank you for your response and information! Greatly appreciate your suggestions with specifics on what to ask which person. I’ve also read that radiation can cause risk of lung cancer/other cancers? Can you share anything on this risk?? It doesn’t make sense to me to fight cancer with another cancer causer??
I have mucinous carcinoma er+ pr+ HER2 negative. Also recurrence of dcis. Should endocrine therapy be the first option or is chemo the best option?
Thanks for writing. It sounds like you are going through a lot. There are other things that can be added to the silvadine as well. It's likely that you are done with radiation therapy at this point. Not every person can get every last treatment. Your medical team will help you decide if you can. And if you can't, try if you can not to view yourself as having not "done it right." Wishing you all the best.
I am in my early 40s and begged my dr for HRT due to the worst post menopausal symptoms, i.e. Brain Fog, Imsomnia, Night Sweats, OAB, Hot Flashes, Hair Thinning, etc. Now I have DCIS that has Estrogen/Progesterone receptors. I DO NOT WANT HORMONE BLOCKERS...please help! An imbalance of hormones is just as bad and causes other health issues.
Hormonal therapy does not improve survival for people with DCIS. Even though it may be recommended, you do not have to take it. The goal is to improve your quality of life through the decrease in the risk of recurrence. If your quality of life is poor on anti-estrogens, then that would not be achieving your goal. In other words, make sure to express your goals with your medical team and to ask questions about what the benefits of hormonal therapy would be in your case. We're providing only general advice here since we do not have access to your pathology report or other specific information in your case.
@@yerbba Not one Dr has mentioned that to me! Wow! That is good information!
I was recently diagnosed with intermediate grade apocrine DCIS, ER+ but I do not want to take tamoxifen because of the side effects and because I want to have kids. Is there any information on reoccurrance if I only have the lumpectomy and radiation but not do the hormone therapy? I read your notes on the benefit being minimal for DCIS patients so I want to make a choice not to take it but would like to understand the reoccurrance if I choose not to.
There is no purported survival benefit to endocrine therapy in people with DCIS who receive radiation therapy. There is a lowering of a subsequent breast "event" (invasive or more DCIS) with taking tamoxifen.
Diagnosed with IDC 12/22. Just had my lumpectomy 3/7/23. Looks like stage 2 w/ IDC in stiu as well. Lymph node biopsy as well, cancer has attached to 2/3. ER+PR- HER2-. I’m NOT taking any sort of HT period. I go to the doctor tomorrow for the path report. HT is not an option too many side effects. I’m going natural health!
Most people do quite well with hormonal therapy but don't share this on the internet, etc. If you want to give it a try ("date" the medicine before "marrying it"), that's an option. As long as you are making a highly informed decision, it really is your decision.
Hi. I hope you are well. Just to let you know that people who post on the internet are usually the ones who suffered with the side effects of the pill. Those who don’t, don’t usually post as they have nothing to say. I would try the medication and see how it affects my body. Everyone is different.
Hello Doctor, I am 58 started taking Anastrozole this month, how do we measure the amount of estrogen in the body? I am reading that aromatese inhibitors lower the estrogen level in the body by 70% is this true? If so shouldn't we eat estrogen rich foods to make up for the lost estrogen that the body needs to function, otherwise 5 years of this medicine can do a lot of damage, kindly advise, thank you
Such a good question. We can measure levels of estrogen in the body, and in people on the AIs, estrogen levels are very low. The long-term effects of low estrogen, including lowering of bone density and increased cholesterol, are reversible. In clinical trials, for most people, the decreased risk of cancer recurrence and death outweighs the downsides. It is more likely that the daily symptoms, such as joint pains and sexual side effects, have a bigger impact on people taking aromatase inhibitors. Trying to increase one's estrogen levels will "undo" the benefits of the aromatase inhibitors, so we would not recommend doing so.
Hello Doc , I would like to ask if you have uterine fibtoids and need to take hormone therapy does it increase the risk of getting uterine cancer or endometrial cancer?
Great question. Whether people have fibroids or not, tamoxifen increases very slightly the risk of uterine (endometrial cancer). The aromatase inhibitors (letrozole, anastrazole, exemestane) do not increase the risk of uterine cancer and can shrink fibroids.
@@yerbba thank you for the reply.
Correct me if I'm wrong. AIs work by decreasing the level of estrogen in the body that is produced by the adrenals.
On the other hand, Tamoxifen does not decrease estrogen levels.
Tamoxifen seeks out estrogen...specifically their receptors and blocks them...not allowing the cancer to get in which prevents cancer growth. Question: Because Tamoxifen does not decrease estrogen in the body, isn't Tamoxifen a healthier choice? Circulating estrogen protects the body's heart, bones and lowers cholesterol. Things that Tamoxifen does and AIs do not do.
You are exactly right in terms of the benefits of tamoxifen compared with the aromatase inhibitors. And there are some downsides, such as an increase in the risk of blood clots (rare) and cancer of the uterus (rare). The benefits of tamoxifen are the main reason the tamoxifen is preferred in the prevention setting, in which people do not already have a cancer. The reason that the aromatase inhibitors are generally recommended in people with no ovarian function is because there is a slightly greater benefit in terms of decreasing the risk of recurrence in the affected breast and the other breast.
I had 2 tumors IDC grade 2 HR+ in my left breast along with extensive DCIS. I had a double mastectomy. My oncologist is recommending aggressive endocrine therapy but I’m still young and don’t know now if I want to do it. Is there a high chance of recurrence without treatment beyond the mastectomy?
My 52 year old friend just had a Lumpectomy for Stage Zero breast cancer and is now going through 5 weeks of radiation. Her Oncologist wants her to take an estrogen blocker, but she doesn't want to because of side affects. Are there other options for her?
In someone with non-invasive breast cancer (also called ductal carcinoma in situ or Stage 0 breast cancer), there is no survival benefit of antiestrogen therapy. Treatment is given to reduce the risk of cancer coming back in the same breast. In someone who is not interested in having radiation therapy, antiestrogen therapy is prudent given the year-over-year risk of getting another in situ (non-invasive) or invasive cancer. Because there is no survival advantage, however, this is what is referred to as a "preference-sensitive" decision.
Will tamoxifen (since it can push you into menopause) make your skin sag, hair thin and make you gain weight? My friend who came off it a decade ago still suffers from mood problems and constant headaches and migraines. 😭
Tamoxifen is a funny medicine to be honest. Although some people stop having periods, it actually does not affect the ovaries at all. So it does not lower estrogen in the body. It just keeps the estrogen in the body from getting to any remaining cancer cells. Despite the fact that estrogen levels are not lowered, however, some people do get hair thinning and even migraines. After coming off the medication, the side effects resolve. If someone is still experiencing problems like the ones your friend has, it is important not to attribute this to the tamoxifen. Rather, the migraines and other side effects can be due to problems with the thyroid or, in the case of headaches, problems in the neck. All of these problems become more common as we get older.
@@yerbba thanks for responding!
@@yerbba You say the side effects resolve. Users say they don't.
I know this is 3 years after the video but my hematologist/oncologist told me last week that studies are showing the mammaprint results like mine (ultra low risk) show hormone therapy may not be necessary but “it’s too early to tell.” She prescribed Anastrozole for me. My diagnosis was 100% ER and PR + and HER 2 -, stage 1, grade 2, DCIS. I am having targeted radiation but not doing to take the hormone therapy.
While evidence suggests ultra-low risk patients have excellent long-term outcomes even without endocrine therapy, current guidelines still recommend endocrine therapy as the standard of care. Skipping endocrine therapy altogether is generally not recommended, even for ultra-low risk cancers. However, there may be select cases where a personalized decision to reduce endocrine therapy duration could be reasonable for an ultra-low risk patient experiencing significant toxicity. This decision should involve a thoughtful discussion between the patient and their physician.
Thank you for this video.
I am 40, Stage 2 B, ER+ (3%), PR+ (8%), Her2 Negative, kie67 60%. Currently on Chemo, afterwards surgey and hormonal therapy.
Given those LOW percentages for the hormone receptors, would tamoxifen still be justified? Not many cells seem to grow due to hormones.
And if absolutely necessary, can it be taken AFTER trying to be pregnant?
I still deeply want to become a mother.
Although the benefit of hormonal therapy is lower, it's not zero. Waiting to conceive and have a child is a completely reasonable decision unless your medical team has told you that you are at very high risk of recurrence. Balancing your treatment with the rest of life is so important!
I wish you luck, difficult time for you Carolina ❤
@carolinalv5708 I am also stage 2B, but ER+(99%), PR-, HER2-. In contrast, your percentages are heavily leaning toward a triple negative type. Hormonal therapy is unlikely to be of much use to you imo; there are other drugs I would think your oncologist would be advising for you.
hi dr.jennifer griggs😊
i diagnose wid invasive cribriform carcinoma(er+pr+her2-)
Will i undergo chemo?
The decision about chemotherapy in cribriform breast cancer depends on the size of the tumor and the number of positive nodes, if any.
Hi! I would like to ask how our immune system is related to developing breast cancer. I’m pretty sure that regardless of wether the cancer is hormonal or not, or even regardless of where we get cancer, this means that our immune system doesn’t detect the cancerous cells early enough and doesn’t kill them when it should, hence the cancer cells start growing. Is this correct? If this is correct, are there tests we can do to check if we have a weakened immune system and if there is anything we can do to improve it? Would it be a good idea to see an immunologist? Thank you!
Completely understandable question. Having cancer cells that evade the immune system does not mean that the immune system is weak. Cancer cells are really "clever" (not that they have intelligence) and are able to evade (escape) even the healthiest immune system.
@@yerbbaThank
You very much for your answer. I was hoping we could do something about it.. at least to check if our immune system is strong enough. As I’ve had bc more than once and my gene test came back negative, I thought it had to do with my immune system. Otherwise, I don’t see any other explanation. I have to say .. all this is quite disheartening. 😞
What about HRT, can a person on letrozol opt for hormone replacement therapy, considering the fact the cancer was ER PR postive?
Accordingly to Dr avrum bluming HRT could be considered after ER PR postive breast cancer, what do u think?
In general, hormone replacement therapy is not considered safe in people with breast cancer. Hormone replacement therapy "undoes" the antiestrogen therapy.
hello,
As someone with migraines (with aura), I was recommended to avoid hormonal contraceptives due to risk of blood clots/stroke. Will this have an impact on me being able to take tamoxifen? thank you.
This is a good question. I have had patients who had migraines during tamoxifen, but most people who experience migraines do not find that they get worse on tamoxifen.
@@yerbba oh ok thank you.have you had anybody who had migraines with aura and have gotten strokes with tamoxifent? (Just worried because of blood clot risk)
When I see comments about cost I am so thankful to live in England where we have free healthcare
Thanks for watching, and I agree that health care financing leaves a lot to be desired.
you're a bit ignorant to the corruption of Big Pharma and the U.S. free Healthcare is paid for by the tax payor in the U.K. too "free Healthcare" can sometimes effect quality (waiting on a list) etc. the U.S. has laws to protect drug companies, they can charge insurance in UK a certain amount and turn to sell same product in the US fifty times more and get away with it. not so black and white, but glad you're happy 😊
Nothing is ever free.
It’s not free! Someone is paying for it!
@@StephenRaftery3141 yes the public ie me and my family, but it’s not dependent upon how much you’ve paid in, you get the treatment you require
Thank you
Thank you for watching!
Thanks 😊
Thank you for watching! We appreciate you.
Would you recommend hormonal therapy for an Invasive Ductal Carcinoma micro invasion? 1.38 mm cancer on initial biopsy. 1 mm residual cancer at biopsy site after mastectomy. 5 mm clear margins around 1mm cancer area. ER+ PR+ HER2- / double mastectomy, no radiation, no chemo needed. I am 48, premenopausal.
In people who have had a mastectomy, there is very little benefit of endocrine therapy. In DCIS, the goal of endocrine therapy is to decrease the risk of the cancer coming back in the same breast. Although rarely cancer can come back after a mastectomy, most people do not find that the benefit is great enough. Of course, ask your medical team about the benefit in your specific case because they know your case the best.
Hello, I was diagnosed with DCIS stage 2 HER+ ER positive with negative receptors. I did 6 chemo rounds and hormone therapy then did a bilateral mastectomy with reconstructive breast surgery. So my doctor said I have to do adjuvant therapy 6 times and the pill for 5 years. Why take the pill if I had bilateral mastectomy?
After all the treatment you've been through, it is natural to ask why you need more. There is significant survival benefit to be gained with endocrine therapy, so we do offer that to people with invasive breast cancer. Of note, while your comment indicates that you had DCIS, it is more likely that you had invasive cancer rather than DCIS (ductal carcinoma in situ, which is non-invasive cancer).
Hello...does Letrozole cause shortness of breath? Or trigger COPD exacerbations? Thankyou in advance.
Letrozole can rarely cause shortness of breath. Most oncologists have seen this in a handful of patients. The shortness of breath is reversible. Letrozole does not cause the damage to the lungs seen in people with chronic obstructive pulmonary disease (COPD).
@@yerbba, thankyou, kindly, for your reply. When I first started Letrozole, I experienced shortness of breath about five days in. I'm happy to say it disappeared a few days later. I have COPD, so any increased shortness of breath is not welcome. I'm also glad Letrozole does not damage the lungs. Thankyou, again!
Can tamoxifen be continued after surgical menopause? After total hysterectomy surgery ?
Yes, tamoxifen can be continued after removal of the ovaries and/or uterus. Great question.
I’m still so confused. In an earlier video, you said estrogen doesn’t cause the cancer. So it causes it to grow? But how does eliminating estrogen lower risk of recurrence? Wouldn’t that just slow down a cancer that’s already started?
Thanks for asking for clarification. It's important that we not view our own estrogen as being something pathologic. Estrogen is important! All that being said, people with hormone receptor-positive breast cancer benefit from blocking the estrogen receptors (with tamoxifen) or by decreasing the levels of estrogen in the body (with aromatase inhibitors). You are correct that endocrine therapy is not viewed as cytotoxic but rather "cytostatic," stopping the cells from growing. Surprisingly perhaps, because we see improved survival, not just delays in the recurrence.
@@yerbba thank you. This has been the best explanation I’ve received during my breast cancer journey.
Hi doc I have swollen underarm and I feel pain sometimes what is the medicine do I take for this is pain reliever safe for me I'm a breast cancer also from Philippines thx ....
The pain and swelling are most likely going to get better without medication. Please see my other response about how to manage these symptoms.
Hi how are you now?
Are there natural alternatives to these medications??
There are no alternatives that have been shown to have the same effectiveness as tamoxifen and the aromatase inhibitors.
Will either of these stop the hair from growing on my face?
I haven't seen people on endocrine therapy with facial hair have any effects on the growth of their facial hair.
@@yerbba thanx
my mother was diognosed with stage 4 breast cancer, with bone metastasis, and with er pr positive,
her doctor told her for hormonal theraphy and give tamoxepen medicine
and not recomending for operation and chemotherapy.
my mother is worry for side effect of blood clot, is this medicine can help her a lot to battle the cancer.
Your mother is fortunate to have you advocating for her. Hormonal therapy is the best treatment for metastatic cancer. It has the fewest side effects and can be effective for a long time. The risk of blood clots is not so high that I would not have her on tamoxifen. Other options include the aromatase inhibitors along with a CDK inhibitor such as palbociclib (Ibrance). In addition, being on a bisphosphonate (like pamidronate or zolendronate) is standard therapy at least in the US. I can't give specific medical advice as you know, but this is the general approach to metastatic breast cancer.
How is your mother?
What is the chance of recurrence when someone doesn’t take hormone therapy? Are there a lot of recurrences when hormone therapy is omitted?
The risk of recurrence depends on the size of the tumor, the lymph node status, the tumor grade, ER and PR, and HER2. Omission of hormonal therapy is reasonable in someone with a very small tumor and negative lymph nodes or with non-invasive cancer (DCIS). For most people, the benefit of hormonal therapy is quite high.
@@yerbba HUGE thank you for all of this. Really respect the term "reasonable choice" in conjunction with good /knowledgeable conversation with a trusted oncologist, I chose NO.
Hi,
my mam 66 y, PR positive strong 95%, ER positive strong 95%, HER2 negative score score,
Grade 2
tumor size 2.5 cm,
done mastectomy and axillary node removal on level 1 and level 2,
27 lymph were examined and only one shows cancers (we are not sure if its isolated cells or not but it did not show in normal screening and only it shows in microscope).
her surgical oncology advised her for hormon therapy but some other oncology suggested chemo as well,
my mam very scared of chemo and she does not want it, but i want if hormon therapy alone is right option for her ? since she has a strong HR receptors ?
thanks
The benefit of chemotherapy may be relatively low in a tumor such as this. If possible, it might be helpful to have a genomic assay performed on the tumor itself. These tests (such as the 21-gene assay, brand name OncotypeDX) can quantify the degree of benefit of chemotherapy.
@@yerbba thanks 🙏
I'm worried about fertility and libido while on Tamoxifen. I am ER+PR positive, 35yo and in a fairly new relationship while just being diagnosed. I think having a baby is out of the question 🤔 😕
Thank you for watching and sharing your experience. If tamoxifen is part of your treatment for ductal carcinoma in situ, DCIS (Stage 0 breast cancer), tamoxifen does not improve survival, so discontinuing tamoxifen for pregnancy would be an option. If you have had invasive disease, tamoxifen's benefits are greater. It would be worthwhile talking with your medical team about your hopes.
@@yerbba Thank you for responding. What do you mean by it doesn't improve survival, I thought it does by blocking the estrogen. I also need to find a new oncologist, she was not able to answer my question about Fertility 🤷🏾♀️
I have stage 4 breast cancer and just started my hormone therapy. I take Letrozole daily, Ibrance daily for 3 weeks and 1 week off and Eligard injection once a once. So far I've been feeling really. 🙏💞
So happy that you are feeling okay. Thank you for writing.
Ibrance is so powerful capsule
How are you now? My breast cancer came back after 6 years, now is in my liver and bone! I am seeing my oncologist later to discuss treatment. I am very anxious, can anyone give moral support? 🙏
My sister as well. I'm praying for you and her.
@@agoodjuan how is she now??
Can i ask pls after we stop arimadex, dose that meen the cancer can come back thank you
Thanks for this question. All breast cancer treatments are given to reduce the risk of recurrence (either in the breast or elsewhere in the body). We can't ever say that treatments will keep the cancer from coming back. Think of it like a seatbelt. We wear a seatbelt to reduce our risk of injury, but there are no guarantees. Your medical team will be able to help estimate for you the risk of recurrence after all your treatment has been complete. Wishing you the absolute best.
What if tripple negative es,PE her2 is that Result ok? thanks
We think you're asking if triple-negative breast cancer is treated with endocrine therapy. People with triple-negative breast cancer do not need endocrine therapy.
If its non-invasive papillary carcinoma of the breast, ER+PR+, Her2 neg. Grade 1, no lymphnode, with lumpectomy, will you need tamoxifen? Ki67-: less than ~5% in early 40s
For non-invasive disease, the benefit of tamoxifen is to decrease the risk of recurrence in the same breast. There is no survival benefit in other words. If there are other features in the breast that suggest a risk of in-breast recurrence, tamoxifen would be a reasonable consideration. If you tolerate it well, a 5-year course could decrease your risk of another breast "event" (invasive or non-invasive cancer). If you don't tolerate it, stopping would be reasonable.
Does a stage 1, grade 1, clear margins, estrogen and progesterone positive, no affected lymph nodes, mucinous cancer and a KI67 of 19% and oncotype 10 require hormone therapy?
For pure mucinous cancer, chemotherapy is rarely needed. If someone has an infiltrating ductal carcinoma with "mucinous features," we treat them the same as if the mucinous features weren't there. In the case of the tumor features you describe, it is unlikely that chemotherapy would be part of the treatment plan either way.
@@yerbba My question was if an aromatase inhibitor would be needed. They already decided per oncotype that I would not need chemo. Should I take aromatase inhibitor? I am one year post op. I was worried about the s/e, but worried about recurrence too. Please advise and Ty.
anything to help with tiredness and cognitive problems while on tamoxifen? (empty mind)
Sorry to hear you're having these side effects. The first thing would be to make sure that you are sleeping as well as possible. Sleep problems are not uncommon with tamoxifen, and sleep problems can interfere with both our energy and with cognition. Ways to combat fatigue and cognitive problems, regardless of the cause, include exercise (even starting with just a 10 minute walk), finding activities that engage your mind that are fun, and treatment of underlying depression in people with depressed mood. Most important, talk with your medical team about your symptoms to see what they might suggest.
@@yerbba thank you! Unfortunately in my country I do not have a medical team… I only have check up appointment with oncologist in January….
im confused you say estrogen in the body has nothing to do with the cancer BUT ALL the drugs are geared around stopping the bodies production of ESTR0GEN,,also many women undergo ovary removal to prevent breast cancer please help me understand ,,thanx
It's understandable that this is confusing. The distinction is that one's own level of estrogen is not related to having breast cancer. Sometimes people tell us that they believe they have "too much estrogen" in their body as if there is something wrong with them. That is not the case. There is a normal physiologic level of estrogen. When treating breast cancer, however, we do either block estrogen (tamoxifen) or decrease the production of estrogen (aromatase inhibitors). This basically uses the fact that doing so will decrease the risk of cancer coming back or developing in the first place or decrease the amount of cancer in the body for many people with metastatic breast cancer. But none of this is related to how much estrogen your body makes. We hope this helps!
Is hormonal therapy safe? Why it's to long medication
Hormonal therapy is extremely safe. The benefits outweigh the risks in most cases. The duration of hormonal therapy has been tested in many clinical studies. We know that 5 years is better than 2, and we know that even longer is better than 5 in people at higher risk.
I have ER+/Pr+ Invasive Ductal Carcinoma grade 3. Will have surgery next month but I do not want hormone therapy, these side affects just scare me too much.
So many people tell us the same thing, so you are not alone. The key to know is that most people tolerate endocrine therapy without the horrible side effects you hear about. You won't know how you feel until you try it. Many people find it helpful to "date" the drug for three months rather than "marrying" it for 5 to 10 years.
I had idc er/pr+ sixteen years ago. I took the letrozole for 5 years with very minimal side effects. I agree with the Dr here to maybe give it a try. You can always stop if side effects are too bad. I see it is a month since your post I hope you are doing well. I have just been diagnosed again with idc and won't know more for a couple weeks. Ugh
@@judybee6698 Thank you! My surgery went well almost to weeks post surgery, I have to see the oncologist next week and will give it try, hopefully no side effects. Good luck to you!! 🙏🙏
@@yerbba9
Can i get benefit frm hormone medicine
Thanks for your comment. Hormonal therapy can be beneficial for many people, but it depends on your specific characteristics of your breast cancer. It's important to talk to your medical team when making these decisions.
Diagnosed with idc.. With 1 lymph node posetive, er, pr posetive with 7 points, her 2 negative, but my ki67 is 60 %... What is the recurrence chance? Hop u help me... Am frm kerala
It's hard to tell exactly in your case what the chance of recurrence will be. The goal of treatment is cure, and chemotherapy tends to work well in tumors that are high Ki67. We're sending lots of good vibes your way!
@@yerbba thanku mam 🥰🥰
Er negative pr positive her2neu negative...pT2N0...help me
Thank you for watching. Decisions about breast cancer treatment are made based on many factors. Please check out our videos on treatment of Stage II breast cancer and about hormone receptors. We are not able to give specific medical advice and hope that the overall information can help you talk with your medical team. I know this may be an overwhelming time for you. Finding a medical team that you can trust will be essential in moving forward.
mam Sudeshna your chemo is finish already do you have maintenance mam
mam sudeshna we are desame diagnose er-pr+her2- i finish my 6 cycle but my onco didnot gave maintenance because only progesterone possitive no need to take maintenance only estrogen possitive have maintenance my onco said im considered 3 negative
Doesn’t Tamoxifen cause uterine cancer?
Tamoxifen is associated with a slight increase in the risk of uterine cancer in people who are not menstruating. The risk increases the longer you take tamoxifen (that is, if you take it for more than 5 years, the risk goes up). With rare exception, tamoxifen-associated uterine cancer is caught early. In a study of tamoxifen compared to placebo, only one person died of uterine cancer, and it was someone on placebo (a medication that does not have any tamoxifen in it). Obviously, when someone gets a cancer from a breast cancer medication, it is not trivial. The outcomes are generally good, however, and the benefits of tamoxifen outweigh the risks for most people.
@@yerbba take chemical drugs for more than 5 years?God have Mercy
Many medications for other conditions are taken for a lifetime. Other medications are taken for a short time (such as antibiotics). With endocrine therapy, the duration of therapy has been studied in extremely large studies with thousands and thousands of patients. The benefit of taking medication for breast cancer in most cases outweighs the risk. Of course, each person has to make their own decision.
Er negative pr positive (11...20%)her2 neu negative....stage 2a...
While someone with a tumor such as this is likely to be offered endocrine therapy, the extent of benefit is lower. This is important because, if the person were to experience side effects of hormonal therapy, it would be easier to make a case
Do you know if Tamoxifen impacts the singing voice? All of a sudden my singing voice is terrible. Also lower. Also does tamoxifen sit in EVERY estrogen receptor in the whole body? Does menopause also mean there is no estrogen in the receptors? 🙏🏽
Thanks for writing. It's entirely possible that your voice has changed with tamoxifen. You may need to retrain (yes, more scales!) your voice to get it back where it was. Even after menopause, we still have estrogen in our body made by the adrenal glands, fat, and other tissues. Yes, tamoxifen goes to all the estrogen receptors in the body. On some of the receptors, tamoxifen acts like estrogen (helping bones and the heart), and on other receptors such as breast cancer, tamoxifen acts as an anti-estrogen.
@@yerbba thank you taking the time to reply!
Quick question: for post menopausal women that have arthritis can they opt for tamoxifen instead of AI to avoid the bone thinning side effects? And if they do opt for tamoxifen instead is it still near the same level of effectiveness in preventing reoccurrence as AI?
Thank you for these amazingly informative videos!
Thanks for watching! For people concerned about the bone loss associated with the Als, we can reassure them that the bone thinning effects are reversible and are not profound. Fortunately, arthritis is not a risk factor for thinning of the bones. The benefits of the AIs as part of one's treatment course outweigh the risk of fractures for most women. If you have been advised to take an AI and are at risk of bone thinning, we can help prevent additional bone thinning while you are on the medication. If someone has severe side effects from the AIs that interfere with quality of life, that is a different matter. In that case, the benefit of the AIs does not outweigh the negative impact of living with severe joint pain or muscle aches. It does not appear that arthritis is a risk factor for these side effects. I hope this answer is helpful.
@@yerbba thanks so much for this great clarification, extremely helpful!!
Always welcome!
Looking for informative videos with no background music but... No luck 🤷🏼
Thank you for your comment. Our newer and upcoming videos have no background music. We listen to all of you.
I form india 🇮🇳 😉amazing
Thank you for watching.
my loved one stopped taking the er+ inhibitor and cancer came back after 2 years. malignant metastatic spread all over. DO not stop taking this drug.
This sounds really hard and is clearly causing you sadness as well as perhaps some other emotions. Sending love your way.
Why not remove the ovaries?
Some people who have functioning ovaries do choose to have their ovaries removed. This is particularly the case in people who have an inherited mutation that increases the risk of ovarian cancer. We can also give medications that induce a "medical" menopause that is reversible. These require regular injections at a doctor's office and can be very expensive if not covered by insurance. The issue with surgical removal of the ovaries is that the procedure is associated with some complications as with any surgery, and some people describe sexual problems after removal of the ovaries. One approach that can be taken is to induce a medical menopause, which is a little more gradual, see how the person feels, and then proceed to surgical removal of the ovaries. All of these are worth discussing with your medical team.
❤️❤️❤️❤️🙏
Hormonal treatment absolutely destroys sexual function.
It can indeed. Between vaginal dryness and pain and decreased interest in intimacy, hormonal treatment can really impact sexual health. Sexual health is part of overall health, and there are some options that can help you. First of all, ask your medical team if the benefit of hormonal therapy is high enough to warrant you staying on it. For people with DCIS, for example, there is no survival benefit. I often would discontinue hormonal therapy. You may also benefit from a switch to another endocrine therapy. You may also wish to see a specialist in sexual health. There are experts in this area who can be so helpful. If libido is a problem, we have a video that addresses some of the ways to deal with this side effect.
is hormone therapy needs in DCIS? ER+ PR+ HER2 2+, thank you doctor.
DCIS is by definition unable to spread to other parts of the body. If someone has breast conserving surgery (such as a lumpectomy), being on endocrine (hormonal) therapy will decrease the risk of developing a new cancer (in situ or invasive) in that same breast. There is no survival benefit, however, so if the side effects are not worth the slight benefit, talk with your medical team about stopping or changing the hormonal therapy. If someone has had a mastectomy, there is no benefit to the breast that had the DCIS. The other breast may benefit, but the risk of cancer in the other breast is decreased from 1% to .5%. Really small benefit! As you know, I don't know all the details in your case, so this is something that you should talk about with your medical team.
The background music is unnecessary and distracting.
Thank you for watching and your feedback. Based on the same feedback from others, we have removed the music from our newer videos.