Joanne Mortimer, MD: Hot Flashes and Breast Cancer
Joanne Mortimer, MD discusses hot flashes, hormones and breast cancer at ASCO 2011. Dr. Mortimer is the Administrative Director of Phase I Programs; Vice Chair, Medical Oncology & Therapeutics Research; Associate Director for Affiliate Programs; Professor of Medical Oncology, City of Hope, Duarte, California.
The Group Room at the 2011 American Association For Cancer Research Annual Meeting was made possible, in part, by:
VIDEO TRANSCRIPT:
Selma R. Schimmel, Founder & CEO, Vital Options International:
This is Selma Schimmel at ASCO in Chicago, 2011. And we’re continuing our discussion, this time about breast cancer with a Group Room regular and favorite- Dr. Joanne Mortimer; Vice Chair Medical Oncology and Therapeutics Research, Director of the Women’s Cancers Program, Professor of Medical Oncology, the City of Hope National Medical Center, Duarte, California. Hello, Dr. Mortimer.
Joanne Mortimer, MD, Director, Women’s Cancers Program, City of Hope Cancer Center:
How are you, Selma?
Selma R. Schimmel:
So, anyone who has had breast cancer, especially anyone who is taking one of these drugs that will impact your hormonal levels, like estrogen… let’s talk about hot flashes.
Joanne Mortimer, MD:
Yes. So, hot flashes are reported by up to 90 to 95% of women who have been treated for breast cancer. And hot flashes, in the population of breast cancer survivors, can occur because chemotherapy put them into menopause, because they were in menopause and stopped their hormones, or just because of normal aging and they’re taking- and they become naturally menopausal and have hot flashes, or the drugs that we give them, tamoxifen and aromatase inhibitors all do cause hot flashes. But the interesting thing is that there does seem to be an association between hot flashes and the benefits of therapy. And a number of presentations here at this meeting support the fact that women who get hot flashes seem to do better than women who don’t experience hot flashes. But at the same time, studies show that women who get hot flashes are more likely to stop the hormone. So, one of the take home messages is that the people who are most likely benefiting from these hormones are also the folks most likely to stop them.
Selma R. Schimmel:
So, I have a question- the woman who doesn’t have breast cancer history or isn’t dealing with active disease goes through menopause naturally, some women have hot flashes and sweat a lot, some women may just get a minor menopause type symptom; so, what does that mean for the average woman who doesn’t have severe hot flashes versus the one that does? Is their health in question?
Joanne Mortimer, MD:
In the breast cancer population, you didn’t have to be really miserable with hot flashes and sweats to benefit from hot flashes; any degree of hot flash seemed to be beneficial. But there really is something that the body is telling us when you have hot flashes. Like women who have hot flashes seem to be more likely to have bone loss, to get osteoporosis. So the hot flash really is a marker of some low estrogen level in the body.
Selma R. Schimmel:
I know what a hot flash is, I’ve had one. But can you tell us, what is a hot flash?
Joanne Mortimer, MD:
Classically what happens with hot flashes is that there is this sudden rush of incredible warmth that may last for, on average it’s like 90-seconds, but it may be 3, 4-minutes for some women and it’s followed by a feeling of chilling, of coldness and often accompanied by perspiration. And what it seems to be due to is, after menopause the body’s ability to regulate heat and cold changes is altered and so that you aren’t able to readjust your internal thermostat over wide ranges of temperature, and so you get these hot flashes.
Selma R. Schimmel:
And so, for the men that are viewing this with the women they love, we are asking them to cut us a little slack.
Joanne Mortimer, MD:
Yes, that’s absolutely true. I think the variability in hot flashes is huge. Some people, it’s just a little discomfort, other people go out and buy scarves to cover their heads because they are constantly pouring sweat down. So it is an incredibly embarrassing and humiliating event.
Selma R. Schimmel:
What is it about 4 o’clock in the morning, we all- it’s when it starts. It’s like clockwork. What is that?
Joanne Mortimer, MD:
It is a very interesting thing. Nobody really understands why that happens, because it’s not even clear whether women have night sweats after a hot flash or if the night sweats wakes them up and so it’s independent of the hot flash, but it is a fascinating thing that there are millions literally, and probably billions of women really worldwide that are awakened between 2-4 o’clock in the morning with a hot flash. Those receptors in the brain that help with sleep and with mood, with libido and with thermal regulation are actually all related to serotonin. And so, presumably, there is a mechanism that has some commonality but we don’t really understand that just yet.
Selma R. Schimmel:
So, if it is related to serotonin, would – and I knew there was some work going on early about whether or not antidepressants that readjust serotonin levels could make a difference.
Joanne Mortimer, MD:
All these antidepressant drugs that actually raise the serotonin level in your brain actually do work in women who have hot flashes, whether it’s because they’re taking a hormone pill for breast cancer, or went into menopause because of chemotherapy, or just natural menopause, all of them have been shown to benefit. Not everybody, but with about a third of women get better because of them.
Selma R. Schimmel:
So that is something for a viewer who is unable to take any hormonal support but would like to find something to maybe help, they could speak to their doctor about the possibility of using an antidepressant, not necessarily for depression, but for this maintenance of their symptoms?
Joanne Mortimer, MD:
You know, there is no question that these drugs do improve the quality of life and unfortunately there is such a stigma attached with being on an antidepressant, but they work differently when you have a hot flash. For these drugs to affect your depression you have to be on them for 3 or 4 weeks. Most women, if they’re going to work for hot flashes, they work within about 7 to 10 days, you start to feel better and, most importantly you sleep better.
Selma R. Schimmel:
Is the dosing different than it would be for depression?
Joanne Mortimer, MD:
So, we normally start with a very low dose, as you do with depression and then work your way up if they did not provide relief.
Selma R. Schimmel:
Thank you, Dr. Mortimer. We will next meet in San Antonio. Dr. Joanne Mortimer; Vice Chair Medical Oncology and Therapeutics Research, Director of the Women’s Cancers Program, Professor of Medical Oncology, the City of Hope National Medical Center, Duarte, California.
Joanne Mortimer, MD:
Thank you.
Selma R. Schimmel:
You’re welcome.
END OF VIDEO