A Brief Guide to Breast Cancer

MYTH No3: Everybody has the same treatment for breast cancer: surgery, radiotherapy and chemotherapy, right?
It is my belief that the future for breast cancer treatment lies within a targeted approach, which does not damage the immune system (like chemo does), and works with the body to contain the cancer cells. The range of hormonal therapies now available go in this direction. Although hormonal therapy can be offered to patients with primary cancers, it is the only current hope for people with secondary tumours, whose time is running out. These treatments cannot cure it, but can help to slow down the progression of the disease.

1.Breast Conditions     2.Grading & Stages     3.Hormonal Therapy
Drugs Working on Oestrogen Other Hormonal Drugs
Approximately 75% of breast cancers are sensitive to oestrogen in post-menopausal women, and between 50-60% in pre-menopausal women. Those cancers are eligible for treatment by the following drugs.

Anti-oestrogens
"Tamoxifen" (marketed as "Nolvadex") is an anti-oestrogen drug. It works by partly blocking the effects of oestrogen on breast cancer cells, therefore stopping them from growing. It is generally offered to pre- and post-menopausal women who have had a primary cancer.
"Faslodex" is a new type of anti-oestrogen, which works in a different way and has fewer side-effects than Tamoxifen. It is given to post-menopausal women with a local recurrence or secondary breast cancer.		 "Trastuzumab" (better known under its marketed name "Herceptin") is a different kind of hormonal drug. It belongs to a new group of drugs called "monoclonal antibodies". The drug works by sticking to a protein found on the surface of cancer cells, known as HER2. Some breast cancers have a higher than normal level of this protein, which encourages the cells to grow. However, this is only the case in about 20 to 25% of breast cancer patients. This drug therefore only applies to a minority.
Herceptin is administered intraveinously at the hospital. Its side-effects are not as mild as those of the drugs listed on the left-hand side column and, as it is often given in conjunction with chemotherapy, it is hard to differentiate between the powerful side-effects of chemo, and the milder ones of Herceptin.

There has been a lot of publicity in the news about Herceptin, as the drug was only distributed to patients with HER2-positive secondary breast cancer in the UK. A recent court case highlighted the fact that patients with primary HER2-positive breast cancer could also benefit from this drug. Clinical trials on women with early (primary) breast cancer were found to reduce the risk of recurrence by more than half. However, the cost to the NHS is estimated at £100 million per year, and the drug must still undergo rigorous protocols to ensure that it is safe for patients to use.

JUNE 2006 NEWSFLASH: Herceptin is now to be available on the NHS for women with primary (early) breast cancer, to whom this drug would be beneficial.
Aromatase inhibitors
Oestrogen continues to be produced within fat cells, muscles, skin and the liver even when the ovaries have stopped working (after the menopause). Aromatase is an enzyme which converts other hormones (such as androgens) to oestrogen. Drugs like "Anastrozole" (marketed as "Arimidex") and "Letrozole" (marketed as "Femara"), neutralise this aromatisation process. Anastrozole is either offered to women with primary cancers, who cannot take Tamoxifen, or to post-menopausal women with secondary cancers. Letrozole is offered to post-menopausal women with primary cancers, who have completed a course of Tamoxifen, and to post-menopausal women with secondary cancers.
"Exemestane" (marketed as "Aromasin") is another aromatase-inhibitor, which is given to post-menopausal women with secondary breast cancer, when the tumours have become unresponsive to Anastrozole or Letrozole.
LHRH Agonists
"Zoladex" (marketed as "Goserilin") is a drug which works by interfering with the signals sent by the pituitary gland to the ovaries. It suspends the ovaries' functions during treatment, thereby halting the production of oestrogen in the ovaries. This drug is administered to pre-menopausal women by an injection in the abdomen every four weeks. This is used to make them post-menopausal, before they can take aromatase inhibitor drugs (see above). It is mainly offered as a treatment for secondary cancer.