Ovarian suppression plus tamoxifen?

auksst

My daughter (age 42) was diagnosed with IDC and DCIS of the left breast in March. She had a double mastectomy with reconstruction. No Chemo, no radiation. Oncotype was 16 and 15 (2 tumors same breast). No lymph nodes involved. Grade 2. Her oncologist put her on tamoxifen (HR/PR+, HER-). The oncologist is talking to her about starting Lupron. But, she is not strongly recommending it. The oncologist wrote : "In summary, your risk of recurrence is relatively low (4% at 9 years per Oncotype). The risk of recurrence continues to go up over time a little bit, so at 15 years, it maybe closer to 7-8% and a bit higher than that at 20 years. Ovarian suppression would likely reduce that risk, but not to a degree that I feel I need to strongly recommend it. So, it's really a shared judgment that we make based on how aggressive you'd like to be." My daughter is trying to make the best decision...there are so many side effects of ovarian suppression including long term effects. Anyone else in this position? How do you decide when the doctor isn't saying a definite yes or no?

ElaineTherese

I'm on year 6 of ovarian suppression + AI (aromatase inhibitor). I'm not sure what you mean by "long term effects." It is the case that OS + AI can produce osteoporosis. (Even that is reversible -- after being on Prolia, my bone density has increased to the point where I'm no longer considered to be suffering from osteoporosis.) But, Tamoxifen doesn't have that impact on bone density. In most cases, the side effects of hormonal therapy end when you stop taking the meds.

auksst

Long term effects are increased risk of diabetes and heart disease. Your heart needs estrogen. These 2 things worry me more than the osteo.

ElaineTherese

Tamoxifen won't decrease the estrogen in your daughter's body but ovulation suppression seeks to eliminate the estrogen produced by her ovaries. If your daughter follows Tamoxifen + OS for five years, she may lose out on some estrogen. But, once she stops, the estrogen will return.

Rah2464

Tamoxifen can have an impact on your bones when you are pre-menopausal. I hope your daughter has had a baseline Dexa scan and a plan in place to maintain her bone health. I developed full blown osteoporosis within two years on the medication so it can happen. As to the ovarian suppression - my understanding is that is not commonly done with Tamoxifen as the action of the drug is different than an AI. I am wondering if the oncologist can share information about studies that would show increased efficacy.