Does Hormonal Therapy Help Both Receptor-Positive and Negative Cancer?

— -- Question: Is hormonal therapy a treatment option regardless of whether my hormone receptor status is positive or negative?

Answer: If a woman has hormone receptor-positive breast cancer -- and 'hormone receptor-positive' means the estrogen and/or progesterone receptor is present in the tumor -- then that women is a candidate for endocrine therapy or hormonal therapy. And again, making the distinction between early-stage breast cancer and metastatic disease, women who have early-stage breast cancer would, and should, get a recommendation for 5 years of adjuvant tamoxifen, if their tumor is hormone receptor-positive. If they're hormone receptor-negative -- in other words, their tumor is hormone receptor-negative -- there is no benefit from getting endocrine therapy. So the idea of reducing your risk of recurrence or prolonging survival by giving tamoxifen to patients with ER -- endocrine receptor-negative disease, there's no evidence that tamoxifen in that setting helps.

If a patient has metastatic disease and has hormone receptor-positive disease, again, endocrine therapy is an option. If the tumor is hormone receptor-negative, there would be no benefit derived from giving hormonal or endocrine therapy.

And the final issue is: is there any role to giving a drug like tamoxifen for preventive measures? In other words, a woman has an established diagnosis of breast cancer. By giving tamoxifen, can you help prevent the risk of developing a second, unrelated breast cancer? Obviously a woman has two breasts, and she remains at risk for developing a second tumor.

The evidence that giving tamoxifen to a woman who has hormone receptor-negative established breast cancer is controversial. And the reason I say that: we know it provides no benefit in terms of risk reduction for the established breast cancer. In terms of reducing the risk of a second primary breast cancer, there is conflicting information; and right now, the information would suggest that there is not any benefit in giving tamoxifen to prevent a second primary breast cancer. But quite frankly, we need additional studies to really truly evaluate the benefit of tamoxifen in that setting.

Next: Is hormonal therapy a treatment option if I am pregnant or want to get pregnant?

Previous: How long will I have to take hormonal therapy?