Question Concerning Tamoxifen

After careful consideration I opted out.   I really could not see taking any medication for 5 years.  With all of the possible side effects of Tamox, and me age 49 (pre-menopausal) i really do not know how i would be able to tell the difference between side effects from Tamox and symptoms of peri-menopause.  My chance of re-occurance is relatively low (very small DCIS to begin with).   I have plans to visit a naturopath this summer to check my estrogen balance, and see what can be done naturally to restore balance.  I tried DIM on my own, but got headaches from it after a few days so I stopped.  I am willing to try DIM again if the naturpath recommend it.

If you are looking for some reading material, Dr Lee has a very good book "what your doctor may not tell you about breast cancer"  This book explains hormone imbalance in detail and is critical of Tamox for DCIS.

There is no right or wrong answer.  You need to do what makes sense for you.  If you start tamox you can always stop if you have problems.

My understanding is that you can ask your MO to calculate your risk of a second BC occurrence based on your risk factors, pathology report, age, etc. This can give you a better idea of how effective Tamoxifen might be for you specifically.  I think that the risk to the other breast is decreased by something like 50% when you take Tamoxifen.  This is a substantial decrease when your absolute risk is high (e.g. 30% so Tamoxifen decreases risk to 15%), but you might not think it's worth the side effects if your absolute risk is low (4% so Tamoxifen decreases risk to 2%).  Look up the Van Nuys Prognostic Index (VNPI).  

After careful consideration of the pros and cons, I decided not to take tamoxifen. It's been a bit over 2 years and there has not been a single day that I wished I'd taken that pill. There are a number of threads on this that I and many others have previously written on, you may wish to search to get the information.  I'm mid-40s and not yet even peri-menopausal, and am looking forward to entering menopause naturally. I did undergo a full course of rads, and have never had regrets about doing those.  

Im thinking of opting out too.  just had my lx friday.  Meeting with Naturopath wed.  Get path report wed or thurs this week.  Doing internal rads, but the hormones just dont make sense to me.  Im still weighing my options.  A lot will depend on the path report.  MO said not all dcis warrants hormones.....but we'll see.

Two years ago I had a unilateral NSM with reconstruction following lumpectomy with close margins. I had DCIS, grade 3, ER+/PR+ and strong family hx of cancer (breast & ovarian). I opted not to take tamoxifen after meeting with two MOs at Mayo who thought that taking it would decrease my risk by .5% so it wasn't enough to warrant it.



I also had a total hysterectomy w/ovary removal the same month as the NSM.



It's important to base your decision on facts and sound consultation with your oncologist.

I hear you infobabe!!  My path report will be back thursday - having it faxed to MO....

 keep me posted on your appt!!  Hope it goes well!