Both hormonal treatment for breast cancer and hormone replacement therapy have made headlines in recent years, leading to some confusion. This common mix-up is further complicated by the fact that hormone replacement therapy for menopause and hormonal treatment for breast cancer have completely opposite goals. While one works to replace estrogen in a woman's body, the other tries to eliminate it.
What is the difference between hormone replacement therapy and hormonal treatment?
Hormone replacement therapy usually refers to the use of estrogen or estrogen-containing treatment to alleviate some of the side effects of menopause. It is also used to help with other health benefits that might be associated with estrogen. For most women with breast cancer it is not recommended.
Hormonal treatment refers to treatment for breast, which reduces the effect of estrogen on breast tissue or breast tumor tissue.
What are the different uses for hormone replacement therapy, both short term and long term?
The use of hormone replacement therapy in the short term is mostly for alleviating side effects of menopause, such as hot flashes or mood swings. And these are used for a short period of time and are generally effective.
Doctors used to think that long-term hormone replacement therapy could also combat things like heart disease and other processes of aging, like Alzheimer's disease and skin wrinkling. That thinking was changed by the Women's Health Initiative study that examined the effects of long-term estrogen replacement in women after menopause.
Doctors knew that hormone replacement therapy could increase the risk of breast cancer by a small amount, but were hoping that the increased risk would be counteracted by a reduction in the much more common problem of heart disease. However, the results showed that there were actually more heart attacks and other cardiac events, as well as the known increase in breast cancer.
More recently, randomized studies have also shown that there does not seem to be an effect on decreasing dementia from estrogen replacement. So this, again, goes against some of the commonly held beliefs.
What is hormonal treatment for breast cancer?
Hormonal treatment for breast cancer is designed to block the effect of estrogen on either normal breast tissue or breast cancer cells. In some breast cancer tumors, estrogen can stimulate growth. There are tests called the estrogen receptor and progesterone receptor tests, which help determine if a tumor is responsive to those hormones. If either of those tests is positive, then, typically, hormonal treatment is used.
Examples of hormone treatment include removing the source of estrogen itself, by removing the ovaries or by using medications to keep the ovaries from producing estrogen. Another method involves using medications that interfere with the effect that estrogen has on breast cells or breast cancer cells. These drugs include tamoxifen and a class of drugs called aromatase inhibitors.
For people with early-stage breast cancer who are cured with surgery, in some cases, the risk of the cancer returning can be lowered when a hormonal treatment is used after breast surgery.
Advanced breast cancer, when the cancer has already spread, is not curable. But hormonal treatment can, in some cases, keep the cancer in check, sometimes for a very long time.
How should women view hormonal treatment and hormone replacement therapy?
Women need to understand that hormonal treatment is for breast cancer and hormone replacement therapy is for menopausal symptoms. Some breast cancers stop growing or grow more slowly based on lowering the level of estrogen, so hormone treatments are used to accomplish that. For women who are having hot flashes or mood swings, hormone replacement is used to try to replace the effects of estrogen. They are two very different regimens with very similar names.