Hormonal therapy before surgery for older women who are ER+/PR+

Yes, I had three months' Femara hormone therapy before my surgery. This was due to having a couple of other health problems which I chose to have investigated first. When the ultrasound was done to put in the wires for surgery the RO had a bit of trouble finding the tumour as it was far less clear than on the original picture, so reckon Femara must have done some good work. All the best and hope this helps.

Dear Shirl -

My surgeon offered me the option of a trial on Femara to see if we could clear my known malignant node and possibly avoid full axillary lymph node dissection, with its attendant risks of lymphedema. I also had a very high Ki-67 (proliferation rate) and we hoped to see that fall.

I started letrozole (Femara) in mid-October. We re-biopsied the tumor in late November. The Ki-67 had dropped like a rock (we were shooting to bring it down to 10% or less and we hit 4%). The tumor itself had shrunk by about 50% and the node was looking much closer to normal.

At that time a marker was placed in the node (the tumor already had one) so that we could be sure to remove the correct node at surgery.

I had another ultrasound earlier this month. The tumor is now about 50% smaller than in November and the node looks normal by clinical indicators. No other sites were found in either breast or axilla. My surgeon says my exam is clinically normal.

We will probably do surgery in April, to allow for a full 6 months on Femara, although she has had patients go longer if the timing was a problem for them. My oncologist and surgeon both say that it's very possible that there will be no cancer found in the node. In that case, unless something completely unforeseen crops up, I won't have to do chemo and we may be able to shorten the course of radiation, too.

I am not in the formal trial group as I didn't want to risk getting randomized to the wrong arm but there is a large trial of this approach underway in the US (and it's about time!). I know that it's been used in the UK and Europe for quite some time with solid results.

I have not had any problems with Femara but was told we could try another Aromatase Inhibitor if Femara did cause too many side effects - the big issue was not which drug but how was my body responding to AIs.

For me this has been an amazingly effective treatment and I have not suffered. I know some women have side effects. Some of those pass off after a couple of months. Some are avoided and/or relieved by exercise. Compared to recovery from a mastectomy or the misery of chemo this has been very, very easy. Frankly, it almost couldn't be easier.

The additional benefit is that I know whether AIs work for my tumor or not. Most women don't have that information.

I am most grateful to have had the opportunity to try this approach. I would encourage you to give it serious consideration. If you have any questions I can answer, I would be very happy to do so.

I apologize for the length of this post. I hope it will help compensate for the dearth of information on the web about this.

Whatever you decide, best wishes for your recovery.

The technical term is endocrine therapy. You'll also see it referred to as AIs - Aromatase Inhibitors. I hope that helps. Cancer has an entire language of it's own that you'll pick up quickly.

Kay, thanks for sharing your friends' experiences. It's really good to hear of others who are doing well. I feel as though, at least in the US, we are a small, but hopefully growing, club. Please pass on my well-wishes to them if you talk with them.

I think certain factors are still being looked at in the UK - as well as the tumour I had an axial node which showed abnormalities on original biopsy (suggestive of Hodgkins). This held up surgery and although the Onc said she thought it unlikely to be so, it was decided to take the node out during the bc surgery and it proved to be non cancerous on path although I have never discovered just what was wrong with it. Fortunately I refused axial clearance on quality of life grounds,and US a few weeks post surgery showed no problem there so it seems Femara did have an effect on both the bc and the node.

It is very difficult for any of us in the UK to get any information at all. The health service works well enough but one never sees the same person twice and patients are never given any information without asking and this is very difficult for bc sufferers who have no idea just what is what - and yet are asked to decide whether they want rads or not and told it is their decision whether they take hormonal therapy or not. Fortunately I worked in health for many years and am fairly switched on but I fear that most women here are incredibly ignorant about bc.

Without this wonderful website I would never have had any idea what to ask and what was relevant - so consider yourselves lucky to have the healthcare you have - although I do sometimes get the impression that the wallet is leading the endless examinations/consultations you have!

Ever onwards! All the very best to you all.

Hi Gemma from London. I grew up in England (North London)  and came over here many years ago.  I am aware of all of the pitfalls of the NHS but at least they are doing research which is far ahead of us.  I hope and pray that our health system does not go to that level because, to be quite honest, I am on Medicare and it's great.  I am extremely impressed by my doctors so far with the BC issue,. I know I would not have that in England right now. Their communication is incredible. They lead me to where I am now with investigating the endocrine therapy before surgery.  Hopeful -- I have been tested for Vit. D levels before dx and they were fine but I supplement with 4000 units daily. I might up that now.   And yes, I intend to have a good weekend.  Going out with friends (widowed twice to two great men) but have built a new life for myself and I sure don't intend this dx to stop any of that.  I am positive.  I have survived much crap in my life and to repeat, this dx is not going to get me. 

Forget the Northeast and this winter. Worst I've experienced.  Another storm coming Sunday. And it's so so cold out.

So enjoy your spring Hopeful.  We can't wait here in NJ. Counting the days.  Ladies, thanks for all of your input. It's much appreciated.  Keep on posting on this great site. We are blessed to have this. Enjoy your weekend.  Shirl