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Category:

Hormonal Therapy

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Question:  #31 6/21/2009		Q:	There is so much talk about women taking bioidentical hormones and I''ve heard no one say these hormones could cause breast cancer just as regular HRT can. Is this a risk women are talking without knowing what can happen. I was taking HRT and did get breast cancer estrogen/prog. 100% positive. I was taking Vivelle dot and Prometrium which I was told was similiar to what my body produced. Any information on the risks of bioidentical?
		A:	little research is yet available about bioindentical hormones to be able to answer that question yet. we know that HRT is a risk factor though. it probably doesn't cause breast cancer but if you are destined to get it, will feed it like fertilizer and speed up its arrival. usually by a decade. being 100% ER /PR positive would definitely make me have a big red caution sign on anything form of estrogen for you though.
Question:  #32 6/20/2009		Q:	I have been on Arimidex 2 yrs now and have been getting dull pain in hands and fingers lately--is this a common normal side effect of the med?
		A:	it is common. some women even develop full blown carpal tunnel syndrome from it.
Question:  #33 6/14/2009		Q:	I asked my oncologist if they do the test CYP2D6 and they said no because no one knows what to do with the results. I was ready to stop tamoxifen because of side effects....we negotiated and I decided to stop the effexor....it turned out all the side effects I was having were due to 75mgm of effexor daily.such as urinary incontinence, severe constipation with liquid leakage. (I ate so much fiber I think I was ready to grow leaves)and 15 pound weight gain and bad hot flashes. Since stopping effexor 2 weeks ago ----weaning---all the problems have resolved.....10 pound weight loss.....even have no hot flashes. Now I am wondering if the tamoxifen is working. thanks.
		A:	direct your oncologist to the latest research that has been done on CYP2D6 which was reiterated again at the latest ASCO conference and announced on ABC news. checking this result does help to determine if tamoxifen is or isn't being properly metabolized in your body or not. your side effects from effexor are odd. i've never seen that happen as a result of taking that drug by the way.
Question:  #34 6/14/2009		Q:	Hi Lillie, My 55 yo mother was diagnosed with Stage 3 er/pr pos, her 2 pos, br cancer in Jul 2007. She had mastectomy,completed TAC, herceptin,and radiation, and has been on Arimidex since Jan. 2008. She complains of terrible pain in her fingers and joints, especially when waking up in the morning, and terrible back and leg pain at night. Her onc has told her to stop the Arimidex for 4 weeks to see if symptoms improve. Do you see this often that a patient is asked to stop Arimidex for 4 weeks? She was last scanned in Jan 09 and scans were clean. We take it day to day, but live with the constant fear of recurrence. Do you hear these type of complaints by others on Arimidex?
		A:	yes, aromatase inhibitors can cause chronic joint pain as you are describing. given however her stage III diagnosis, scans may be wise to do again and rule out mets to the bones. also check her vitamin D level.
Question:  #35 6/1/2009		Q:	I am 52, diagnosed april 06, stage 3a 2 lynpnodes involved, her2 pos right mastectomy, chemo and radiation. I take arimidex and been on zoloft for 5 years. I read that taking zoloft can actually lower the levels of arimidex.Should i stop taking the zoloft, I want the full benefit of the arimidex. thanks, sharon
		A:	Hi Sharon, Zoloft and arimidex hasn't been studied as carefully, but I believe what you have been hearing is tamoxifen and zoloft which may actually decrease effectiveness of tamoxifen due to blocking the enzyme CYP2D6. For now, arimidex and zoloft is probably okay, though talk to your doctors about this. Hope that helps.
Question:  #36 6/1/2009		Q:	If one is having oophorectomy for stage II er pr pos breast cancer, what is standard time frame to do this after completion of chemo?
		A:	There is no real standard, but depends upon your healing from chemo, your preference and your surgeon's recommendations.
Question:  #37 6/1/2009		Q:	Have you ever heard of hair loss as a side effect of Femara? I was on tamoxifen for 5 years and my hair was rather thin, but now that I have switched to Femara, it is coming out by the handfuls. I really don''t think I can handle this again. I am high risk due to being stage 3, but my oncologist told me that taking the the Femara would only lower my risk a few percentage points and not to lose any sleep over it, if I felt that the Femara was affecting my quality of life. What is your opinion?
		A:	I am inclined to agree with your oncologist, but you should really seek a professional 2nd opinion if you want to change or discontinue a therapy. There are other classes of aromatase inhibitors, Aromasin for example, which may be as effective but may also not have the same side effects. Best wishes.
Question:  #38 6/1/2009		Q:	I think that tamoxifen reduces risk of recurrence of breast ca even after the five year therapy period, and that the new studies show that AI''s for a few more years after that continue to reduce risk...So if a woman with er/pr pos breat ca continues to be cancer free well after completion of hormone therapy -say 15 yrs later- is the thought that the hormonal therapy continues to work years later? Do the protective effects of hormone therapy decrease at all after therapy is finished? If that were the case, it would seem that one''s risk of recurrence would increase after completion of hormone therapy? Thanks so much.
		A:	There is benefit of hormone therapy even beyond stopping the drug; no one knows the precise reasons for this though there are many theories. But it does seem that AI's after tamoxifen is beneficial. No one knows yet if the reverse is true, and no one knows whether AI's for more than five years adds additional benefit though these are being studied in clinical trials.
Question:  #39 6/1/2009		Q:	I had a mastectomy for 7mm tumor and 4 rounds of cytoxin/taxotere. Because of family genetics, I am having a hysterectomy/oophrectomy next week. Is there any significant benefit to taking tamoxifin or arimidex following surgery. I am concerned about the side effects of arimidex as I am already dealing with many of them..carpal tunnel, joint problems, high cholesteral.
		A:	If you have truly invasive breast cancer (not DCIS or LCIS), then there may still be benefit for taking hormone therapy for five years even after mastectomies and oophorectomies, though your tumor size was so small (and presuming nodes were negative), that the benefit would probably be small. I would suggest talking with your medical oncologist about this, including side effects as there are other drugs to consider for hormone therapy like tamoxifen or a different class of aromatase inhibitor such as aromasin.
Question:  #40 5/10/2009		Q:	Hello again, and many many thanks for all of your help! Question about CYP2D6 gene testing-I will go on hormone therapy after completion of ACT-hopefully chemo renders me postmenopausal...(49 yrs old) Thinking about oophorectomy, but advised not necessary by onc, unless I really want it done. So I am wondering about the possibility of having the CYP2D6 gene testing just to see if I''m a poor metabolizer of tamoxifen.I know it''s not done if you are premenop, only postmenopausal. What are your thoughts on this?
		A:	yes, request that it be done. there also seems to be a correlation with minimal side effects of tamoxifen and it not metabolizing well, which this test can tell you in advance.
Question:  #41 5/10/2009		Q:	I would like to share my experience with others. I was on Arimidex for 9 months when I suffered from severe carpal tunnel in both hands and 3 trigger fingers. I went off Arimidex and still had the problem. I had 3 months of occupational therapy and had a splint made for each hand. This finally fixed the problem. I went on Arimidex again and my carpal tunnel came on in two months. I stopped Arimidex and saw my oncologist. I changed to Femera and now in the 8th month I started having symptoms again. I had not worn my hand splints since starting Femera. I wear them every night now and my hands have gotten better. If anyone starts to get symptoms of carpal tunnel or trigger fingers I suggest they at least purchase a splint from a local store and maybe it might help from getting worse. Wish I had known what to do when I first started to have problems with my hands, I could have alleviated a lot of pain. Hopes this helps someone.
		A:	aromatase inhibitors have showns symptoms of carpel tunnel syndrome in some women.
Question:  #42 5/11/2009		Q:	I am 62, have stage one ,7mm, IDC that was removed 12/19/07, no node involment & 7 weeks rad. I have been told by doctors ( both cancer & kidney ) to take femara & 1200 of cal. per day with vit. D. As of March ''08 my bone test was very good. I was born with one normal size kidney and now kidney doctor has me on a low oxalate diet , as I was passing oxalates. Any sugestions on timing these meds to protect my bones and one kidney ? Thank you - Mrs. G.
		A:	Not entirely sure as it isn't clear to me that this is related to your medicines per se. Have you discussed this with your kidney doctor? I think this may be worth discussing with your kidney doctor and maybe also an endocrinologist who specializes in bone metabolism. Hope that helped.
Question:  #43 4/20/2009		Q:	Hi Lillie, Thank you for your wonderful service to us all. I had IDC 2 years ago, age 48. Had lumpectomy,chemo,radiation. I have been on Femara for 2 years and my recent Papsmear came back with abnormal squamous cells, cannot rule out HSIL. I have never had an abornmal pap. Can Femara cause vaginal tissue changes? I know I have a lot of dryness from the femara.If tamoxifen can cause uterine cancer, is there any reports of issues with Femara?
		A:	There is no known risk of Femara and uterine cancer. Regardless, you must follow up on this, but I would talk with your oncologist regarding this result, though continuing with Femara would likely be recommended.
Question:  #44 4/20/2009		Q:	I recently got my Vitamin D levels checked, and they came back as 20 ng/whatever. It says below 20 is "deficient" and 20-30 indicates "vitamin D insufficiency". It also gave levels for D2 and D3 but said no reference range has been established - that seems a little strange - why not? Anyway, my oncologist said that my levels were normal and to just take the regular amounts of Calcium+Vitamin D as usual. But I don''t see how that will increase my D levels? And, reading about it, it doesn''t seem like there is much consensus. Some people say take mega-amounts (but not to toxicity) for 6-8 weeks and then go back to maintenance, etc. It seems like there might be a between Vitamin D and breast cancer (which of course I had), as well as with the joint/muscle aches due to AIs (which I have taking femara). So - what''s a survivor to do? I live in a sunshine state so I get plenty of sun,by the way!! Thanks, a 3 year survivor
		A:	As you said there is no consensus, and more research is being carried out and is needed. There is a move that more vit. D is better, but nothing definitive in terms of guidelines are yet agreed upon. For now, I'd recommend following your doctor's advice.
Question:  #45 4/19/2009		Q:	great site...you have been a valuable resource for me for 5 years....GEAUX LILLIE..dx.jan. 2004..bilat.br ca..rt side..1.9cm GrI est+prog+ her2neg. Lft..side 1.7cm GrIII Est. favorable. Prog. borderline.Her2 3+ strongly positive...bilateral mastec with immediate reconst. 2 pos nodes of 14 on lft..rt sent.nodes neg.. 4rounds dense dose a/c. then 2 taxol 2 taxotere. one year herceptin q3 wk..5 years arimidex. never missed a day...what now? more arimidex ?..tamoxifen? i am 58 yo cautiously optimistic nurse..scans normal..BRAC negative...i have a daughter..30yo. any thoughts greatly appreciated....
		A:	you have been very aggressive with your treatment and should be proud of yourself. being more than 5 years out too dramatically reduces your risk of recurrence since you are well passed the 2 year mark when risk of recurrence is its highest. ask your oncologist if you are a candidate for enrolling in a study that would enable you to do 5 more years of hormonal therapy with a different hormonal therapy drug. LS
Question:  #46 4/12/2009		Q:	In a previous question you answered that if you are on hormonal therapy (tamoxifen) and don''t have menopausal systems there could be concern that it is not working. I have been taking this for about 15 months with a hot flash possibly once every couple of months and no other symptoms. Should I be concerned (ER & PR + 100% and Her2 - post menopausal)?
		A:	request a blood test called CYP2D6. it will determine if you are able to metabolize the tamoxifen correctly or not.
Question:  #47 4/13/2009		Q:	I was diagnosed at 33yo in Feb ''07 my periods stopped after my first month of chemo treatments. After chemo, mastectomy and radiation I was put on Zolodex injections every 3 mo. to keep me in menopause and have been taking aromasin, and will maintain that schedule for 5 years. I have had no period since March ''07 until today?? Would appreciate your thoughts on this.
		A:	This is a relatively new regimen of hormonal therapy for premenopausal women and is probably considered a more aggressive course of therapy, likely recommended because you are so young. That said, there is no definitive data suggesting that this therapy is better than the current standard of care for premenopausal women, Tamoxifen. There are ongoing clinical trials looking at this question, and also what the long term side effects of your regimen might be. Regardless, some form of hormone therapy should be instituted. If you have further concerns, I would encourage you to seek a second opinion.
Question:  #48 4/13/2009		Q:	I am on faslodex and in a recent CT scan had some minor tumor progression and one new tumorin my lungs. How much tumor progression would one have before determining that the faslodex is no longer effective?
		A:	That depends on a number of factors, including how long you have been on the faslodex. Generally speaking, hormone therapies can take a few weeks to work after their initiation. Certainly if you have been on this for awhile, then this demonstrates that the faslodex may be losing its effectiveness. However, minor tumor progression and a small (how big is it?) new lesion might not be a reason to change therapies just yet. I would encourage you to talk with your oncologist about his/her threshhold for changing up therapies.
Question:  #49 4/11/2009		Q:	Hi Lillie, Just read an article that if you don''t have hot flashes or night sweats that you have a higher risk of recurrance!? Is this true? Because if you don''t have hot flashes or night sweats that your still producing estrogen.. Should I get my estrogen levels checked? Diag 10/2006, Stage II, 7mm , >90%ER & PR+, HER-, Grade 3, 1 node out of 22 positive (UGH), did chemo AC & T, Lump & rads and had my ovaries removed. I experienced night sweats a couple of times before my period stopped on chemo. Currently on Arimedex and once in a blue moon feel flushed/hot flash during the day. Its bad enough that you worry everyday but now I feel even more anxious.. Your the best.. Thanks
		A:	first, you are well past the milestone that we worry most about recurrence which is during the first 2 years from diagnosis. congrats! the study you might be referring to relates to taking hormonal therapy, specifically tamoxifen. if women don't have side effects from it of menopausal symptoms then there is concern that it may not be doing its job thus the patient may not be benefitting from the therapy. your prognostic factors were very favorable. you did chemo for added insurance. try to worry less, especially being past the 2 year milestone.
Question:  #50 4/5/2009		Q:	I reached my 5 year survival anniversary on 2/13/09. I have had no problems and will complete Arimidex in July 2009. I had a Stage 3 Cancer and received neoadjuvant chemo with AC and Taxotere.The tumor was downsized and I had a lumpectomy and radiation.BRCA testing was negative as well as KI69. All 11 nodes were negative. My surgeon said to me that I better take it longer and to discuss it with my oncologist. Why do doctors scare you like this?I was celebrating the fact that I made it to this milestone and her message was alarming. Is there any research supporting that this drug should be taken longer than 5 years? Thank you for this wonderful forum.
		A:	Hi Js1391. This is Ben Park MD, PhD and I was referred by Lillie regarding your question. Congrats on finishing therapy!! Truly a milestone that you should be very happy about. As far as your surgeon's recommendation, there is no answer for this currently. It is an ongoing research question in a number of clinical trials and no data supports the use of arimidex longer than 5 years. It may be like tamoxifen that more than five years is not any better and only increases risks of side effects, or it could be better; hence the need for clinical trials. And, arimidex can have long term consequences like worsening osteoporosis and a slight increased risks of heart attacks. So my advice would be to complete five years and then ask your oncologist about a clinical trial if you are even thinking about taking it for longer. On another note, many insurance companies will not pay for arimidex once you have completed 5 years and it can be quite expensive. Hope that helped.
Question:  #51 4/5/2009		Q:	I am 48 years old, premenopausal, and being given Zoladex shots every 3 months since 1/2009 to shut down ovaries. I had a period last month, and estradiol was 69. Is it premature to say that the 3 mo. Zoladex is not working well for me? I was only able to stay on Tamoxifen for a little over one year post surgery, because I had three pulmonary embolisms in 12/2008. ILC, ER/PR +++
		A:	it is a little premature. bit it another month or so.
Question:  #52 4/5/2009		Q:	Thank you for answering my question. I was diagnosed Sep 2007. 30 years old. Completed surgery,chemo,rads and Herceptin. I am now on Tamoxifen,Lupron and Zometa. I have heard about removal of ovaries with young woman, but I am worried about doing it at a young age and the possible consequences. My onc has me doing Lupron for 3 years. Is it ok to continue with the Lupron longer than the 3 years or until the SOFT Trial results are made available?
		A:	your oncologist might opt to extend the time you stay on lupron. that is a possibility. taking ovaries out is also an option. both methods would be accomplishing a similar result-- ovarian suppression. in both cases, you need to be sure to be getting enough calcium and vitamin D3 to keep your bones strong.
Question:  #53 3/29/2009		Q:	What are the real difference between Femara and Arimidex? Is Aromasin the same as Femara and Arimidex. If a woman fail''s Arimidex, will she automatically fail Femara and Aromasin?
		A:	all are aromatase inhibitors and to read about their differences, just go to the pharmaceutical website for the company that manufactures them. yes, it is common for a doctor to switch a patient from one to another either due to one not working or due to side effects.
Question:  #54 3/9/2009		Q:	I am 36 years old and am currently undergoing treatment for stage 2 ductal breast cancer. The tumor that they found was 97% estrogen based and prog. positive. I am finishing up chemo and then will do radiation. My question is about ovary suppression. What do you suggest? I am contemplating removing the ovaries or a hysterectomy.
		A:	A couple of things 1) consider genetic testing as your young age makes you a candidate for this 2) removing ovaries is an acceptable option, but adding either tamoxifen or an aromatase inhibitor on top of that would still be a further option and an area of clinical research. I would talk to your oncologist about this and consider getting a 2nd opinion at a major academic cancer center. THere is a trial addressing this in premenopausal women now using medicines to supress the ovaries.
Question:  #55 3/9/2009		Q:	I had BC 4 yrs ago , had a mastectomy and chemo. Two years later I had a myomectomy for fibroids. Went on Tamoxifen a year later. While I was on Tamoxifen I went to my GYN who told me i was postmenopausal because of the Tamoxifen. I couldn''t deal with the effects, so stopped after a year and didn''t go back to oncologist. I haven''t had a cycle in 6 months. I just had a pelvic exam and need to go in for an ECB. I really don''t know what to do whether I should go back to taking Tamoxifen or not.
		A:	There are other hormonal therapy options for you, so I would strongly recommend you talk to your oncologist regarding this. Tamoxifen and hormone therapy in general are powerful drugs in preventing breast cancer from coming back, so it is worth it to explore this with your doctors.
Question:  #56 3/9/2009		Q:	It is my understanding that estriol is a safer form of vaginal estrogen than estradiol. All the products such as Vagifem and the Estring sold in the United States are made from estradiol. I know it is possible to buy estriol in European and other non US countires. Is it true that estradiol is a more dangerous form of estriol? And is there a way to buy the estriol cream in this country? Thank you
		A:	No one knows if any vaginal form is safer than the next regardless of formulation of estrogen. Sorry, but I am unaware of any way to get estriol in this country, but again, I wouldn't recommend it as safer either.
Question:  #57 3/9/2009		Q:	I was dx with Metaplastic Carcinoma (Adenocarcinoma with Spindle Cell Metaplasia (5% Ductal Diff, 95% Spindle Cell Diff) Sept. ''08. ER/PR Neg for Spindle Cell Component & ER/PR Pos for ductal component. I''ve had a mastectomy with clear margins, Node Negative, completed 4 cycles AC (dose dense), have had 1 cycle Taxol (scheduled for 3 more cycles dose dense). Would hormone treatment be helpful? My onocologist is considering, but I have not found any research supporting use especially since 95% of tumor is ER/PR negative.
		A:	This is a very unusual and difficult case of breast cancer. I would strongly suggest getting a second opinion at a place like Hopkins or other NCI comprehensive cancer center.
Question:  #58 3/9/2009		Q:	Hi Lillie, I have a history of ERPR+ tubular cancer. Following lumpectomy and radiation, my oncologist prescribed Evista to me. I am a menstrating woman 43 years old. Everyone that I read about and talk to seem to be on Tamoxifen. What is your opinion considering Evista vs. Tamoxifen?
		A:	Tamoxifen would be the first drug of choice. Evista is (as of now) only indicated for women at risk of developing breast cancer and only in postmenopausal women. Doesn't mean it won't work, and biologically it should, but it hasn't been studied in this context yet. That said, Evista does not seem to increase endometrial cancer risk, while tamoxifen does slightly.
Question:  #59 3/9/2009		Q:	I have taken Arimidex for nearly 5 years for early stage breast cancer. Can Femera be taken for another 5 years? Has it been approved for treatment after the first 5 years?
		A:	No it has not. Studies are ongoing whether 5 vs. 10 years of an aromatase inhibitor is better, but for now, there is no data.
Question:  #60 3/9/2009		Q:	I had dcis diagnosed in 10/05. Agressive was what they said, and completed the radiation/lumpectomy. Last year had two bioposys on the other breast,located at opposite ends of the breast, ADH for both of them. One more than the other. Decided to do bialateral mastecomy last year, have finally finished reconstruction 1/09. Good news is Im pregnant as of 2/09, and my progesterone is low. This greatly increases my risk for miscarriage and my doctor won''t do progesterone supplements due to my history. Does this seem reasonable? I thought my risk of reacurance was almost 0? My tumor was er+ and Pr-. What are your thoughts?
		A:	No one can no for sure what effect progesterone will have for your breast cancer risk, but most studies haven't found conclusive evidence of this. Although your risk is as low as it can be for breast cancer now that you've had double mastectomy, it still is not 0%. I would recommend you talke with your oncologist and gynecologist, (and have them talk together), to determine the optimal risk/benefit profile and figure which is in your best interest.