How I Learned to Stop Worrying and Love Tamoxifen Part 2

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Last week regular blog contributor Randi Rentz shared the first part of her journey with Tamoxifen, currently used for the treatment of both early and advanced ER+ (estrogen receptor positive) breast cancer in pre- and post-menopausal women. In December, 2012 The Lancet, one of the world’s leading general medical journals in Oncology, Neurology and Infectious Diseases published a report suggesting for women with ER-positive disease, continuing tamoxifen use to 10 years rather than stopping at 5 years produces a further reduction in recurrence and mortality, particularly after year 10¹. Here she continues her story…

Where were we?

Oh, yeah.

If I was a betting woman (I’m not anymore) I’d venture that based on ATLAS (the study published in The Lancet) sales of antidepressants to breast cancer survivors are poised to go through the roof. According to studies, taking tamoxifen can lower the risk of a breast cancer recurrence by up to 50%.  So, many women are more than willing to tolerate its side effects to remain free of their cancer.

But…

Many of these women are also taking antidepressants to help restrain the hot flashes, vaginal dryness, low libido and osteoporosis that the estrogen suppressor can cause.

Don’t get me wrong. This drug does help many and the new study has found that taking tamoxifen longer than five years can further reduce deaths from the disease.  The researchers studied a group of nearly 7,000 women with ER-positive breast cancer. The women were randomly assigned to stick to just five years of tamoxifen or to take it for an additional five years. The study found a significant benefit from remaining on tamoxifen for 10 years:  Women were less likely to have a recurrence of breast cancer, and they were less likely to die of breast cancer than women who took the drug for only five years.

Be aware, however, that after menopause, tamoxifen may increase the risk of uterine cancer.  It also may increase the risk of blood clots in the legs and lungs in all women. My legs are already throbbing thinking about it. So it’s like most treatments:  There are both benefits and risks, and you have to work with your doctor to balance them.

So, what’s my decision? We’ll, I’m 4 ½ years in and have already had a conversation with my oncologist, which is forever changing. At the moment, I’m going to go for 7 years. I’m cautious about laying in a lifetime supply of tamoxifen. I’m open to using different drugs over time, or listening to a new study that could come out reporting different results.  What I really want and need is effective prevention. Until that comes, I’ll work with the drugs that I have for now.

Be sure to check out Randi’s website and read the excerpt from her upcoming novel ‘Why Buy a Wig…When You Can Buy Diamonds!’.

For January’s Ask the Expert , Living Beyond Breast Cancer’s monthly online Q&A forum, Adam Brufsky, MD, PhD, answered questions about ATLAS, a major new study that has shown that tamoxifen treatment for estrogen receptor-positive breast cancer is even more beneficial when taken for 10 years instead of five. These questions were submitted during our January 9, 2013 webinar on News From the San Antonio Breast Cancer Symposium.

¹Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of estrogen-receptor-positive breast cancer: ATLAS, a randomized trial.  Published online December 5, 2012 in the Lancet, First author:  Christina Davies, MBChB, University of Oxford, United Kingdom.

For more of LBBC’s coverage of the ATLAS clinical trial, please visit our Spring 2013 issue of Insight our quarterly newsletter and additional news coverage.

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8 Responses to “How I Learned to Stop Worrying and Love Tamoxifen Part 2”

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  3. Jo Says:

    Randi, I am you. 37. Lumpectomy, chemo, radiation, Tamoxifen. I also had endometriosis, which WAS under control, but went nutso on Tamoxifen. So now I’m facing total hysterectomy, plus bowel resection in about 6 weeks from now.
    I am loathe to continue with Tamoxifen after the hysterectomy, because I (and I assume, like you) can never have HRT. Ever. Not even a little bit. So, theoretically, won’t the double whammy of no female reproductive organs, coupled with the oestrogen-morphing Tamoxifen, technically put me in the negative as far as my estrogen allowance? AND nobody ever mentions the fact that, along with being 3+ ER positive, my cancer was also 3+ PR positive. So what of the progesterone? Why is that not as naughty as estrogen?
    So how are you going now? What do I have to look forward to? Am I going to murder my own relationship because my vagina will be too dry and my eyes too wet with tears for my own pity to care about anything or anyone outside of my own stupid body? Is there any good news? Can you just make some up?

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  8. Nancy Gregory-Riggs Says:

    Does anyone else feel like Tamoxifen has caused significant mental changes, i.e. Memory loss & mood changes? Vaginal discharge is also an ongoing problem. I feel like I’m the only one having these issues.

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