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    • Home
    • Types
      • Ductal carcinoma in situ
      • Lobular carcinoma in situ
      • Early breast cancer
      • Paget's disease of the nipple
      • Inflammatory breast cancer
      • Locally advanced breast cancer
      • Metastatic breast cancer
    • Statistics
    • Risk factors
    • Symptoms
      • Ductal carcinoma in situ
      • Lobular carcinoma in situ
      • Early breast cancer
      • Paget’s disease of the nipple
      • Inflammatory breast cancer
      • Locally advanced breast cancer
      • Metastatic breast cancer
    • Awareness
      • iPrevent
    • Diagnosis
      • Tests
        • Triple test
      • Stages of breast cancer
      • Receiving a diagnosis
      • Diagnosis of early breast cancer
        • What the pathology report means
      • Diagnosis of ductal carcinoma in situ
        • What the DCIS pathology report means
      • Diagnosis when breast cancer spreads
      • Questions to ask
    • Treatment
      • Treatment team
        • Members of the team
        • Talking with health professionals
        • Questions to ask
      • Deciding about treatment
        • Travelling
        • Pregnancy
        • Tips for making decisions
        • Questions to ask
        • MammaPrint ® (70 gene signature) test
      • Surgery
        • Breast-conserving surgery
        • Mastectomy
        • Surgery to the armpit (axilla)
        • Surgery for metastatic breast cancer
        • Breast reconstruction
        • Choosing a surgeon
        • Questions to ask
        • Care after surgery
      • Radiotherapy
        • Early breast cancer
        • Metastatic breast cancer
        • Questions to ask
        • Skin care
        • Travelling
      • Chemotherapy
        • How does chemotherapy work?
        • Type of chemotherapy
        • What does chemotherapy involve?
        • Side effects
        • Questions to ask
      • Hormonal therapies
        • Hormone receptors
        • Types of hormonal therapy
        • Side effects
        • Menopause and oestrogen production
        • Deciding about hormonal therapies
        • Questions to ask
      • Targeted therapies
        • HER2 receptors
        • Types of targeted therapy
        • Questions to ask
      • Complementary & alternative therapies
        • Complementary therapies
        • Questions to ask
        • Where to find more information
      • Palliative care
        • What is palliative care?
        • Accessing palliative care
        • Questions to ask
      • Ductal carcinoma in situ
      • Lobular carcinoma in situ
      • Early breast cancer
      • Paget's disease of the nipple
      • Inflammatory breast cancer
      • Locally advanced breast cancer
      • Metastatic breast cancer
      • Follow-up
        • Physical examinations
        • Breast imaging tests
        • Questions to ask
      • Advanced disease
        • When treatment stops
        • Facing the possibility of dying
        • Putting your affairs in order
        • Questions to ask
      • Recurrent and secondary cancer
        • What makes spread more likely
    • Living with
      • Practical aspects of diagnosis
        • Costs of treatment and prostheses
        • Travel schemes
        • Questions to ask
        • Choosing a cancer treatment
      • Physical changes
        • Body image
        • Menopause
        • Fertility
        • Lymphoedema
      • Emotional changes
        • How you might feel
        • Effects on partners
        • Effects on children
        • Effects on family and friends
      • Physical changes – metastatic
        • Pain
        • Symptoms and treatment side effects
      • Emotional changes – metastatic
        • Common feelings
      • Practical aspects - metastatic
        • Work
        • Financial support
        • How to access support at home
        • How to access support outside home
        • Questions to ask
    • Life after
      • Health
        • Fatigue
        • Poor sleep
        • Lymphoedema
        • Menopause
        • Pain
        • Diet
        • Exercise
      • Feelings
        • Finding a new ‘normal’
        • Fear of recurrence
        • Feelings of loss
        • Isolation
        • Anxiety and depression
        • Not sure how you feel?
      • Relationships
        • Partners
        • Children
        • Friends
        • Colleagues
      • Practical issues
        • Returning to work
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      • What happens in a clinical trial?
      • What are the phases of a clinical trial?
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  1. Home
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  3. Hormonal therapies
  4. Deciding about hormonal therapies
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    • Hormone receptors
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    • Questions to ask
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Deciding about hormonal therapies

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  • A|A

When deciding about hormonal therapies it’s important to consider the likely benefits and possible side effects of the different treatments.

Hormonal therapies and early breast cancer

For women with early breast cancer, the long-term benefits and risks of taking tamoxifen are well known. Tamoxifen reduces the risk of breast cancer coming back and improves survival.

Studies have shown that treatment with an aromatase inhibitor reduces the risk of breast cancer coming back more than tamoxifen. However, studies have not been going long enough to say whether aromatase inhibitors improve survival more than tamoxifen. Also, we do not yet know the long-term side effects of aromatase inhibitors.

For post-menopausal women with a higher risk of breast cancer coming back, the short-term benefits of aromatase inhibitors outweigh the risks of side effects (both known and unknown).

For post-menopausal women with a lower risk of breast cancer coming back, it’s possible that long-term side effects of aromatase inhibitors (as yet unknown) outweigh the short-term benefits of treatment compared with tamoxifen.

CYP2D6 test for the effectiveness of tamoxifen

A number of consumers have raised questions about the effectiveness of CYP2D6 genotype testing for women considering tamoxifen as treatment for breast cancer.   

There have been a number of studies looking into the potential role of CYP2D6 genotype testing (a blood test) as a marker for whether an individual will be resistant to treatment with tamoxifen.

Currently, there is not enough evidence to recommend routine testing for the CYP2D6 genotype when making clinical decisions regarding the use of tamoxifen in either pre or post menopausal women.

Cancer Australia recommends consideration of the use of adjuvant hormonal therapy for most women with hormone receptor-positive early breast cancer. Women should make decisions about which hormonal therapy is most suitable for them in consultation with their medical oncologist.

As the biology of breast cancer is becoming better understood, the management of breast cancer is increasingly being tailored according to patient and tumour factors. Cancer Australia will continue to monitor new evidence and provide updated information as appropriate.

Hormonal therapies and metastatic breast cancer

For women who haven’t yet reached menopause and who have hormone receptor-positive breast cancer, treatment usually starts with tamoxifen with or without an ovarian suppression drug.

For women who have reached menopause and who have hormone receptor-positive breast cancer, treatment usually starts with an aromatase inhibitor. If a woman is already taking tamoxifen when her metastatic  breast cancer is diagnosed, it’s recommended that she changes to an aromatase inhibitor.

If a woman’s metastatic breast cancer stops responding to treatment with an aromatase inhibitor, or if she has side effects that are difficult to manage, she may be advised to change to a different type of hormonal therapy.

In general, fulvestrant and progestins are only recommended if other hormonal therapies have stopped controlling the cancer.

 

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updated: 20 October 2020 - 3:32pm
Australian Cancer Trials

Related information

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Treatment and side effects
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The treatment that your doctors recommend will depend on the type of cancer you have, how advanced it is, and other personal factors.

Living with cancer
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A diagnosis of cancer marks the beginning of a journey full of emotional, psychological, physical and practical challenges.

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While looking forward to finishing their cancer treatment and getting on with life, for some people, the end of treatment can also be a confusing or worrying time.

A-Z List of Cancer Types

Information on more than 70 types of cancer

  • Bladder cancer
  • Bowel cancer
  • Brain cancer
  • Breast cancer
  • Breast cancer in men
  • Breast cancer in young women
  • Cervical cancer
  • Children's Cancer
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  • Lung cancer
  • Lymphoma
  • Melanoma of the skin
  • Mesothelioma cancer
  • Myeloma
  • Neuroendocrine tumours
  • Oesophageal cancer
  • Ovarian cancer
  • Pancreatic cancer
  • Prostate cancer
  • Sarcoma
  • Stomach cancer
  • Testicular cancer
  • Thyroid cancer
  • Unknown primary
  • Uterine sarcoma
  • Vaginal cancer
  • Vulval cancer

About Cancer Australia

Cancer Australia was established by the Australian Government in 2006 to benefit all Australians affected by cancer, and their families and carers. Cancer Australia aims to reduce the impact of cancer, address disparities and improve outcomes for people affected by cancer by leading and coordinating national, evidence-based interventions across the continuum of care.

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