Understanding Aromatase Inhibitors in Breast Cancer Management

Breast carcinoma is one of the most prevailing diseases in the world. Globally, 2.3 million women are diagnosed with breast cancer annually. Breast cancer occurs when abnormal growth of the breast cells forms multiple tumours. The conventional methods of treatment for breast cancer include chemotherapy, surgery or radiation therapy. Not only did these treatments have more side effects, but the chances of recurrence of breast cancer were also high. The development in medical science has led to the establishment of various novel treatments, one of which is the use of Aromatase Inhibitors. This article will help you in giving a detailed overview of the role of aromatase inhibitors in breast cancer therapy.

Types of Breast Cancer

Breast cancer is categorised based on the region in which it forms the lump, how it grows and its characteristics. The most common types are:

1. Invasive Ductal Carcinoma (IDC):  It is the most prevalent type of breast cancer. It occurs when the abnormal cells lining the milk ducts invade breast tissue beyond the duct. 

2. Ductal carcinoma in situ (DCIS): Unlike IDC, Ductal carcinoma is a noninvasive type of breast cancer. The cancerous cells line the milk ducts of the breast. DCIS does not spread to other places and stays in its place (in situ).

3. Invasive Lobular Carcinoma (ILC): This type of cancer affects the milk-producing lobules or glands and can spread to other tissues. These malignant cells may spread to the lymph nodes and other areas of the body.

What are Aromatase Inhibitors?

Estrogen is a hormone known to cause the growth of breast cancer cells. This is where aromatase inhibitors come in as knights in shining armour. Statistics show that aromatase inhibitors decrease the risk of breast cancer by 50%. They reduce the production of estrogen in the body, resulting in the prevention or cessation of the growth of estrogen receptor-positive breast cancer cells. Generally used aromatase inhibitors are Arimidex (Anastrozole), Letrozole, and Exemestane.

Benefits of Aromatase Inhibitors

1. Improved life expectancy: Studies suggest that intake of aromatase inhibitors can increase the survival rates of women with estrogen receptor-positive breast cancer cells. They show efficacy in both early and advanced stages.

2. Effective endocrine therapy: Having proven highly efficacious in post-menopausal women suffering from estrogen receptor-positive breast cancer, they are often prescribed to patients after surgery, chemotherapy, etc, to avoid the recurrence of cancer.

3. Alleviated risk of side effects: Aromatase inhibitors generally have a lesser risk of side effects than other hormonal or endocrine therapies like tamoxifen. Hence, they are used more widely for long-term treatment.

4. Targeted delivery: Aromatase Inhibitors work by obstructing the aromatase enzyme responsible for estrogen production. This targeted approach does not affect other hormones, leading to fewer side effects compared to other hormonal therapies.

5. Better tolerability: Other medications like tamoxifen are prone to have side effects like vaginal bleeding, endometrial cancer and blood clots. Aromatase inhibitors have a lower risk of these side effects, which is very beneficial in older patients, especially those with other risk factors for blood clots.

Risk Factors of Breast Cancer

1. Hormones: An extended period of exposure to estrogen due to early menstruation or delayed menopause, endocrine replacement therapy with estrogen, and progesterone can elevate the risk of breast carcinoma.

2. Lifestyle: Consumption of alcohol or smoking can put an individual at high risk of cancer. Stoutness and lack of physical activity may also be contributing factors to this condition.

3. Reproductive factors: Late pregnancy or no pregnancy and no breastfeeding can increase the risk of breast cancer.

4. Genetics: Individuals with immediate family members who are affected by breast cancer have a high chance of getting breast cancer. Inherited mutations in genes such as BRCA1 and BRCA2 significantly increase the risk of breast cancer.

5. Exposure to radiation: Women who were previously exposed to radiation due to medical imaging like X-rays, CT scans or radiation therapy for other cancers are at a higher risk of developing breast cancer.

A Few Commonly Asked Questions

Q.1) Are there any side effects of Arimidex 1mg tablets?

Yes, any medication we use will have certain side effects. The common side effects are rashes, joint pain, etc. Although these appear to be troublesome, they are manageable. If any other severe side effect occurs, it is always advisable to consult your doctor. 

Q.2) Can pre-menopausal women use aromatase inhibitors?

The primary use of aromatase inhibitors is in the post-menopausal period. Women produce a high amount of estrogen in the pre-menopausal phase, resulting in suppression of the effect of aromatase inhibitors. However, they may be used simultaneously with other ovarian therapies.

Q.3) Which aromatase inhibitor is best for breast cancer?

The selection of the best aromatase inhibitor varies depending on the patient's condition. Some factors that are considered while these medications are prescribed include the subtype of cancer, status of menopause, any other specific medical condition, etc. The three best aromatase inhibitors are Anastrozole (Arimidex 1mg tablet), Letrozole (Femara 2.5mg tablet), and Exemestane (Aromasin 25mg tablet). These are drugs of choice for first-line treatment as they show efficacy with minimum side effects.  

Reality Check!

Myth: A lump in your breast always means you have breast cancer.

Fact: There are two types of tumours - benign and malignant. Not all lumps are cancerous; a few are benign and not harmful. A proper diagnosis and regular clinical checkup from a healthcare provider are always advised.

Myth: If you have a family history of breast cancer, you will definitely get it.

Fact: While having this condition in the family increases your chance of developing breast cancer, it is not mandatory. Most people who have breast cancer do not possess a history of this condition in their family. Your lifestyle and environment play a major role in the development of this carcinoma. 

Myth: Using antiperspirants and deodorants can cause breast cancer.

Fact: There is no scientific evidence that states that using a deodorant or antiperspirant can cause breast cancer.

Myth: Chemotherapy is the only solution for breast cancer.

Fact: Treatment is based on the type and stage of your cancer. Sometimes, hormone therapy and surgery can cure breast cancer. 

Recent Advancements

1. Combination therapies: Combining Aromatase Inhibitors with certain other inhibitors, such as CDK4/6 Inhibitors (e.g., Palbociclib) and mTOR Inhibitors (e.g., Everolimus), has shown promising results in breast cancer therapy. Researchers are also exploring the effect of the combination of Aromatase Inhibitors with PI3K Inhibitors (e.g. Alpelisib), which has already shown favourable results in the treatment of breast cancer.

2. Personalised medicines: These are exclusive to the patient and aid the doctors in determining the best treatment plan for the individual. Genomic and molecular profiling based on the specific mutations or characteristics of the tumours helps identify patients who are most likely to benefit from Aromatase Inhibitors.

Parting Words

In this fight against breast cancer, aromatase inhibitors are the game changers with their estrogen level-lowering mechanism of action and minimal side effects. Knowing the benefits, answering common queries, and busting myths can help patients and healthcare providers make smart choices about breast cancer treatment. People who are suffering from breast cancer should always stay updated on recent breakthroughs in cancer treatment and consult oncologists for expert care.