After surgery, women diagnosed with hormone-receptor-positive breast cancer usually take hormonal therapy medicine to reduce the risk of the cancer coming back (recurrence). Hormonal therapy medicines work in two ways:
- by lowering the amount of estrogen in the body
- by blocking the action of estrogen on breast cancer cells
There are several types of hormonal therapy medicines. Tamoxifen, a selective estrogen receptor modulator (SERM), is one of the most well-known. Tamoxifen can be used to treat both premenopausal and postmenopausal women. In the early 2000s, the aromatase inhibitors:
- Arimidex (chemical name: anastrozole)
- Aromasin (chemical name: exemestane)
- Femara (chemical name: letrozole)
were shown to be more effective at reducing recurrence risk in postmenopausal women and are now used more often than tamoxifen to treat women who’ve gone through menopause. Aromatase inhibitors aren’t used to reduce recurrence risk in premenopausal women.
Hormonal therapy often is taken for 5 years after surgery. Still, research has shown that taking tamoxifen for 10 years instead of 5 years after surgery reduced the number of recurrences and improved overall survival. Many doctors wonder if the aromatase inhibitors may offer more benefits if taken for longer than 5 years.
Both tamoxifen and aromatase inhibitors can cause side effects. Tamoxifen may cause hot flashes and increase the risk of blood clots and stroke. Aromatase inhibitors may cause muscle and joint aches and pains. Less common but more severe side effects of aromatase inhibitors are heart problems, osteoporosis, and broken bones. Research has shown that about 25% of women who are prescribed hormonal therapy to reduce the risk of recurrence after surgery either don’t start taking the medicine or stop taking it early.
A Columbia University study has found that household net worth has a big effect on whether women will stick to their hormonal therapy treatment plans.
The research was published online on Feb. 17, 2015 by the Journal of Clinical Oncology. Read the abstract of “Household Net Worth, Racial Disparities, and Hormonal Therapy Adherence Among Women With Early-Stage Breast Cancer.”
"We know that oral hormonal therapy can reduce the recurrence of hormone-receptor-positive breast cancer by 50%,” said Dawn Hershman, M.D., M.S., associate professor of medicine at the College of Physicians and Surgeons and associate professor of epidemiology at the Mailman School of Public Health, Columbia University Medical Center. Dr. Hershman also is a member of the Breastcancer.org Professional Advisory Board and was lead author of the study. “Yet up to 10% of patients discontinue therapy annually, and only about half finish the recommended 5-year course of therapy. Thus, it's imperative that we understand what is preventing women from taking their medications and what we can do to improve adherence."
In the study, the researchers looked at prescription and financial information for 10,302 women ages 50 and older diagnosed with early-stage, hormone-receptor-positive breast cancer who had been prescribed an aromatase inhibitor between 2007 and 2011. Of these women, 2,473 (24%) stopped taking hormonal therapy early or didn’t start taking it.
The women’s household net worth was divided into three categories:
- low: less than $250,000
- moderate: $250,000 to $750,000
- high: more than $750,000
Household net worth is the total market value of all the assets (houses, cars, stocks, electronics, etc.) owned by every member of a household, minus the debt each person owes.
The researchers found that certain factors were linked to the likelihood that women wouldn’t take the complete course of hormonal therapy:
- being Black
- being older
- having other health problems
- having Medicare insurance
Other factors were linked to the likelihood that women would take the complete course of hormonal therapy:
- having medium or high household net worth
Still, when the researchers looked within the specific net worth groups, they found that there were no differences between the likelihood that Black and white women would take the complete course of hormonal therapy. In other words, Black and white women in the medium and high household net worth categories were equally likely to finish their hormonal therapy treatment.
Dr. Hershman said that the results suggest that looking only at a person’s income may not be a good way to assess whether they can pay for their medicines.
“It's important that physicians ask patients whether they are able to pay for their medications," said Dr. Hershman. "Many patients aren't comfortable raising this issue and just discontinue therapy if they can't afford it. By engaging patients in conversation, we may be able to come up with a solution, perhaps by finding less expensive alternatives or by asking pharmaceutical companies to assist patients with co-payments."
It definitely makes sense that more women would stick to their hormonal therapy regimen if the cost were more affordable. Still, we also know that side effects can have a huge effect on whether a woman sticks to her hormonal therapy treatment plan.
If you’re a postmenopausal woman who’s been diagnosed with hormone-receptor-positive, early-stage breast cancer and will be taking an aromatase inhibitor after surgery and other treatments, it’s very important that you take the medicine for as long as it’s prescribed. Hormone-receptor-positive breast cancer can come back and hormonal therapy after surgery reduces that risk -- you must remember that.
There are many different reasons why people may not follow their treatment plan as they should, including financial issues, side effects, and depression. If the cost of hormonal therapy is a concern for you, there are organizations that can help, including the assistance programs of many pharmaceutical companies and the National Cancer Institute. For more information, visit the Breastcancer.org Staying on Track With Treatment pages.