Why Stop Hormonal Therapy After 10 Years for Breast Cancer? Expert Insights
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- เผยแพร่เมื่อ 10 ก.ค. 2023
- Why is hormonal therapy recommended to be discontinued after 10 years? How long should you take estrogen blockers for breast cancer? What are the possible risks of taking hormonal therapy longer than ten years? In this video, Dr. Jennifer Griggs explains everything you need to know about the duration of hormonal therapy for breast cancer treatment. #breastcancer #cancer #breastcancertreatment
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Thank you, Dr. Griggs, for your continuous support.
Thank you for watching. Yerbba appreciates you!
Thank you for answering this important question. As you know the medications have many positive side effects. I’m so thankful that there is a therapy to prevent recurrence. I’m also glad they are effective. My concern is that there honestly should be more research to understand the efficacy in individual users. Everyone metabolizes drugs differently. I don’t see enough being done to help those who are having many difficult physical issues from the side effects. Why can’t we know if the drugs are really working?
What tests can be developed to track and support long term therapy benefits?
Such great questions. We do actually know a lot about how to manage side effects…the biggest problem with that is that the management comes with its own side effects. There is some evidence that people who have more symptoms also have more benefit from treatment. In terms of knowing if they are working, we only have time. That is, if you are doing well over time, it is likely that the medications are helping or, of course, that all the disease was removed with surgery.
I understand the importance of keeping cancer from coming back but if it escaped into the body (metastatic) does aromatase inhibitors kill it? It it did metastasize how does it not mutate after you stop hormonal therapy? My wife has been on Exemestane for almost 3 years and it’s almost destroyed our marriage. It really reduced her quality of life mentally and physically. Not to mention our sex life is almost non existent. Not to mention her moodiness, low energy and muscle and joint pain. Technology needs to get better. Removing the cancer from the body is Ofcourse the main goal but quality of life for her and me has been an absolute roller coaster with threats of divorce from her and just not loving like she used to be. The meds side effects are more awful than you can imagine. Quality of life goes into the shitter. Not mention if she is on it for 10 years she will be in her early 60’s. Basically her 50’s are destroyed. Something needs to change. Isn’t there a rest to see if any cancer cells escaped. It makes sense that there would be a test for this unless the money driven by pharmaceutical companies is so huge a test like that would mean no one would have to take these meds.
This sounds really hard for both of you. It's so challenging to balance treatment with quality of life. Aromatase inhibitors like exemestane can help prevent recurrence, but their side effects can be tough. It's important to keep an open dialogue with your wife's oncologist about her experiences. Perhaps there might be other treatments or supportive therapies that can help mitigate these side effects.
Thanks again for the informative video and keep up the good work . I have just subscribed. I think it would be interesting to hear more about the advances that have been made in Immunotherapy and now cancer vaccines (i.e. Alpha-Lactalbumin trial in Cleveland, or multigene vaccine Dr Disis @ University of Washington or individualised vaccines Biontech/ Moderna). In terms of screening a talk on ctDNA would be interesting too. Best wishes.
Thanks for writing. Great topics. One reason we tend not to do videos on recent advances is because the videos can quickly become outdated. We'll put our heads together and see what we can share that is a little more timeless. Thanks for writing.
So appreciate your insights! What are the leading studies regarding endocrine therapies and the numbers needed to treat for these studies? Can you please link to the studies.
The number needed to treat will depend on the absolute benefit achieved with therapy. The relative benefit is pretty straightforward (44%), but the absolute benefit depends on knowing the risk of recurrence in one particular person. The number needed to treat is lower if the risk of recurrence is higher. We hope that makes sense.
Great Video, what about stopping Hormonal Therapy like Tamoxifen to conceive a baby ? How long should one wait ? Can you do a video about it ? Thank you soooo much !!!
Thank you for watching and for your excellent question! Depending on the risk of the cancer recurring, stopping tamoxifen to conceive and have a baby is entirely a possibility. For people with very high risk of recurrence, interruptions in treatment may not be in your best interest, but it's not a simple decisions. We'll be covering the topic of pregnancy within our upcoming video on tamoxifen. Stay tuned!
Thank you doctor, anastrozole is recommended for 5 years only after chemo and radiation, some oncologists say the risk is less within first 5 years and greater after 5 , 10 and 15 years for ER+ PR+ HER2-, what is the truth.
Such a good question. We have clinical trials that indicate that blocking the production of estrogen affects bone health and that those effects are reversible. We also know that blocking estrogen raises cholesterol (also reversible). In these 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.
After surgery and radiation, I am nearly 2 weeks into hormone therapy with Anastrozole. Having read the possible severe side effects of aromatase inhibitors, I'm scared stiff, however, I'm not feeling any different. How soon does it take for these side effects set in? I'm gratified that I'm feeling OK, or is it just a matter of more time?
For most people, side effects occur quite early, but it may take several months for you to notice some of the side effects. Just keep in mind if you develop stiffness or other symptoms that they may be from the AI. And thanks for writing to let other people know that there are people out there who feel good on the AIs.
Can tamoxifen be taken by post menopausal women ?
If post menopausal women opt for tamoxifen, will the effect be similar to that on premenopausal women ?
Like u have already mentioned that aromatease inhibitors will not work on premenopausal women,.
Does that mean that tamoxifen will not work on postmenopausal women?
Plz reply
Great question. Tamoxifen will work in both pre- and postmenopausal people and is a great choice in people who do not tolerate the aromatase inhibitors.
Can you please advise why Hormonal theory is not used for stage 4 patients? Thank you!
Hormonal therapy is actually the mainstay of treatment for people with hormone receptor-positive Stage IV breast cancer. We'll be doing several more videos on Stage IV breast cancer soon, so keep coming back.
Thank you ,can you also advise why red meat and sugar is bad for breast cancer..so is much information that is confusing
Red meat and added sugar are things we should have in moderation. There is no evidence that either "feeds" cancer. Sugar is in everything (milk, fruit, vegetables). Added sugar in processed foods probably contributes to weight gain, which we want to avoid if possible. Red meat is advised in moderation because of the increased risk of heart disease (mostly through high cholesterol, but even that is debatable). Meat can also have hormones in it depending on how the animals are treated.
Very helpful information, I got her2 positive breast cancer , im on the estrogen tablets, though not sure how long for , im also on kayda, im suffering really bad pains in hands and wrist, every day now ,looks like it's Arthritis and Nerve damage, can you advise how i can manage the pain also should I stop these medications really don't want to stop as scared the cancer will come back ,was diagnosed as early breast cancer, hope I can get some advice thanks
In general, use of the aromatase inhibitors is for 5 to 7 years. If you are having difficult side effects, switching to another aromatase inhibitor may make a difference. Check out our video on aromatase inhibitor side effects and how to manage them as well as our video on managing joint pain.
@yerbba thanks so much for your Advice, really appreciated
I was diagnosed and treated for stage 1 grade 1 breast cancer. Now I'm on Letrozole for 5 years. I had 5 days twice a day with the savvy.
Doctor recommended me letrozole but I can't afford 😢
@@SofiaAhmad-rp8sm do you not have insurance it doesn't cost me that much
Thanks for sharing your experience with the Yerbba community.
@@farmlifewithrenee No I don't have insurance
Madam, what about eating food containing phytoestrogens while taking letrozole?
I am 68 in excellent health with stage 1, grade 2 ER +ve IDC. My oncologist said my cancer is almost 100% estrogen whereas some ER +ve cancers can be far less estrogen +ve (if I understood him right). I am told I should only take Letrozol for 5 years and when I asked why I wasn’t recommended 10 yrs. In my case, I was told ‘less is better”. Should patients like me advocate for longer if we are tolerating it fairly well?
A high level of estrogen receptor expression generally means a more robust benefit from antiestrogen therapy. Longer term periods of the AIs has not been shown to be better than 5 years. You may find it helpful to talk about changing to tamoxifen after the aromatase inhibitor as that may improve your bone density. A good question to ask your doctor would be about the risk of recurrence now that you are 5 years out.
Hello there and thank you for this video...
My wife was on Tamoxifen for 10 years...stopped last January 2024...After 4 months she got what looks as if her period came back (breast tenderness, bloating, pelvic cramps, back pain and normal bleeding)...However the symptoms have been going on for a little more than 3 weeks....now is the peak let's say...It started only with the breast nipple (which checked was ok)...then after a week a little pink, then after another week like the old days...not heavy or severe beedling)
Is this normal? Is this the way of the body restarting? I have read that other women took about a year before they get back to period normality after stopping Tamo....
Could you kindly share your opinion? She is 49 now, all exams were clear over the past 11 years since May 2013 that she was diagnosed with IDC type II (left breast mastectomy/right breast was kept), estrogen positive, no nodes affected....
Many thanks in advance
Tamoxifen can stop people from having periods without affecting the ovarian function. Menopause happens only when the ovaries stop working altogether. Periods reflect only bleeding. People who come off tamoxifen can have their periods come back. It's important to avoid unwanted pregnancy of course. A blood test can help see the ovarian function to be sure.
@@yerbba Thank you....Just fyi, she was heavily bleeding for a whole week...Went to the doctor...it was a polyp...quite big...27*16*22 mm...Last Saturday he removed it and took it for biopsy along with some endometrial lining which was 18,5mm...He was optimistic from what he saw that it is benign...But we are both so scared...15 days for the results of the biopsy...Stressed and gutless....We hope the demon has not come back... :(
Should we consider a hysterectomy to help prevent uterine cancer?
The risk of uterine cancer in people who are not on tamoxifen is 1 in 1000 people. The risk on tamoxifen is 2.3 in 1000 people. So while the risk is increased, it's still quite low. And a hysterectomy is not without risk of course. For that reason, we have not recommended a prophylactic hysterectomy in people on tamoxifen.
My SO has been on estrogen blockers since 2018 and has been a totally different person to me since. Never says I love you, in person, unless I do - she also does not want to have sex unless I initiate it. She was never like this before. Could it be the blockers? Our relationship hasn’t changed, itself.
Thanks for sharing your experience. This sounds really difficult, and it is likely that this is more than just the anti-estrogen therapy. If you haven't sought out couples' therapy, this might be helpful.
my doctor said i need hormonal therapy for 15 years... 14 years to go...
15 years is an unusually long time to be on endocrine therapy. It would be worth inquiring about the recommendation.
Does anastrozole cause a fatty liver?
There is some evidence that yes, the aromatase inhibitors can cause hepatic steatosis (fatty liver). Although uncommon, this is a known reversible effect of the AIs.
Yes, it can cause fatty liver.
My doctor told me tam increases risk of uterine cancer but better for bones. I'm not inclined to prevent breast again only to develop uterine.
My doctor said Tam makes bone joints weak
Thanks for writing. The benefit of tamoxifen on bone health is a really good "side effect." Uterine cancer is quite rare…so rare that most of us have had a handful of people with uterine cancer after treating thousands of people with tamoxifen. The main reason to take it, of course, is to decrease the chance of the cancer coming back by nearly half.
@@yerbba I'm on Anastrozol bc I have a history of endometriosis, cyst and fibroid. I was concerned with getting on Tamoxifen because of that history and my doctor put me on Anastrozol and lupron shots every 3 months. I moved from that State and my new doctor took me off lupron and I expressed concern bc all my previous doctors told me 5-10 years. I was so uncomfortable that I asked for a hormone level test bc I needed data and not just what the medical journals said. I got the results back and it's shows I'm not in menopause. My FSH is 8.3 and LH is 0.1. I knew I wasn't in menopause and I turned 52 today. My last lupron shot by my previous doctor was at the end January 2024. They have now ordered lupron after that test but what if I didn't stay on them to check my hormone levels. Now, they have to get prior authorization from my insurance. I'm thinking about going back to my former doctor in the State I moved from just to get the shot bc my prior approval was good through November 2024. I'm considering getting ovaries removed after getting my results back from my pelvic ultrasound and will see a Gynecologic, Oncologist next month. What do you think about me not having a lupron shot since January and only taking the Anastrozol? I was diagnosed as triple positive.
The damage for me was done after 2 and a half years treatment. 23 years later I still get daily, horrendous hot flashes, insomnia, hair loss, dry skin, and muscular/joint pain. I stopped treatment after 2 and a half years. My doctor was not happy. I was not happy because no one told me my health could be impacted so severely. When I reached menopause I was advised to take HRT. My tumour was oestrogen positive, so I blame the HRT. No one told me I could get breast cancer. And no one took responsibility or apologised. I am shocked that menopausal women are still being advised to take HRT!
It sounds like you've been through a lot. 23 years ago, HRT was still thought to be relatively safe. The increase in the risk of breast cancer is seen in women who take HRT containing both estrogen and progesterone. The progesterone decreases the risk of cancer of the uterus, which is why both were given. In people on HRT for long periods of time, there is a 30% increase in the chance of breast cancer.
The onset of your symptoms after 2.5 years is quite unusual. Most people get symptoms within a few months. It would be worth ruling out other possible explanations, such as thyroid problems. Talk with your medical team about an evaluation.
What studies showed a 30% increase in breast cancer?