How does menopause affect your breast cancer treatment?

I understand how heavy and scary it must be when you are diagnosed with breast cancer. On the one hand, there is the worry about the disease, and on the other hand, when doctors say words like ``(Chemotherapy)`` and hormone therapy , your mind becomes even more confused, doesn't it? "Will I also get chemo? Will my hair fall out? Will it be difficult for my body?" You must have many questions in your mind. But don't worry. Today, we will talk about how your age and whether you have gone through menopause or not will be important in determining the treatment you are given.

In the past, almost everyone was given chemotherapy as soon as they found out that breast cancer had spread to the lymph nodes. It was like holding a hammer and making everything look like a nail. But now medicine has advanced a lot. Now we know that not all breast cancers are the same, and not all patients will respond to the same treatment. Sometimes the side effects of chemotherapy can outweigh the benefits. So now doctors are more concerned not only with the size of the tumor and the stage of the cancer, but also with the biological nature of the cancer.

Why is menopause important to this story?

Whether or not you've gone through menopause, the period when your monthly periods permanently stop, is very important in breast cancer treatment. There are several reasons for this.

Simply put, breast cancer in younger, premenopausal women is more likely to be slightly more aggressive than cancer in postmenopausal women .

Additionally, it also determines the type of treatment you will receive. For example, if you have hormone-dependent cancer, the type of hormone treatment you can receive will vary depending on your menopausal status.

• Postmenopausal: You may be given a medication like Arimidex, which stops the body from producing the hormone estrogen.
• If you are premenopausal: Your ovaries are still producing estrogen, so medications like Arimidex won't be very effective. So your doctor will often prescribe a drug called Tamoxifen. This works by blocking the message that estrogen sends to cancer cells.

Biology of Cancer: Hormone Receptors and HER2

Okay, now let's dig a little deeper. Leaving aside whether or not hormone therapy is right for you, the next big question is whether or not you need chemotherapy.

This decision is often based on the types of receptors on the surface of your cancer cells . Think of these receptors as the 'antennas' on the cancer cells. These antennas pick up the 'signals' that the cancer needs to grow. There are two main types of receptors that we look at.

1. Hormone Receptors (HR): Receptors sensitive to the hormones estrogen and progesterone.

2. HER2 receptor: This is another protein that helps cancer cells grow.

See the table below for how cancers are classified and treatment is determined based on the combination of these.

What is the Oncotype Dx test?

If your cancer is HR-positive, HER2-negative, that is, the first type in the table above, the question "Do I need chemo?" is the hardest to answer. It is in cases like this that doctors use a genomic test like `Oncotype Dx` .

This test analyzes 21 genes in a small sample of your cancer. Based on this, it gives you a score indicating whether your cancer has a low, moderate, or high risk of recurrence in the future.

• Low score: You can often get better without chemotherapy .
• If the score is high: Chemotherapy is most appropriate.

But many people get an intermediate score . That's where the problem arises again.

Answers from new research

Fortunately, two large recent studies, TAILORx and RxPONDER, have provided very good answers to the question of what to do with these moderate-score women. These studies have further confirmed the importance of menopause.

• TAILORx trial (for people whose cancer has not spread to lymph nodes):
• This study clearly shows that postmenopausal women with moderate Oncotype Dx scores do not gain any additional benefit from chemotherapy. Hormone therapy alone is sufficient for them.
• RxPONDER study (for people with cancer that has spread to the lymph nodes):
• This also shows the same thing. The majority of postmenopausal women, even if their cancer has spread to the lymph nodes, do not benefit much from chemotherapy.
• However, the story is completely different for premenopausal women, especially those under the age of 50. When chemotherapy is added to hormone therapy for them, the ability to prevent cancer from coming back is significantly increased .

Simply put, if you are a young woman who is premenopausal, chemotherapy can be a powerful weapon that can save your life. But if you are postmenopausal, you may be able to get better results with hormone therapy without experiencing its side effects.

Final decision and things to consider

With all of this, you probably understand how difficult it is to make these decisions alone. That's why it's so important to talk openly about all of this with your doctor.

If you are premenopausal, especially in your early 40s, there is something else to keep in mind. Chemotherapy can cause your periods to stop permanently and cause early menopause. For those who are younger, your periods may stop temporarily and then start again. But if you are hoping to have children in the future, be sure to talk to your doctor about fertility preservation before starting treatment.

Ultimately, you and your doctor will decide what treatment is best for you. During that discussion, your cancer type, stage, Oncotype Dx score, and whether you are postmenopausal are all important topics to discuss.

Breast Cancer, Menopause, Chemotherapy, Hormone Therapy, Cancer Treatment, Women's Health, Oncotype Dx, Tamoxifen, Arimidex, HER2, Cancer Symptoms