When your doctor tells you or someone you know has breast cancer, they may have mentioned hormone therapy as a treatment option. You may be a little worried when you hear this. But don't worry. Today we're talking about a very effective type of medication that is given to people with cancer cells that are sensitive to the hormone estrogen (`Estrogen Receptor-Positive` or `ER+`). These are called Aromatase Inhibitors.
Simply put, what are these Aromatase Inhibitors?
Okay, let's break this down. Aromatase inhibitors, or AIs for short, are a class of drugs that are commonly used in hormone therapy. They are used to treat ER+ breast cancer, especially in postmenopausal women .
Now, look, estrogen is a hormone that is essential for our bodies, especially for women's reproductive health. However, for some breast cancer cells, this estrogen hormone is like food. That is, when estrogen is present, those cancer cells grow rapidly.
This is where `AI` drugs come in. What these drugs do is block an enzyme called aromatase in our body. This aromatase enzyme converts other hormones into estrogen. So, when this drug stops the aromatase enzyme from working, the estrogen levels in the body decrease. Then those cancer cells lose their "food", they stop growing, and the cancer is controlled. Do you understand?
Simply put, what this drug does is stop the cancer cells from getting the "fuel" they need.
In what situations is this medicine recommended?
There are several situations in which your doctor may recommend this ``AI`` treatment:
- If you have had surgery for ER+ breast cancer, this medicine is given to reduce the risk of the cancer coming back .
- If the cancer has spread to nearby lymph nodes.
- If the cancer has spread to other parts of the body (e.g. lungs, bones, brain, liver), we call this metastatic cancer.
- If you have this `ER+` cancer before menopause. At this time, your ovaries are still producing estrogen, so you may be given other treatments to control that estrogen hormone along with `AI` medication.
- If a man develops `ER+` breast cancer. (Yes, men get breast cancer too, and they also have low levels of estrogen in their bodies).
- Some studies have shown that this drug can also help reduce the risk of breast cancer in people at high risk , but it is not yet officially approved.
The most commonly used types of aromatase inhibitors
There are several types of these ``AI`` medications on the market. Your doctor will choose the one that best suits your condition.
| Drug Name |
|---|
| Letrozole |
| Anastrozole |
| Exemestane |
How do I get this treatment and how long does it take?
This ``AI`` medicine is a pill that you have to take every day . Sometimes, treatment starts with this medicine. Other times, your doctor may first give you another hormone medicine called tamoxifen for a few years and then switch you to the ``AI`` medicine.
Usually, this treatment is continued for about five years . After five years, if you have no signs of cancer and the tests are normal, you can stop the treatment.
However, some studies have shown that the cancer can come back up to 20 years after treatment. This is called 'late recurrence'. Therefore, it is very important to talk openly with your doctor about the risks that are specific to your situation.
Benefits of treatment and possible side effects
The biggest advantage of this treatment is that it can almost completely cure ER+ breast cancer. Studies have shown that 95% of people who receive this AI treatment after surgery will not have their cancer return within 5 years . That's great news, right?
But, like all medications, this one can have side effects. Because, as we discussed earlier, estrogen is a hormone that also helps keep our bones and heart healthy. So, when you lower estrogen levels with an `AI`, some side effects can occur.
| Side Effect | Simply put... |
|---|---|
| Osteoporosis and bone fractures | The bones become weak and the risk of breaking easily increases. |
| Muscle pain (Myalgia) | Muscle aches. |
| Joint pain | Joint pain, such as knees and elbows. This is the most common side effect. |
| Hot flashes | Suddenly feeling extremely hot and sweating. |
| Vaginal dryness | Pain may occur during sexual intercourse. |
| Cardiovascular disease risk | Somewhat increased risk of heart disease. |
How to cope with side effects?
Don't be alarmed by these side effects. The most important thing is to talk to your doctor about them. Especially if things like joint pain are severe, you don't have to put up with it. Your doctor can give you solutions. For example:
- Painkillers, especially NSAIDs (e.g., ibuprofen), may be prescribed.
- If you find it difficult to tolerate, you can switch to a different type of AI instead of the AI you are currently using.
- In some cases, tamoxifen can be substituted for AI.
The most important thing is to inform your doctor about any discomfort, rather than making decisions alone.
When do you need to talk to the doctor?
In the following cases, be sure to talk to your doctor.
- If the side effects are much worse than you expected.
- If the medicine given by the doctor does not provide any relief from the side effects.
- If you notice signs of cancer recurrence (e.g., new lumps, persistent pain, difficulty breathing) , ask your doctor what symptoms to look out for.
Take-Home Message
- Aromatase inhibitors are a very important and effective hormonal treatment for estrogen-sensitive (ER+) breast cancer.
- These medications work by reducing estrogen levels in the body and stopping the growth of cancer cells.
- This treatment significantly reduces the risk of cancer recurrence.
- Side effects such as joint pain and thinning of bones can occur, but most of these can be managed.
- Most importantly: Never stop taking your medication or change the dosage without your doctor's advice. Talk openly with him about any discomfort you feel.
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