Anyone out there on tamoxifen alone that has talked to their doctor about this study and whether they should begin ovarian suppression and an AI instead ?

I'm coming to this a little late, but have been thinking about this a lot since I'm supposed to start hormone therapy in about a month and am trying to figure out what to do.

My MO has left it up to me, though she lightly leaned more towards tamoxifen w/o ova suppression. I guess we'll
learn more about that when the results of the SOFT/TEXT tamoxifen-only arm come
out. She said that's because I'm stage I (even though I'm HER2+, grade 2, and just finished chemo). She did say that if I were metastatic then it'd be a different conversation, definitely go with suppression + AI's. At the same time, I'm a bit scared of getting a recurrence, those chemo treatments were tough.

So I went directly to the paper (here's the link), and even though the numbers are better for suppression + AI's, here are some things to consider (from Fig 2):

1. AIs + ova supp do better against local recurrences than tamox + ova supp, with absolute rates differing ~4% over 5 years.

2. AIs + ova supp do better against distal recurrences, but then the difference in absolute rates is only ~2% over 5 years

3. Overall survival rates were about the same. 

Now I'm no MO or MD (I am a scientist but I study rocks), but with these rates and side effects of AI's, I'm leaning towards tamoxifen. 

Wondering what others think?

Hi Voracious, thanks for the pun!  I like puns, they have a way of keeping us, um, grounded... (*groan!*)  ;-)

I have to agree that the state of knowledge does keep changing, and all you can do is work with the best available data at the time. 

That said, the message I keep hearing from the SOFT/TEXT trials is that if your goal is not having a recurrence, then OS + AI's are your treatment of choice. This is more important for higher-risk women, but how do you define higher risk? This seems critical since OS+ AI's can come with a lot more side effects, especially for us pre-menopausal gals. If the increase in risk is slim, how much do you want to put your body through?  And even then risk is kind of abstract - you either get a recurrence over a period of time or you don't. No one gets say 10% of a tumor.

But when you go to the article, it's not so simple. You make a fantastic point re. absolute numbers. Relative numbers are bigger and sound much more dramatic. Some reports (e.g. cancer.gov) only reference the relative ones. So for OS+AI's vs. OS+tamoxifen: 

28% relative reduction in any cancer recurrence, 34% reduction in breast cancer recurrence

vs

2% absolute reduction in any cancer and 4% reduction in breast cancer recurrence.

So this tells me that if you put 50 women treated w/OS+tamoxifen in one room, and 50 women with OS+AI's in another room, then after five years about 4 women in the tamoxifen room are likely to have a distal recurrence whereas ~3 women in the AI room are likely to have a distal recurrence. Since you went from 4 to 3, that's a 25% reduction (close to 28%). And 5-6 may have a local recurrence (i.e. breast) with tamoxifen vs. 3-4 for the AI room (about two-thirds, or a 34% reduction). Now of course reality isn't so simple, there are things like nodal status, size of the original tumor, degree of hormone receptivity, HER2 status, other treatments, lifestyle, genetics, environmental factors etc. that will all affect this, but I think that puts it into perspective a little.

My point is that if you didn't look at the original study, you might think you're gaining a lot more w/AI's than you actually are. It's key to consider how high-risk you are. But I also have to admit, it makes me a little bit uncomfortable that the Pfizer was one of the main funding sources for the study - Pfizer makes AI's but tamoxifen is generic. Looking at the peer-reviewed NEJM article, I sincerely believe it was written objectively and the data are good, as far as my layperson eyes can tell. However, as for the presentation to media outlets, I'm not so sure.

After all that, I'll probably start with just tamoxifen, but as you say it's not set in, um, stone. Maybe that will change as the research develops...