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hi today I'd like to talk to you about
the gynecologic care of women with
breast cancer but before I do that I
just want to review some of the
medications that we use to treat women
with breast cancer there's a whole group
of medications called selective estrogen
receptor modulators or CERN's for short
this is a class of synthetic compounds
that actually interact with the estrogen
receptor and so depending on what tissue
they are interacting with the estrogen
receptor they have different effects
either agonistic or antagonistic and
there's different ones so first let's
review what the structure of estradiol
looks like so 17 beta estradiol looks
like this while clomiphene citrate
another selective estrogen receptor
modulator which is used for infertility
ovulation induction looks like this and
tamoxifen which you've probably heard of
is used to treat breast cancer at least
Estrin receptor positive breast cancer
looks like this so hormones and
selective Estrin receptor modulators
work this way hormones or the
medications the serbs go into the
circulation they diffuse into a cell
through the cytoplasm and into the
nucleus to bind to the estrogen
receptors you either Estrin receptor
alpha or Estrin receptor beta these
receptors then interact with the DNA
within the nucleus and change
transcription that is the making of
messenger RNA or mRNA the mRNA provides
the message at the ribosomes to make
proteins so let's now talk about breast
cancer in the u.s. breast cancer is the
most common non cutaneous malignancy
among women representing four in ten
female cancer survivors in the US long
term survival is common after breast
cancer with the five-year survival rate
being almost 90 percent which is very
good news the most common malignancy
that affects women younger than 45 is
breast cancer so after surviving breast
cancer it's important to know how to
take care of these patients so
patients who have estrogen
receptor-positive tumors will be given
tamoxifen to down-regulate
estrogen within their breast tissue so
again to review selective estrogen
receptor modulators compete with the
estrogen compete for the estrogen
receptor and blocks the growth of
er-positive cancer cells they have mixed
agonist and antagonist capability and
they are most applicable in
premenopausal patients so patients who
are still reproductively capable it is
currently recommended that the treatment
be extended from five now to ten years
tamoxifen though does have risks there
are increased risk of stroke increased
risk of endometrial cancer blood clots
osteopenia which is before osteoporosis
with decreased bone density there's an
increased risk of fractures hot flushes
which is commonly called in layman's
terms hot flashes changes in
menstruation mood changes and increased
triglycerides which can cause long-term
cardiovascular problems there are
another group of drugs that we use and
those are called aromatase inhibitors
and they're more appropriate for the
postmenopausal patient or a woman who
has already gone through menopause so
let's review how aromatase inhibitors
work so strategy gnosis that is the
formation of steroids occurs with
cholesterol going down a very long
pathway that leads to androgens turning
in to estrogens through aromatisse which
is also abbreviated sip 19 a one
aromatase inhibitors inhibit this enzyme
so that there's less estrogen being made
that is ester own or estradiol an
aromatase inhibitors do have symptomatic
symptoms including vaginal dryness
decreased libido decreased libido
essentially means decreased sexual drive
there's increased musculoskeletal pain
and there's also increase in cholesterol
which can have
long-term cardiovascular effects
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