Hormonal therapies are treatments which either reduce the levels of hormones in the body or block their effects on cancer cells. They are often given after surgery, radiotherapy and chemotherapy for breast cancer to reduce the chance of the cancer coming back.
Hormonal therapies are only effective in women whose cancer cells have receptors for oestrogen and/or progesterone on their surface. This is known as being oestrogen-receptor positive (ER+) or progesterone-receptor positive (PR+). It means that the breast cancer cells are affected by oestrogen or progesterone. These are female hormones that the body produces naturally and that can stimulate breast cancer cells to grow. When a cancer is removed and the tissue is studied in the laboratory, testing for whether these hormonal receptors are present is one of the checks that are normally done.
There are many different types of hormonal therapy and they work in slightly different ways. Hormonal therapies for breast cancer include the drug tamoxifen which is from a group of medicines known as a SERM (selective oestrogen receptor modulator). These block the effect of oestrogen on tissue receptors. Another family of drugs which act to reduce hormone levels are the medicines known as aromatase inhibitors (these drugs work by blocking the aromatase enzyme which converts androgen hormones into oestrogen and so they reduce the amount of oestrogen in the body). These do not block the effect of oestrogen from your ovaries, and so are only effective in women whose ovaries have stopped making oestrogen: someone has gone through their menopause either naturally or after surgery to remove the ovaries. Other hormonal treatments work by stopping the ovaries from producing hormones. This can either be through medical therapy, for example having a medicine called zoladex (goserelin) which switches off the ovary, or through surgical therapy, which would involve removing the ovaries.
Which hormonal therapy is best for each woman depends on several factors, including:
- A woman’s age
- whether a woman has had her menopause (change of life)
- the stage and grade of the cancer
- which other treatments are being used.
Ovarian ablation is a treatment that stops or lowers the amount of the hormone estrogen made by the ovaries. This includes surgery to remove both ovaries, radiation therapy, and the use of certain drugs to ‘shut down’ the ovaries, such as Zoladex (goserelin). In some breast cancers, known as oestrogen receptor positive breast cancer, oestrogen can stimulate the breast cancer cells to grow. In women who haven’t yet reached their menopause, the ovaries are the main source of oestrogen. Stopping the ovaries from producing oestrogen means there is less of the hormone available in the body. For premenopausal women, research has shown that ovarian ablation after surgery can:
- reduce the risk of the cancer coming back
- increase chances of survival
- reduce the risk of getting another new breast cancer.
After having ovarian ablation, women are usually prescribed aromatase inhibitors.
A few younger women we spoke with had had their ovaries removed.
Penny chose to have her ovaries removed to reduce her chances of getting breast cancer again. She…
Having a double mastectomy and her ovaries removed helped Tess feel that she was doing something…
Surgery to remove the ovaries is known as an oophorectomy. The operation is usually done using laparoscopic or keyhole techniques. This involves using a laparoscope: a thin, flexible tube with a light and magnifying lens at the tip. It enables the surgeon to look into the abdomen (tummy). The surgery usually involves a general anaesthetic. Two or three small cuts are made into the skin and muscle of the abdomen to allow the laparoscope and other instruments to be inserted. Most women will be in hospital 1 or 2 days.
Penny described what happened when she went to hospital to have her ovaries removed. She felt a…
Tess had her ovaries removed in the morning and was out of hospital the same day. She found the…
Removing the ovaries with surgery produces an immediate and permanent menopause. This means that periods stop straight away and women may experience typical menopausal symptoms.