Tamoxifin verses Evista for LCIS

I'm on tamoxifen.  I started it 7-06, so I have 2 more years to go.   I was just officially pronounced postmenopausal.

Krisc:

I am 53 and diagnosed with LCIS and ADH (atypical ductal hyperplasia) and I decided to take the Raloxifene (Evista) because I can only fathom mastectomy for cancer.  For me, a BLM (bilateral

mastectomy) is worse than the disease (of course if the disease is caught early).

 After my diagnosis in September, my Norfolk breast surgeon offered Tamoxifene --mentioned bilateral mastectomy but downplayed that, especially when I almost gasped.   

I sought a second opinion from an oncologist in Chicago ( I've lived in Norfolk Va for only two years).  The Chicago oncologist was "evangelical" about the upsides of Raloxifene for reducing cancer risk for us LCIS gals.  He cited the STAR study and said "if only all women knew about the very significant risk reduction, it would make sense for more women to take this drug."

Since I also  have osteoporosis in the spine and osteopenia in the hip-the Evista has needed bone benefit. Add to this, with menopause at 49, my cholesterol has been creeping up--so again, the Evista makes sense for me to lower cholesterol.  I chose to "ease into the full dose" half a dose for the first month or two, since the abrupt start of Raloxifene set me back to my first horrendous year of menopausal symptoms (hot flashes, insomnia, muscle aches).  I found with the lower dose to start, my hot flashes are only slightly more frequent and sleep is back to normal.  For my body, it seems the absolute level of "estrogen" (hypothalmus) is not as problematic as "abrupt changes". I hope I can stick with 5 years of Raloxifene 

 I'm also going to Weight Watchers since my breast surgeon believes for me, a reduction of adipose (40 lbs worth)-- my estrogen "factory" would probably give me as much protection as the Tamoxifene. 

Other (low) Risk factor facts: menarch age 14; menopause at 49. first child at 32. Next at 38. Third at 41. Breast fed all three, 3 mos; 1 year; 2 years (second year only at night). No miscarriages or abortion.  Breast feeding was incredibly healthy for me--low cholesterol, low blood pressure, happy beyond measure.  But the weight gain seems to have been a risk factor -excess 40 lbs.  

My 83 year old mother is healthy no osteoporosis, no heart disease or high cholesterol; no excess weight -she is in great shape--sharp as a tack. She was a "50's" mom--never breast fed her two children--but had us in her mid 20's.  She had a hysterectomy at 40 (left her an ovary); she then started ERT when she was 50--took it for 20 years!

Dad's side, not so good.  All the women gain significant weight with pregnancy and beyond. Great Grandmother, and grandmother--both breast cancer-died of heart disease.  2 of 5 aunts, breast cancer--one died of it. One of the non-cancer aunts actually participated in the STAR study--took the TAMO--she's now 75 and cancer free. 

Rather than give you isolated information, I gave all (maybe more than you wanted to hear) info, so you could following my reasoning with facts--not just my emotional reaction-which, just like everyone else in this forum--was (is) considerable!

God bless you with your decision. 

I am  60 yrs old with  a dx of LCIS - was on tamoxifne for 18 months then aromasin - and now at the 5 year mark Evistra is the recommendation  - I have the consensus of the Ob/Gyn, Onc and my surgeon who all say that  more time on Aromasin is not recommended and that Evista is the best choice - I amalso on alternating MRI's and dx mammos but that  is supposed to change this year with only getting the  1/yr dx mammo - I am not  happy about that but will discuss that next month when the Onc officially d?c me because "youdo not have bc" - which is true - I have LCIS - any thoughts or comments?

I Ihave had diagnosis of LCIS two times in two years and this last biopsy(1 week ago) also found atypical ductal hyperplasia. I started Evista last year after my first biopsy found LCIS and will continue with this on the reccomendation of my bs, PCP, and gyn. I am post menopausal and have a younger sister who is a breast cancer survivor of IDC. I like the additional bone protection that Evista is supposed to provide. The main se I have had is hot flashes and have recently started taking the supplement pycnogenol which is pine tree bark extract. I do think it has reduced the frequency and severity of the hot flashes especially at night.  I know you posted this last Aug and have probably made the decision that is best for you.

Mary

glo--- I have taken both tamoxifen (5 years) and now evista (over a year) for prevention (I am high risk due to LCIS and family history of bc--mom had ILC); fortunately I tolerate them both well. But evista has only been approved for post menopausal use, as far as I know. If you are premenopausal and tolerating tamoxifen well (sounds like it), why does the doctor want to change meds?  (are you having any uterine issues? a yearly transvaginal US is a good idea while on tamox to monitor the uterine lining and the ovaries). Do you have MRIs? I have alternating MRIs with mammos every 6 months and breast exams on the opposite 6 months. PM me if you'd like to talk.

anne

Anne - Thank you for your response - I am getting the  message that I need to push for continuing MRI's on the alternating schedule -  It also seems Evista is a good drug with minimal SE's  - so thankyou again for your response - Jv

Leaf---good to hear your bone density levels are normal. (my osteopenia is due to the accelerated estrogen depletion from my surgical menopause). But just to let you know Evista is not known to cause any endometrial problems (although it does have the blood clot risk, although less than tamox); since tamox is thought to keep reducing risk up to 10 years after stopping, my taking evista is probably overkill, but all my docs and I agree it's a good idea anyway.  Between the evista, the mammos, the MRIs and the breast exams, I get more peace of mind. Take care. 

anne