A Pill in my Palm: My Cancer Safety Net

I’m going to include here this information from The National Cancer Institute, an official website of the United States government, because it’s part of my story now.  I’ve learned so much about cancer and treatments and I know so many who are dealing with this.  I often wonder what treatments will be like 50 or 100 years from now.  I’m learning more about what women did in the past.  I’m grateful to live now and I’m hopeful that someday we’ll be closer to cures for the dozens and dozens of kinds of cancer.

I visit often with close friends who have been dealing with cancer in their lives.  They say 1 out of every 2 men will have cancer sometime in their lives, and 1 out of 3 women.  We each have a different story.  Mine has had a happy ending.  Some have not.  One friend had a mastectomy 3 weeks ago.  Another friend’s body is riddled with cancer right now.  I have friends who are worried and scared and others who are quietly hopeful.  It’s a frightening path for all of us.

One month ago I started my hormone therapy treatments that will continue for the next 5 years.  Here is the tiny little pill I will be taking every day to keep me safe.

Here is information I’ve copied from the National Cancer Institute about this therapy.  If you’d like to learn more, read on.

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 (or hormone-dependent) breast cancers. Hormone-sensitive breast cancer cells contain proteins called hormone receptors (estrogen receptors, or ERs, and progesterone receptors, or PRs) that become activated when hormones bind to them. The activated receptors cause changes in the expression of specific genes, which can stimulate cell growth.

To determine whether breast cancer cells contain hormone receptors, doctors test samples of tumor tissue that have been removed by surgery. If the tumor cells contain estrogen receptors, the cancer is called estrogen receptor positive (ER positive), estrogen sensitive, or estrogen responsive. Similarly, if the tumor cells contain progesterone receptors, the cancer is called progesterone receptor positive (PR or PgR positive). Breast tumors that contain estrogen and/or progesterone receptors are sometimes called hormone receptor positive (HR positive). Most ER-positive breast cancers are also PR positive.

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 is hormone therapy?

Hormone therapy (also called hormonal therapy, hormone treatment, or endocrine therapy) slows or stops the growth of hormone-sensitive tumors by blocking the body’s ability to produce hormones or by interfering with effects of hormones on breast cancer cells. Tumors that are hormone insensitive do not have hormone receptors and do not respond to hormone therapy.

Hormone therapy for breast cancer should not be confused with menopausal hormone therapy (MHT)—treatment with estrogen alone or in combination with progesterone to help relieve symptoms of menopause. These two types of therapy produce opposite effects: hormone therapy for breast cancer blocks the growth of HR-positive breast cancer, whereas MHT can stimulate the growth of HR-positive breast cancer. For this reason, when a woman taking MHT is diagnosed with HR-positive breast cancer she is usually asked to stop that therapy.

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 (called oophorectomy) 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 (GnRH) agonists, which are also known as luteinizing hormone-releasing hormone (LHRH) agonists. By mimicking GnRH, these medicines interfere with signals that stimulate the ovaries to produce estrogen.

Can hormone therapy be used to prevent breast cancer?

Yes. Most breast cancers are ER positive, and clinical trials have tested whether hormone therapy can be used to prevent breast cancer in women who are at increased risk of developing the disease.

A large NCI-sponsored randomized clinical trial called the Breast Cancer Prevention Trial found that tamoxifen, taken for 5 years, reduces the risk of developing invasive breast cancer by about 50% in postmenopausal women who were at increased risk (25). Long-term follow-up of another randomized trial, the International Breast Cancer Intervention Study I, found that 5 years of tamoxifen treatment reduces the incidence of breast cancer for at least 20 years (26). A subsequent large randomized trial, the Study of Tamoxifen and Raloxifene, which was also sponsored by NCI, found that 5 years of raloxifene (a SERM) reduces breast cancer risk in such women by about 38% (27).

As a result of these trials, both tamoxifen and raloxifene have been approved by the FDA to reduce the risk of developing breast cancer in women at high risk of the disease. Tamoxifen is approved for this use regardless of menopausal status. Raloxifene is approved for use only in postmenopausal women.

Two aromatase inhibitors—exemestane and anastrozole—have also been found to reduce the risk of breast cancer in postmenopausal women at increased risk of the disease. After 3 years of follow-up in a randomized trial, women who took exemestane were 65% less likely than those who took a placebo to develop breast cancer (28). After 7 years of follow-up in another randomized trial, women who took anastrozole were 50% less likely than those who took a placebo to develop breast cancer (29). Both exemestane and anastrozole are approved by the FDA for treatment of women with ER-positive breast cancer. Although both are also used for breast cancer prevention, neither is approved for that indication specifically.

What are the side effects of hormone blocking therapy?
Some effects vary from drug to drug.
Tiredness. You may feel more tired when you are taking hormone therapy
Digestive system problems
Menopausal symptoms
Hair thinning
Muscle and bone changes
Weight gain
Memory problems
So, these are my 2 medications.  I take the Anastrozole every day.  The other is to help my bones stay strong while taking the drug.  I take a tablet once a week.

It’s incredible to me that such a tiny pill can keep me safe.  Feeling safe is HUGE.  I’m grateful that so far I’ve had no side effects.  I know many do–about 25% of women taking hormone therapy know the list above really well.  What a gift I’ve been given!

About Ann Laemmlen Lewis

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1 Response to A Pill in my Palm: My Cancer Safety Net

  1. Julie Merkley says:

    Thank you for sharing

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