The Who, What, Where, When and Sometimes, Why.

Hormone Therapies

Hormone therapies may also be called endocrine therapies. The endocrine system in the body makes hormones.

When are hormone therapies used?

Estrogen and progesterone are female hormones produced in the body. Some breast cancer cells need estrogen and/or progesterone to grow. When these hormones attach to special proteins called hormone receptors, the cancer cells with these receptors grow.

Hormone therapy drugs slow or stop the growth of hormone receptor-positive tumors by preventing the cancer cells from getting the hormones they need to grow.

All tumors are checked for hormone receptors. A pathologist determines the hormone receptor status by testing the tumor tissue removed during a biopsy

  • Hormone receptor-positive (estrogen receptor-positive/progesterone receptor-positive) tumors express hormone receptors. This means they have a lot of hormone receptors.
  • Hormone receptor-negative (estrogen receptor-negative/progesterone receptor-negative) tumors do not express hormone receptors. This means they have few or no hormone receptors.

Hormone therapies are only used to treat hormone receptor-positive breast cancers. Most breast cancers are hormone receptor-positive.

Learn more about hormone receptor status.

How do hormone therapies work?

Hormone therapy drugs slow or stop the growth of hormone receptor-positive breast cancers in a couple of ways:

  • Some hormone therapies, such as tamoxifen, attach to the hormone receptor in the cancer cell and block estrogen from attaching to the receptor.
  • Others, such as aromatase inhibitors and ovarian suppression, lower the level of estrogen in the body so the cancer cells can’t get the estrogen they need to grow.

Benefits of hormone therapies

Treatment with the hormone therapies tamoxifen and/or an aromatase inhibitor lowers the risk of [78-80]:

Premenopausal women who get ovarian suppression plus tamoxifen or an aromatase inhibitor may lower these risks further [81].

Learn more about tamoxifen.

Learn more about aromatase inhibitors.

Learn more about ovarian suppression.

Hormone therapy options

For women with hormone receptor-positive breast cancer, hormone therapy drug options depend on whether or not a woman has gone through menopause.

Men with hormone receptor-positive breast cancer can take tamoxifen.

 

 Hormone therapy options

Premenopausal (before menopause) women

Postmenopausal (after menopause) women

Men

Tamoxifen

Tamoxifen plus ovarian suppression

Aromatase inhibitor plus ovarian suppression

Tamoxifen

Aromatase inhibitor

Tamoxifen

Hormone therapy versus menopausal hormone therapy

Hormone therapy for breast cancer treatment is different than menopausal hormone therapy (MHT). MHT may also be called postmenopausal hormone use or hormone replacement therapy (HRT).

  • Hormone therapies used in breast cancer treatment act as “anti-hormone” or “anti-estrogen” therapies. They block hormone actions or lower hormone levels in the body.
  • MHT is used to increase hormone levels in the body to treat menopausal symptoms.

MHT increases the risk of breast cancer. It’s not usually recommended for women with breast cancer. For other women, it’s only recommended at the lowest dose, for the shortest time needed, to ease symptoms.

Learn more about MHT and breast cancer risk.

Learn more about MHT and breast cancer survival.

Learn about other ways to ease menopausal symptoms.

Hormone therapy drugs for early and locally advanced breast cancer

Figure 5.7: Hormone therapies for early and locally advanced breast cancer

Drug

Brand name

Used in pre- or postmenopausal women?

Injection or pill?

Tamoxifen

Nolvadex

Pre- and postmenopausal

Pill

Anastrozole

Arimidex

Postmenopausal

Pill

Letrozole

Femara

Postmenopausal

Pill

Exemestane

Aromasin

Postmenopausal

Pill

Goserelin

Zoladex

Premenopausal

Injection

Leuprolide

Lupron

Premenopausal

Injection

To learn more about a specific hormone therapy, visit the National Institutes of Health’s Medline Plus website.    

Hormone therapy drugs for metastatic breast cancer

Figure 5.8: Hormone therapies for metastatic breast cancer

Drug

Brand name

Used in pre- or postmenopausal women?

Injection or pill?

Anastrozole

Arimidex

Postmenopausal

Pill

Exemestane

Aromasin

Postmenopausal

Pill

Fulvestrant

Faslodex

Postmenopausal

Injection

Goserelin

Zoladex

Premenopausal

Injection

Letrozole

Femara

Postmenopausal

Pill

Leuprolide

Lupron

Premenopausal

Injection

Megestrol acetate

Megace

Pre- and postmenopausal

Pill

Tamoxifen

Nolvadex

Pre- and postmenopausal

Pill

Toremifene

Fareston

Postmenopausal

Pill

To learn more about a specific hormone therapy, visit the National Institutes of Health’s Medline Plus website.  

Tamoxifen can be used to treat hormone-receptor positive breast cancer in:

  • Premenopausal women
  • Postmenopausal women
  • Men

Premenopausal women may get tamoxifen plus ovarian suppression.

Learn more about tamoxifen.

Learn more about tamoxifen with ovarian suppression.

Aromatase inhibitors can be used to treat hormone-receptor positive breast cancer in:

  • Postmenopausal women
  • Some premenopausal women who also get ovarian suppression

Learn more about aromatase inhibitors.

Learn more about aromatase inhibitors with ovarian suppression.

Ovarian suppression can slow the growth of hormone receptor-positive breast cancer in premenopausal women. It uses drug therapy or surgery to prevent the ovaries from making estrogen. 

Ovarian suppression is always given in combination with tamoxifen or an aromatase inhibitor. It’s never given alone.

Learn more about ovarian suppression.

Hormone therapies have different side effects.

Learn about the side effects of tamoxifen.

Learn about the side effects of aromatase inhibitors.

Learn about the side effects of ovarian suppression.

Research is ongoing to improve hormone therapy.

Learn more about emerging areas in hormone therapy for early and locally advanced breast cancer.

Learn more about emerging areas in hormone therapy for metastatic breast cancer.

Learn more about clinical trials.

  • Do I need hormone therapy? Why?
  • What tests were done on my tumor? What were the estrogen receptor status and progesterone receptor status of my tumor? How do these affect my treatment plan?
  • Should my tumor be tested with Oncotype DX® or another tumor profiling test to help decide if I need chemotherapy?
  • How will hormone therapy affect my risk of a local breast cancer recurrence, metastasis or a new breast cancer? Please explain the differences.
  • Which hormone therapy do you recommend for me and why?
  • In what form and how often will the hormone therapy be given?
  • How long will I be on hormone therapy? How will that decision be made?
  • Is there a generic form of this hormone therapy?
  • How soon after surgery will I begin hormone therapy?
  • What is the best way for me to treat menopausal symptoms, such as hot flashes? What can I do to manage vaginal dryness and/or painful intercourse?
  • What are the other short- and long-term side effects of this hormone therapy? What side effects should I report to you?
  • Are there medications I should avoid while using hormone therapy?
  • If I take an aromatase inhibitor, will I be given a baseline bone density test? How will you follow my bone density status? What can be done to help reduce bone loss? What signs or symptoms of bone loss should I report to you?
  • Is there a clinical trial I can join?
  • Should I see my regular physician or gynecologist during my treatment?
  • How often will I have check-ups and follow-up tests after treatment ends?
  • Will a follow-up care plan be prepared for me?
  • Which health care provider is in charge of my follow-up care?
  • Where can I find a support group for people with breast cancer (or cancer in general)?
  • What do I need to consider before treatment if I would like to have a child after being treated for breast cancer?
  • Who will talk with me about the cost of my treatment (including the expenses covered by my insurance and the costs I should expect to pay out-of-pocket)?

Learn more about talking with your healthcare provider.

It may be helpful to download and print Susan G. Komen®‘s Questions to Ask Your Doctor About Hormone Therapy and Side Effects resource and take it with you to your next doctor appointment. There’s plenty of space to write down the answers to these questions, which you can refer to later.

There are other Questions to Ask Your Doctor resources on many different breast cancer topics you may wish to download. They are a nice tool for people recently diagnosed with breast cancer, who may be too overwhelmed to know where to begin to gather information.

Treatment guidelines

Although the exact treatment for breast cancer varies from person to person, guidelines help ensure high-quality care. These guidelines are based on the latest research and agreement among experts.

The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) are respected organizations that regularly review and update their guidelines.

In addition, the National Cancer Institute (NCI) has treatment overviews.

Talk with your health care providers about which treatment guidelines they use. 

Importance of following your breast cancer treatment plan

Breast cancer treatment is most effective when all parts of the treatment plan are followed as prescribed.

It’s important to follow the treatment plan (for medications and other therapies) prescribed by your health care provider in terms of:

  • Timing
  • Dose
  • Frequency

Completing hormone therapy

Hormone therapy with tamoxifen and/or aromatase inhibitors is prescribed for 5-10 years. The length of treatment along with side effects can make it tough to complete treatment.

Dealing with menopausal symptoms related to hormone therapy can be hard. Talk with your health care provider about ways to ease these and other side effects.

To get the most benefit from hormone therapy, you need to take the full course of treatment. People who complete the full course have better survival than those who don’t [82-84].

If you have trouble remembering to take your medicine, a pillbox or setting an alarm on your watch or phone (you may be able to download an app) may help [1].

However, you don’t need to panic if you miss a day or two.

Learn more about the importance of following your breast cancer treatment plan.

Learn about ways to manage hot flashes and other menopausal symptoms.

Prescription drug assistance

Hormone therapy drug costs can quickly become a financial burden for you and your family.

Medicare and many insurance companies offer prescription drug plans. One may already be included in your policy or you may be able to buy an extra plan for prescriptions.

Most hormone therapies are pills, so they’re covered under your health insurance plan’s prescription drug benefit rather than the plan’s medical benefit. This means there are usually out-of-pocket costs, which can add up over time.

You may qualify for programs that help with drug costs or offer low-cost or free prescriptions.

Tamoxifen and aromatase inhibitors (anastrozole, exemestane and letrozole) all have generic forms. Generics cost less than name brand drugs, but are just as effective.

Learn more about insurance plans and prescription drug assistance programs.  

Learn about other financial assistance programs.

Susan G. Komen®‘s position on fairness in oral cancer drug coverage

Insurance coverage of oral cancer drugs

Cancer medications given by vein (through an IV) are usually covered under a health insurance plan’s medical benefit. However, cancer medications that are pills (oral cancer drugs) are usually covered under a health insurance plan’s prescription drug.

As a result, people often find themselves facing high out-of-pocket costs when filling prescriptions for oral cancer drugs. Sometimes this can cost thousands of dollars a month.

The impact of high drug costs

High prescription drug costs are a barrier to care. They can prevent people from getting the medications prescribed by their health care providers.

No one should be forced to get less appropriate treatment because an insurer gives more coverage for IV drugs than pills.

Efforts to increase fairness in drug coverage

Komen supports state and federal efforts to require insurers to provide the same or better coverage for oral cancer drugs as they do for IV cancer drugs. This would help ensure patients have access to affordable, appropriate treatment.

Take action

Ask your U.S. representative to co-sponsor the Cancer Drug Parity Act.

 

 

Komen Treatment Assistance Program

Susan G. Komen® offers the Komen Treatment Assistance Program to help eligible, underserved breast cancer patients in treatment. To learn more about this program and other helpful resources, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636).

 

Clinical trials

Research is ongoing to improve all areas of treatment for breast cancer.

New therapies are being studied in clinical trials. The results of these studies will decide whether these therapies become part of standard care.

After discussing the benefits and risks with your health care provider, we encourage you to consider joining a clinical trial.

Susan G. Komen® Breast Cancer Clinical Trial Information Helpline

If you or a loved one needs information or resources about clinical trials, call our Clinical Trial Information Helpline at 1-877 GO KOMEN (1-877- 465- 6636) or email clinicaltrialinfo@komen.org.

BreastCancerTrials.org in collaboration with Susan G. Komen® offers a custom matching service to help find clinical trials that fit your needs.

Learn more about clinical trials.

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Komen Perspective

Read our perspective on clinical trials.*

 

 SUSAN G. KOMEN® SUPPORT RESOURCES

  • If you or a loved one needs more information about breast health or breast cancer, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636). All calls are answered by a trained specialist or oncology social worker in English and Spanish, Monday through Friday from 9:00 a.m. to 10:00 p.m. ET. You can also email the helpline at helpline@komen.org
  • We offer an online support community through our closed Facebook Group – Komen Breast Cancer group. The Facebook group provides a place where those with a connection to breast cancer can discuss each other’s experiences and build strong relationships to provide support to each other. Visit Facebook and search for “Komen Breast Cancer group” to request to join the closed group.
  • Komen Affiliates offer breast health education and some fund breast cancer programs through local community organizations. Your local Affiliate may also help you find breast cancer resources in your area. Find your local Affiliate.
  • Our Family and Friends section has detailed information and resources for loved ones.
  • Our fact sheets, booklets and other education materials offer additional information.  

 

 

*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date.