Bisphosphonates for Early Breast Cancer: This leaflet explains the use of bisphosphonates in early breast cancer to reduce the risk of cancer recurrence. If you have any further questions or concerns, please do not hesitate to speak with a doctor or nurse caring for you.
Leaflet Details
| Title | Bisphosphonates for Early Breast Cancer |
| Department | Breast Clinic |
| Author(s) | Dr. May Teoh |
| Review Date | June 2021 |
| Next Review | June 2023 |
| Download | A5 Booklet PDF |
| Accessibility Options | Click on the Recite Me button to show our accessibility resources |
Patient Information
Introduction
This leaflet explains the use of bisphosphonates in early breast cancer to reduce the risk of cancer recurrence.
If you have any further questions or concerns, please do not hesitate to speak with a doctor or nurse caring for you.
What are bisphosphonates?
Bisphosphonates are a group of medications that are used to treat thin bones (osteoporosis). Bisphosphonates control the cells that break down bone (osteoclasts) and allow the cells that rebuild bone (osteoblasts) to work better. As a result, they increase bone density and strength, and therefore reduce the risk of fractures.
Why are bisphosphonates being used to treat breast cancer?
Clinical trials have also shown that bisphosphonates can reduce the risk of breast cancer coming back in patient’s bones and often meant that patients lived longer. The greatest benefits were seen in:
- Post-menopausal women
- Pre-menopausal women who were treated with drugs to suppress their ovaries
In these groups of women, 1 in 3 recurrences of breast cancer in the bone and 1 in 6 deaths from breast cancer at 10 years after diagnosis had been prevented.
How do I take bisphosphonates?
Bisphosphonates will either be administered through a drip into a vein using a drug called Zoledronic Acid (Zometa®) or as a daily tablet called Ibandronic Acid.
Zoledronic Acid (Zometa®)
Zoledronic acid is given by a drip (infusion) into the vein through a fine tube called a cannula. It is usually given as an outpatient at the hospital. The infusion takes at least 15 minutes and is given every 6 months for 3 years.
Ibandronic Acid tablets
Ibandronic Acid is given as a tablet, which should be taken once a day, for a total of 3 years.
The following instructions must be followed in order for the drugs to be effective:
- They must be taken at least 30 minutes before the first food or drink of the day (other than plain tap water).
- The tablet must be swallowed whole and taken with a glass of plain tap water (not less than 200ml or 7fl oz).
- You must stay upright (sitting, standing or walking) for at least 60 minutes after taking the tablet to help it ‘go down’ properly.
- It is recommended that it is taken at the same time each day. If you forget to take it on one day, DO NOT double up to make up for a forgotten dose.
What are the side effects?
The side effects of bisphosphonates depend on whether they are being given as a drip or as a tablet. Most people will not experience side effects and if they do, they are usually short lived.
Zoledronic Acid (Zometa®)
- Flu-like symptoms such as fever, aching muscles or headache - this can happen during the first dose but usually resolves after the first couple of days and is less likely to occur with subsequent treatments. Mild painkillers such as paracetamol and ibuprofen can be taken if required.
- Drop in calcium levels - very rare and usually temporary. You are unlikely to experience any symptoms. If the calcium levels drop very low, you may experience a tingling sensation in your lips or tongue. Your doctor will carry out blood tests to monitor the level of your calcium in your blood.
- Effect on kidneys - this does not usually cause any symptoms and the effects are generally mild. Your doctor will check how well your kidneys are working during your treatment by doing blood tests.
- Red or sore eyes - your doctor can prescribe eye drops to ease this.
- Anaemia - this is rare. Symptoms of anaemia include feeling very tired and breathless. Your doctor can check whether you’re anaemic by doing a blood test.
- Headache - this is rare. It is important to drink plenty of fluids and let your doctor know so they can advise you on what medicines to take.
- Feeling sick (nausea) and being sick (vomiting) - if this happens your doctor can prescribe anti-sickness drugs to prevent or reduce the sickness.
Ibandronic Acid
** Can potentially cause all the side effects as above, and the following:
- Indigestion and heartburn - this may be a sign that the drug is irritating your gullet. If you find swallowing painful or difficult, of if you have heartburn that is new or getting worse, stop taking ibandronic acid tablets and let your doctor know as soon as possible. If you’ve had stomach problems before, ibandronic acid can make them worse. Your doctor will monitor you closely if you’ve had problems with your stomach in the past. Your doctor may also recommend another medication to help with indigestion and heartburn symptoms.
- Abdominal (tummy) pain - if you experience this, let your doctor know if it is severe or if it continues.
Both treatments
A rare side effect of bisphosphonates is a condition called osteonecrosis of the jaw. This is when healthy bone tissue in the jaw becomes damaged and dies. Gum disease, problems with your dentures and some dental treatments (such as having a tooth removed) can increase the risk of this. So before you start taking the drug you’ll be advised to have a full dental check-up.
During treatment with bisphosphonates, it is very important to look after your teeth by brushing them regularly and having routine dental check-ups. Always let your dentist know that you’re taking bisphosphonates. Some of the symptoms of osteonecrosis can include pain, swelling, redness of the gums, loose teeth or a feeling of numbness or heaviness in your jaw. Tell your cancer specialist and dentist straightaway if you have any of these symptoms.
Do I need to take extra calcium or vitamin D?
You may require extra calcium and/or vitamin D supplements while you are having bisphosphonate treatment. For vitamin D, you should take an over the counter supplement at a dose of 800 – 1000 IU daily. You may also require a calcium supplement (1200mg daily) especially if you do not have adequate intake of calcium in your diet. Your specialist will advise you on what supplements you should be taking.
Where can I find further information?
Further information can be found on the following link:
Acknowledgement to Sheffield Teaching Hospitals NHS Foundation Trust, Guys & St Thomas’s NHS Foundation Trust and Macmillan Cancer Support for the content of this leaflet.
