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Endocrine Therapy for Surgeons: Practical Pearls for Managing Menopausal, Bone Loss and Sexual Adverse Effects

  • Breast Oncology
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Abstract

Breast cancer patients are living longer than ever before and as such the population of breast cancer survivors continues to grow. Approximately 80% of breast cancers are hormone receptor-positive (HR+) and most patients will receive neoadjuvant or adjuvant estrogen blockade, referred to as endocrine therapy. Although endocrine therapy reduces HR+ breast cancer recurrence by 30–50%, significant adverse effects pose a threat to treatment adherence. These adverse effects include vasomotor symptoms, colloquially referred to as hot flashes, bone loss, joint arthralgias, genitourinary syndrome of menopause (GSM), previously referred to as vaginal atrophy, and low libido. This review will present the evidence-based treatments available for each of these adverse effects, including clear treatment algorithms for GSM, which is often experienced by patients but overlooked by providers. The most important takeaway is to ask open-ended questions, encourage reporting of these symptoms, and refer patients to specialty providers as needed. Surgeons may be the first to encounter these symptoms, therefore it is critical to remain informed of the treatment options.

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This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Dewitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA

    Kristin Rojas MD, FACS, FACOG

  2. Sylvester Comprehensive Cancer Center, MUSIC™ Sexual Health After Cancer Program, Miami, FL, USA

    Kristin Rojas MD, FACS, FACOG

  3. Harvard Medical School, Boston, MA, USA

    Laura M. Spring MD

  4. Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA

    Laura M. Spring MD

  5. Suffolk, UK

    Liz O’Riordan MD, FRCS, PhD

  6. Division of Surgical Oncology, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Anna Weiss MD, FACS

  7. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA

    Anna Weiss MD, FACS

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  1. Kristin Rojas MD, FACS, FACOG
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Correspondence to Anna Weiss MD, FACS.

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There are no disclosures directly related to this work, however there are disclosures outside this work. Kristin Rojas reports the following relationships: consultant for Merck and Roche Diagnostic Solutions; and speaker's honoraria from Pacira Pharmaceuticals. Laura M. Spring declares the following relationships: consultant/advisory board for Novartis, Puma, G1 Therapeutics, Daiichi Pharma, and Astra Zeneca; institutional research support from Phillips, Merck, Genentech, Gilead, and Eli Lilly. Liz O’Riordan is not affiliated with an institution; she is the author of “Under the Knife” and co-author of “The Complete Guide to Breast Cancer: How to Feel Empowered and Take Control”. She is a paid consultant, writer and speaker (liz.oriordan.co.uk). Anna Weiss reports the following relationships: advisory board for Merck and Myriad; and institutional research support from Myriad.

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Rojas, K., Spring, L.M., O’Riordan, L. et al. Endocrine Therapy for Surgeons: Practical Pearls for Managing Menopausal, Bone Loss and Sexual Adverse Effects. Ann Surg Oncol 30, 5951–5961 (2023). https://doi.org/10.1245/s10434-023-13907-4

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