Prophylactic oophorectomy vs Zoladex...A cost/insurance issue

dtorrent

(I originally posted this in the surgery section, but think it might be more appropriate here.)

Long story short, 42, ILC < 1cm, lots of LCIS everywhere, BMX 4/8/2015. No reconstruction, healing fantastic, nodes clean, no radiation, Oncotype 11! Just got that number yesterday, thrilled!

So my MO thinks my best therapy is Zoladex + AI. I know Zoladex is frightfully expensive. My insurance does cover it as a specialty drug, I would have to pay all costs of it until I meet my max out of pocket, which is $6600. I have obviously met that this year, so everything till the end of the year is no cost to me.

However, next January I would start afresh, and I can't afford big money for Zoladex every month. Especially given the hope that I won't need any more treatment, and therefore won't come close to meeting max out of pocket.

Am I crazy to think the best option is to try the Zoladex for a few months ("free"), see how I do with side affects, and then talk my doctor into an oophorectomy before the end of the year so it's covered under this year's insurance?

Its nuts that I am thinking about having another surgery to save me money next year...but this $6600 this year has drained my bank account.

peggy_j

I don't know anything about ILC, but are you a candidate for tamoxifen? It's a generic so practically free compared to what you're paying. I can't advise on whether it makes sense to do the surgery (though my surgeon pointed out that will drugs you can always quit. There aren't any do-overs with surgery). I agree w/ your strategy, that if you're going to do it, you may as well work the insurance to your advantage. Too bad you don't have better Rx coverage. ;(

rgiuff

Dtorrent, I agree with Peggy. Tamoxifen has been used for years as the drug of choice for PREMENOPAUSAL women. Just because a recent study showed that suppressing ovaries along with use of an AI, was a few percentage points better than just tamoxifen,  doesn't make tamoxifen alone a bad option. And I would hate to see you go through a drastic surgery that may have life impacting effects, just for monetary reasons when there is another way. I would ask your Oncologist about this, especially since you had an early stage cancer. I had a non aggressive, early cancer and I used tamoxifen alone. I only did 3 years of it, but feel that I'm doing plenty by exercising regularly, not letting myself stress over things anymore, taking vitamin D, and avoiding as many xenoestrogens as I can. I'm 7 years past lumpectomy now.

farmerlucy

I totally get the insurance thing. When my original CT scan showed an incidental finding of a large gall stone I made sure to get my gallbladder removed during that insurance year. I had a prophy ooph a couple weeks ago but I am 54 and was having issues w tamoxifen. I am glad they're gone since my family history is shaky. You might consider an appointment w a gyn onc to get his/her opinion about an ooph just from the stand point of ovarian cancer risk. Even at 54 I am having some big time hot flashes so I can only imagine how tough it could be at your age. Do you know if you'll be on hormonal therapy for 5 years or ten years? If five you very well may be pre-meno when you are done and could have a few years before menopause with working ovaries. Best of luck with your decision.

PS the oopherectomy was a very easy surgery for me.