Archive for the ‘Endocrine Therapy’ Category

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … www.LegacyEducators.org  and click on “Cancer Information”



Females are VERY vocal. If you were ever in doubt about the strength in numbers and just how vocal females can be regarding a cause of mutual interest … take a look at Breast Cancer.  Everyone knows pink = breast cancer.

However, despite the awesome global attention and exposure and the many research underway, there still exist a problem; patients are still not certain of the “labels” that physicians use in describing certain aspect of Breast cancer and are often times terrified by the information found on the internet – especially as it relates to triple negative breast cancer. The questions I am often asked are;

  1. What are receptors?
  2. What does “triple negative” breast cancer mean?
  3. Is “Triple Negative” breast cancer a good or bad thing?
Receptors - Complicated?

Receptors – Complicated?

What are receptors?  There are currently 3 receptors of interest in Breast Cancer: Estrogen Receptors (ER), Progesterone Receptor (PR) and Herceptin receptors (Her-2-neu)

Receptors are often times describe as, “little antennae’s” on the surface of cells that controls behavior, such as rate of growth, of the cell.  Clear as mud? Apologies, that is still “Doctor talk” that would not make sense to my non-medical Mom…so probably not for you either.

Uuhhhmmm….thinking, thinking…Lord Help me here…Hhhmmm. Got it! A bit overly simplified…but,

Think of Breast Cancer Growth being similar to a plant. There are 3 things required to make a plant grow;

  1. Soil
  2. Water
  3. Sun

Think of each of these components as a receptor, and things that make a cancer grow,

  1. Soil   (Estrogen receptor or ER)
  2. Water (Progesterone receptor or PR)
  3. Sun (Her2neu receptor)

When all 3 are present, the Plant grows (cancer grows).  We also have the ability to “block” each of these components in hopes of preventing the Cancer from growing.

  • If the soil is removed, the plant will be destroyed. (ER+, PR-, Her2Neu-)
  • If water is taken away from the plant, it will be destroyed. (ER-, PR+, Her2neu-)
  • If  Sun exposure is removed, the plant will be destroyed. (ER-, PR-, Her2neu+)

When there are positive receptors, we have available medications that will block the growth of cancer cells in addition to the regular treatment of surgery, radiation therapy and chemotherapy. Oncologist like this, because there are more options of Medications to use, and the more different types of drugs we have, it is believed that the chance of controlling the cancer, will theoretically improve. You may be familiar with some of these drugs Tamoxifen, Arimidex,  Herceptin, etc.,

Triple Neg How ChemoIn Triple Negative Breast Cancer (ER-, PR-, Her2neu-) … The example would be a plant that is not sustained by any identifiable component…yet it is growing; a plant in a dark room, without soil or water available…grows. What is causing it to grow? Other factors that are not hormone receptor related (Well research are ongoing in this area).  However, we are still able to offer the same Surgery, Chemotherapy and Radiation Therapy as for hormone positive tumors…we just lack that “extra arsenal” of hormone/Antibody blockade that we have for positive receptor tumors.  For this reason, triple negative breast cancer is sometimes considered more aggressive. BUT, others sees it as a Breast Cancer without the hormone treatment options…3 out of 4 still remains (surgery, chemotherapy, radiation therapy). Glass half empty or half full?

Now that you understand the basics, more will be explored next time! Questions? Let me know!

Click below to watch.

Robin Roberts speaks on Triple Negative Breast Cancer


Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

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From the Physician’s Desk … Weekly Blog! 


Greetings! Now that you are aware of the meaning of “Adjuvant” *smile* let us review a recent article from the New England Journal of Medicine (NEJM) on 1 JUN 2014 and some other recent changes for Breast Cancer treatments (not to worry! I will also cover other types of Cancers as information becomes available;).

In the diagnosis of breast cancer, the receptor status is very important (please review blog here on receptor status).  If, the Estrogen Receptor (ER) and/or the Progesterone Receptor (PR) are positive, then a medication in pill form (Endocrine/Hormone Therapy) is usually given for 5-10 years. Depriving ER-positive breast cancers of estrogen can slow their growth. Tamoxifen is an anti-estrogen that has long been a mainstay of hormonal (or endocrine) therapy for breast cancer.

The type of medication given in the adjuvant setting (after surgery and/or Radiation Therapy) to women who are still having monthly menstrual cycle (Pre-menopausal) is different from the medication given to those who are no longer have menstrual cycles (Post-menopausal – or as my elders refer to it as, having “gone through the change of life!” ).  A previous study showed that an AI decrease recurrence risk more than Tamoxifen in post-menopausal women and so AIs are commonly used in the post-menopausal setting.

breastIn general terms, the study question was – Can we decrease the recurrence risk for pre-menopausal women as we did for post-menopausal women with the use of an AI? If we made patients who are still having menstrual cycle become “post-menopausal” would their outcome also improve with an AI ? The study concluded that;

“…for premenopausal women with hormone-receptor-positive breast cancer, adjuvant treatment with ovarian suppression plus and aromatase inhibitor (AI) Exemestane … [as compared with ovarian suppression plus tamoxifen] … provides a new treatment option that reduces the risk of recurrence. Premenopausal women who receive ovarian suppression may now benefit from an AI, a class of drugs that until now has been recommended only for post-menopausal women.”        June 1, 2014 at the 2014 American Society of Clinical Oncology Annual Meeting and published online on the same day by the New England Journal of Medicine.

Read more about this study by clicking HERE

In essence, if you are diagnosed with estrogen receptor positive (ER+) Breast Cancer at a young age, that is, while still experiencing monthly menstrual cycle, a NEW option of AI plus ovarian suppression can reduce your risk of breast cancer coming back…the “suggestion” is that AI in this setting may be better than Tamoxifen.  Toxicity may be an issue for some patients, so should be taken into consideration. This is definitely worthy discussion with your Medical Oncologist to decide which option is best for you (or individual patient)!

So for pre-menopausal women in the adjuvant setting:

Tamoxifen OR

Ovarian Suppression plus Tamoxifen    OR

Ovarian Suppression plus Exemestane (AI) OR




breast pink



Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

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