If you or someone you know is diagnosed with breast cancer, it is normal to feel a great deal of fear and shock. Similarly, as we age, bones become weaker and even a small fall can break them. However, thanks to the advancement of medicine, there are effective treatments for these conditions. Today, we are going to talk about one such specific treatment.
Simply put, what are these SERMs?
SERMs are short for Selective Estrogen Receptor Modulators . This is a type of hormone therapy. This involves managing the way the hormone estrogen in our body works. Think of it like a smart manager. It blocks the effects of estrogen in some parts of the body, and acts like estrogen in others to help the body.
Two of the main drugs in this class are Tamoxifen and Raloxifene . These are currently used as highly effective treatments for some types of breast cancer and osteoporosis.
How do these SERM drugs work inside the body?
This may seem a bit complicated to understand, but it's actually quite simple. Let's understand this with an example.
Think of estrogen as a key. Our body's cells have receptors that match this key. When you put this key in the door, the door opens and a message is sent to the cell.
- In breast cancer: Some breast cancer cells (called Hormone Receptor positive or ER-positive cancers) need the message from the key called estrogen to grow and divide. SERM drugs work by blocking the door (receptor) on these cancer cells. It's like putting something else in the keyhole of a door. Then the real estrogen can't get to the key and open the door. As a result, the cancer cells lose the message to grow, and their growth stops or slows down.
- In the bones: At the same time, when this SERM drug goes to our bones, it works like estrogen there. That is, it goes to the doors in the bones and opens those doors, helping to keep the bones strong and retain calcium. This prevents osteoporosis.
Have you seen the amazing ability of this medicine? The same medicine works in two completely different ways in two places. That's why it's called "Selective".
What are the main uses of SERMs?
Doctors recommend this treatment mainly in two situations.
1. For breast cancer
SERMs are a very important treatment, especially for hormone-sensitive (ER-positive) breast cancer.
- For those at high risk of cancer: If someone in the family has had breast cancer, or if genetic tests have confirmed that they have genetic mutations that increase the risk of cancer, they are given this medicine to prevent cancer from developing.
- After cancer surgery: After cancer has been surgically removed, SERMs are used to prevent the cancer from coming back (`recurrence`) and to prevent cancer from developing in the other breast.
- In DCIS: To prevent the recurrence of Ductal Carcinoma in Situ (DCIS), an early stage cancer that occurs in the breast ducts.
- For cancer that has spread throughout the body: To control cancer that has spread to other organs in the body (Metastatic Breast Cancer).
- For male breast cancer: Although it is rare for men to develop breast cancer, this treatment is also used for it if it does occur.
2. For osteoporosis
A SERM called Raloxifene is used to control bone loss, strengthen bones, and reduce the risk of fractures, especially in postmenopausal women.
How successful is this treatment?
Yes, this is a very effective treatment. Studies have shown that the drug Tamoxifen in particular can reduce the risk of breast cancer by about 40% .
- If someone who has had surgery for cancer in one breast takes Tamoxifen, the risk of developing cancer in the other breast is reduced by 50% .
- For someone who has had cancer before menopause, the risk of cancer recurring can be reduced by between 30% and 50% .
- Raloxifene has also been found to significantly reduce the risk of spinal fractures caused by osteoporosis after menopause.
What happens during treatment?
This treatment is usually given as a pill or liquid that is taken daily. The duration of treatment may vary depending on your condition and your doctor's recommendations.
- Tamoxifen: People taking it to prevent or treat breast cancer usually take this drug for 5 years in a row. Your doctor may extend this period to 10 years. You may also be switched to another drug (such as an aromatase inhibitor) after a few years.
- Raloxifene: Those taking it to reduce the risk of breast cancer or for osteoporosis should take it as a daily pill for as long as their doctor recommends.
The most important thing is to take this medicine for the full duration as prescribed by the doctor. Stopping it halfway may not produce the desired results.
What are the possible side effects of this treatment?
As with any cancer treatment, SERMs can cause some side effects. However, not everyone will experience all of them. Most of these can be managed.
| Common and rare side effects of Tamoxifen | |
|---|---|
| Side effect | Description |
| Common side effects (women) | |
| Hot flashes | Similar to a symptom of menopause. |
| Night sweats | Sleep may be disturbed. |
| Irregular menstruation/vaginal bleeding | The menstrual cycle of premenopausal women may change. |
| Vaginal dryness, itching, discharge | Sexual difficulties may occur. |
| Rare but serious side effects | |
| Blood clots | It can occur in the veins of the legs (Deep Venous Thrombosis) or in the lungs (Pulmonary Embolism). |
| Risk of uterine cancer | There is a very small risk. If you experience any unusual bleeding, you should inform your doctor. |
| Cataracts | Be careful if there is a change in vision. |
| Stroke | It is a very rare but serious condition. |
Raloxifene can have similar side effects (e.g. hot flashes, leg pain), but the risk of uterine cancer is lower than with Tamoxifen. Your doctor will explain this to you in more detail.
What can I do to manage the side effects?
There are a few things you can do yourself to make living with these side effects easier.
- For hot flashes: Reduce caffeine-containing beverages such as coffee and tea. Some people may find relief by eating foods containing phytoestrogens such as soybeans, chickpeas, and lentils.
- For insomnia: Regular exercise can improve the quality of sleep.
- Vaginal dryness: There are special vaginal moisturizers that can be used for this. Ask your doctor about these.
When should you seek immediate medical advice?
If the common side effects get severe, tell your doctor. However, if you experience any of the following symptoms, go to a hospital's emergency department (ETU) immediately or call 1990. These could be signs of a serious condition such as a stroke or a blood clot in the lungs (pulmonary embolism).
- Numbness or weakness on one side of the body or face.
- Difficulty speaking, slurring of words.
- Sudden severe headache.
- Sudden difficulty breathing.
- Sharp pain in the chest, arm, shoulder, or jaw with no identifiable cause.
Don't ignore these symptoms. Taking immediate action can save lives.
Take-Home Message
- SERMs are a special class of drugs that control how the hormone estrogen works. They are a very effective treatment for breast cancer and osteoporosis.
- These drugs stop the growth of breast cancer cells and also help strengthen bones.
- Tamoxifen and Raloxifene are two of the most commonly used SERMs.
- As with all medications, there are potential side effects, but most of them can be managed. Talk openly with your doctor about them.
- Be aware of serious but rare side effects such as blood clots and stroke. If such symptoms occur, seek medical advice immediately.
- Only your doctor can give you the best advice on whether SERM treatment is right for you, and what its pros and cons are. So don't be afraid to ask any questions you have.
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