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Topic: Pre-surgery hormone therapy

Forum: Hormonal Therapy - Before, During, and After —

Hormonal therapy medicines can be used to lower the risk of early-stage hormone-receptor-positive breast cancer from coming back, shrink or slow the growth of advanced-stage or metastatic hormone-receptor-positive breast cancers, and lower the risk of developing breast cancer in certain women who are at high risk. They work by lowering the amount of estrogen in the body or by blocking the effect of estrogen on breast cancer cells.

There are several hormonal therapy medicines, including, tamoxifen (Nolvadex, Soltamox), Arimidex (anastrozole), Aromasin (exemestane), and Femara (letrozole).

Hormonal therapy is usually prescribed for multiple years. Common side effects include hot flashes, joint pain, fatigue, and bone thinning.

Note: This is a safe place to share YOUR experience, not to be influenced or influence others. Please contact your doctor about any questions or concerns you may have if you are currently taking hormonal therapy.

Intro medically reviewed by: Brian Wojciechowski, M.D.
Last review date: November 22, 2020

Posted on: Sep 24, 2020 03:08PM

TXLorelei wrote:

My oncologist has me doing six months of letrozole before a mastectomy and probably radiation. (I already know from the MRI and biopsy thatI have several positive nodes.) I know that taking that little pill is supposed to “starve” the cancer, but somehow I feel like I should be doing more. At first I wanted to do the surgery right away, just to get it over with!

In some weird way, I feel like I should be suffering more. All I have is hot flashes! I do think this is influenced by my memory of Mom’s chemo treatment 25-30 years ago.

Has anyone else played this waiting-for-physical-action game?

Dx 7/7/2020, LCIS/ILC, Right, Grade 1, ER+/PR+, HER2- (FISH) Hormonal Therapy 8/11/2020 Femara (letrozole)
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Sep 24, 2020 04:48PM Beesie wrote:

What's your MO's reasoning for this?

Neoadjuvant (pre-surgery) chemo is often done for those with large tumors, or who are HER2+ or TN or sometimes, node positive. But letrozole before surgery? That's more unusual, although I believe some studies have suggested it shows promise as a treatment regimen instead of neoadjuvant chemo. Is your tumor large?

Why didn't you have surgery right away? I know there have been some delays because of Covid but you were diagnosed in July, and I thought most delays were done by then.



“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Sep 24, 2020 05:16PM LillyIsHere wrote:

Beesie, the breast center i go to has been doing the same, starting patients who qualify on anti-hormone therapy during Convid19 months to postpone the surgery for later on.

I am very curious to know if letrozole has shrinked your tumor TXlorelei. I hope so, that means that letrozole is working for you.

“Within five years, cancer will have been removed from the list of fatal maladies.” That was the optimistic promise to U.S. President William Howard Taft in 1910 when he visited Buffalo’s Gratwick Laboratory, “What’s taking so long?” Dx 7/31/2019, ILC, Left, <1cm, Stage IIA, 2/5 nodes, ER+/PR-, HER2- Surgery 9/19/2019 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic ovary removal; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 11/30/2019 Femara (letrozole)
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Sep 24, 2020 06:12PM - edited Sep 24, 2020 06:14PM by TXLorelei

The MRI showed one large and one small tumor totaling about 5 cm together

According to the MO, this recommendation was discussed with the care center's Tumor Board. She told me that doing this would hopefully eliminate the need for chemo. I expect that I'll have another biopsy in a month or so to see how it's working.

Dx 7/7/2020, LCIS/ILC, Right, Grade 1, ER+/PR+, HER2- (FISH) Hormonal Therapy 8/11/2020 Femara (letrozole)
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Sep 24, 2020 09:02PM LillyIsHere wrote:

TXLorelei, how does MO know if letrozole is working? When are they going to have another MRI to check if the size of the tumor is shrinking? I don't want to scare you but I did have ILC. Before surgery, MRI didn't catch 2 positive lymph nodes and the LCIS in the other breast that were confirmed from biopsy after the DMX. ILC is not easy to be seeing with scans.

“Within five years, cancer will have been removed from the list of fatal maladies.” That was the optimistic promise to U.S. President William Howard Taft in 1910 when he visited Buffalo’s Gratwick Laboratory, “What’s taking so long?” Dx 7/31/2019, ILC, Left, <1cm, Stage IIA, 2/5 nodes, ER+/PR-, HER2- Surgery 9/19/2019 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic ovary removal; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 11/30/2019 Femara (letrozole)
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Sep 24, 2020 09:09PM Cowgirl13 wrote:

TX, I would definitely get a second opinion as soon as you can. Even if he discussed this at a tumor board meeting. When I was looking for a second opinion I was told that it is good to go outside because often the people who comprise the tumor board can tend to have the same outlook. Good luck.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER+/PR+, HER2+ Surgery 6/17/2009 Chemotherapy 8/2/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/22/2010 Arimidex (anastrozole)
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Sep 24, 2020 09:26PM MinusTwo wrote:

Lorelei - If you don't mind my asking, you're in Houston so where are you going?

You have a plethora of medical institutions to choose for a 2nd opinion. Even if you're committed to staying in your area, it might be worth going to the med center &/or one of the research/teaching hospitals for a 2nd opinion. I didn't want to be a number in line at MD Anderson, but you certainly can get a 2nd opinion there. Or Methodist, or Baylor, or St. Luke's or Memorial. I was sure glad I got a 2nd opinion at the Med Center.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Sep 24, 2020 09:31PM OCDAmy wrote:

I had a large tumor and my MO tried to shrink it prior to surgery with AI. It reduced the size but not by much so I still ended up with MX andchemo after surgery but I have read some research that it can be quite effective in shrinking tumors.

Dx 2/2017, IDC, Left, 4cm, Stage IIB, Grade 2, 2/13 nodes, ER+/PR+, HER2- Surgery 11/14/2018 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting, Silicone implant Surgery Lymph node removal; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy Arimidex (anastrozole) Surgery Reconstruction (left): DIEP flap Radiation Therapy Whole-breast
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Sep 24, 2020 11:01PM TXLorelei wrote:

My next MO appointment is in a couple weeks so I’ll find out then how they’ll check my progress.
@MinusTwo - I'm already going to Baylor in the Med Center since I live inside the Loop. I feel like I'm in good hands.

I do know that my sister who is a pharmacist was completely unsurprised when I told her about the treatment plan. (She does drug education at a hospital in a different state.)

I’m just incredibly impatient. I had everything planned in my mind and I guess I still haven’t mentally reset all my expectations.

Dx 7/7/2020, LCIS/ILC, Right, Grade 1, ER+/PR+, HER2- (FISH) Hormonal Therapy 8/11/2020 Femara (letrozole)
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Sep 25, 2020 01:51PM MinusTwo wrote:

Lorelei - Yup - you're in good hands at Baylor. Still, be sure you "click" with the docs you get. It's a long haul and you want someone you feel comfortable with who gives you all the time & information you deserve. If personalities don't match with one of the docs, don't be afraid to go for a 2nd opinion.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Jan 26, 2021 12:06PM hopewhispers2021 wrote:

I am in the same boat. Anastrozole started on 09/03/20 after learning my Oncotype DX recurrence number is 6, so no chemo for me... and the tumor has shrunk. Verified by ultrasound in November. I am scheduled for a MRI on 02/02 then we will discuss surgical options..

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Jan 26, 2021 02:16PM TXLorelei wrote:

I got a new MRI last week that showed the “mass and non mass” area had shrunk a noticeable amount. I got the go ahead to schedule a consultation with the surgeon next week. Hopefully I can soon move on to MX and then radiation.

Dx 7/7/2020, LCIS/ILC, Right, Grade 1, ER+/PR+, HER2- (FISH) Hormonal Therapy 8/11/2020 Femara (letrozole)
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Jan 26, 2021 02:25PM LillyIsHere wrote:

TXLorelei, this is wonderful news. Good luck and let us know how it goes with BS.

“Within five years, cancer will have been removed from the list of fatal maladies.” That was the optimistic promise to U.S. President William Howard Taft in 1910 when he visited Buffalo’s Gratwick Laboratory, “What’s taking so long?” Dx 7/31/2019, ILC, Left, <1cm, Stage IIA, 2/5 nodes, ER+/PR-, HER2- Surgery 9/19/2019 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic ovary removal; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 11/30/2019 Femara (letrozole)
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Jan 26, 2021 02:43PM ctmbsikia wrote:

Good news. Saw the topic header and read since I have not heard of doing hormone therapy pre surgery. And with nodes involved. Wonder if it's just for lobular cases, all cases, what the actual criteria is? There's probably a study around somewhere.

Good luck going forward and thanks for sharing.

Dx 12/14/2017, DCIS/IDC, Left, 4cm, Stage IIB, Grade 2, 1/2 nodes, ER+/PR+, HER2- Dx 1/16/2018, LCIS, Right Surgery 1/30/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 4/10/2018 Whole-breast: Breast Hormonal Therapy 6/25/2018 Arimidex (anastrozole)
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Jan 27, 2021 01:10AM MinusTwo wrote:

Great news Lorelei. Thanks for sharing, Will you do the surgery with Baylor too?

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Jan 27, 2021 06:00PM TXLorelei wrote:

Baylor is in partnership with St. Luke’s so I think that’s where they’ll send me.

My MRI was actually delayed 3 weeks because of the contract dispute between St. Luke’s and my insurance company. At least now they’re back in-network for me.

Thanks everyone

Dx 7/7/2020, LCIS/ILC, Right, Grade 1, ER+/PR+, HER2- (FISH) Hormonal Therapy 8/11/2020 Femara (letrozole)
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Jan 27, 2021 06:38PM YesIamaDragon wrote:

I am late to this discussion, but my breast surgeon told me that the hormone blocking treatment for early stagers pre-surgery was standard in a lot of other countries. I was HER2+ so straight to chemo for me, but I have wondered if more of us triple-positives would have PCR if we got the hormone blockers up front. I didn't start mine till I was done with radiation!

Dx 6/2019, IDC, Right, 2cm, Grade 2, ER+/PR+, HER2+ Hormonal Therapy Arimidex (anastrozole) Radiation Therapy Targeted Therapy Kadcyla (T-DM1, ado-trastuzumab) Surgery Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy Perjeta (pertuzumab) Targeted Therapy Herceptin (trastuzumab)
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Jan 27, 2021 08:19PM - edited Jan 27, 2021 08:26PM by KMom57

Late to the discussion too, but neoadjuvant endocrine therapy was also recommended to me instead of chemo.Two surgeons and one MO concurred. Another thought my nodal involvement was too much. It's been awhile and lots of other decisions since then, so I don't recall all the details, but my research and questions at the time also indicated it was becoming standard treatment for highly ER+ BC in Europe, less so here in the U.S., but that treatment was moving that direction in the US too. One surgeon at an NCI cancer center told me she'd had a couple of patients who got PCR, and others who were able to have BCS instead of mastectomy. Her hope was it would save the nodes in mine. It did not, unfortunately. The MO reasoning for doing it was to make sure my cancer was responsive to letrozole as you lose that opportunity if you have already done surgery.I did have clinical improvement, but not much apparent pathological response. Incidentally, The way they tell if the cancer is responsive is they rebiopsy the Tumor after one month and look to see if the ki-67 drops below 10. Mine dropped to below 1. But I still didn't get PCR or any nodal clearance. I have no idea why. They also reimage after a certain period of time to make sure it is not growing. The science as explained to me made senseto me at the time. I still don't know whether I made the right choice as I still had a lot of cancer in final path.
EDITED to add: Another NCI center recommended neoadjuvant chemo. I ended up doing letrozole before before surgery and chemo after. Had we known how many nodes I had positive (we thought there were onlythree), maybe it would not have been recommended. May never know if it was the right choice.


Dx 10/2019, ILC, Left, 2cm, Stage IIIA, Grade 2, 8/11 nodes, ER+/PR+, HER2- Hormonal Therapy 11/6/2019 Femara (letrozole) Surgery 2/14/2020 Prophylactic ovary removal Surgery 5/17/2020 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 7/30/2020 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy Breast, Lymph nodes, Chest wall Hormonal Therapy Femara (letrozole)

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