tamoxifen

Odd-Ms

do you think a 75 year old woman would still need an estrogen blocker. I dont think my body has made any in years. Im not on it yet but supposed to start.

ChiSandy

As long as you have any fat cells (even if you’re skinny) & adrenal glands you still make estrogen--regardless of whether you have working ovaries (or ovaries at all). The fat cells & adrenals make an androgen called androstenedione (the same stuff that Sammy Sosa & Mark McGwyre “juiced” with during their home run battle). The liver makes an enzyme called aromatase, that converts that androstenedione to estradiol and estrone, which are estrogens. At our age, rather than take Tamoxifen to just block estrogen from getting to the tumor, we need to shut down estrogen production, which is why we are prescribed aromatase inhibitors, which inactivate aromatase and keep it from turning androgens into estrogens. They all have side effects, but for older women they are not only more effective than Tamoxifen but also cause fewer cardiovascular problems and don’t cause endometrial cancer or interact with as many other medications.

BarredOwl

Hi Odd-Ms:

Yes, a post-menopausal woman still produces estrogen as noted by ChiSandy.

In another thread you wrote: "My nodes are clear. So I had a mastectomy 3 months ago, and Doc said no Radiation because of my age and he didnt feel that I needed it. and on my onctest I fell in the lowest number in middle of chart. 18. So the recommendation was Hormone Therapy with or without chemo. I chose without . . ."

Based on that information, I am assuming you were diagnosed with invasive breast cancer, were node-negative (N0), and received the Oncotype test for invasive disease. Your Recurrence Score was 18, the lowest possible score in the standard intermediate range (i.e., 18 to 30). Please advise if my understanding is not correct.

It is critical for you to understand that all recurrence risk information provided in your node-negative (N0) Oncotype report is with 5-years of tamoxifen (at least). Thus, the test "assumes" the patient (regardless of age) will be receiving 5-years of endocrine therapy (e.g., tamoxifen or an aromatase inhibitor ("AI")).

In other words, with a Recurrence Score of 18, if your report says the "10-yr Risk of Distant Recurrence" is X %, that number (X%) is WITH Tamoxifen treatment ("Tam Alone"). Please see the information printed next to the first graph in your report. Request a copy if you do not have one.

If you do NOT receive either tamoxifen or an aromatase inhibitor ("AI"), the 10-yr Risk of Distant Recurrence would be MUCH HIGHER than indicated in the report. (This is a risk of being diagnosed with incurable metastatic disease in the first 10 years.)

A person who is post-menopausal ordinarily has the option of tamoxifen or one of the aromatase inhibitors. However, tamoxifen and the aromatase inhibitors have different side effect profiles. Thus, the choice between these options is informed by factors such as medical history and any co-morbidities may be potentially relevant to the side effect profiles of the specific drugs. For your information, you may wish to inquire about the basis for the selection of tamoxifen in your particular case.

Again, the 10-yr Distant Recurrence risk information in your report is based on the assumption that you will be receiving 5-years of tamoxifen or other suitable endocrine therapy. Please discuss this specific point with your Medical Oncologist before declining the recommended treatment with tamoxifen or an AI.

BarredOwl

sas-schatzi

Hi, folks thought some may want to come and join the discussion. The mods did take action and change the title of the Attitude main board study (same study as April's link). The BCO medical Advisor is going to post a statement. The Mods have posted what that statement will look like. You can find it in their response.

We have a dialogue going.

I think the importance of this is that we can have an impact on discrediting this article not just here, but in the "domain"(world). This very irresponsible study, is out in the world now. It will be quoted forever by docs, church members, nurses, family, and friends. It's being used in all manner of publications going out to the public. It will be cited in many teaching pages and incorporated into other studies. It will be causing trouble for years.

If you think it's an exaggeration. Think margarine. It was promulgated as a better alternative to butter by the American Heart Association in the 1970's. Then the problem of trans-fatty acids was identified. It was known in the research/ medical community to be a problem for years before it was corrected to the public. The research in the 70's wasn't solid, yet caused decades of problems. There are many more that I could cite, but don't want to belabor the point.

So, join us Not sure how we will change the "domain", but it's a work in progress

https://community.breastcancer.org/forum/73/topics/847566?page=1

BarredOwl

Hi Odd-Ms:

In case you might be confused about that last post from sas-schatzi, please note that it does not have anything to do with your specific question, and does not contradict the advice you received above. It concerns a matter of potentially general interest to the community at large.

BarredOwl