Should I be followed by a gynecologist while on Tamoxifen?

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CeBee
CeBee Member Posts: 7
edited July 2014 in Hormonal Therapy - Before, During, and After

I am wondering if I should be followed by a gynecologist while taking Tamoxifen. My breast surgeon told me that I should be followed by one. My primary care physician didn't agree. When I went in for my 6 month mammogram, I asked my surgeon again and he said yes. At that point I  asked my physician again and she put in a referral for me to be seen....which was denied. I called my surgeon back at the breast clinic, and his nurse said that I don't need to. She said "a doctor" was in the office with her, and he agreed. I am pretty sure it was not my doctor. I am a military dependent, and my surgeon is separating from the Navy, and as far as I know he may already be gone. Very confused, and frustrated.

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  • snorkeler
    snorkeler Member Posts: 145
    edited July 2014

    Are you pre-menopausal or post-menopausal? According to the American Congress of Ob-Gyns (ACOG): 

    Postmenopausal women taking tamoxifen should be closely monitored for symptoms of endometrial hyperplasia or cancer. Premenopausal women treated with tamoxifen have no known increased risk of uterine cancer and require no additional monitoring beyond routine gynecologic care. Unless the patient has been identified to be at high risk of endometrial cancer, routine endometrial surveillance has not proved to be effective in increasing the early detection of endometrial cancer in women using tamoxifen and is not recommended. If atypical endometrial hyperplasia develops, appropriate gynecologic management should be instituted, and the use of tamoxifen should be reassessed.

    Here is the link to the entire committee opinion which was just updated in June 2014:

    http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Tamoxifen-and-Uterine-Cancer

    The opinion also mentions that post-menopausal women can be divided into high risk and low risk groups. I am pre-menopausal, and my primary care physician provides my routine gynecological care. She will refer me to a gynecologist if I have any issues, but I am not regularly followed by a gynecologist. At follow-up appointments with my oncologist, she presses down on my abdomen to feel for my ovaries just like my primary care doctor. I have never had gyno issues, even before breast cancer, so that may also make a difference.

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  • CeBee
    CeBee Member Posts: 7
    edited July 2014

    Thank you! I am premenopausal. I feel better though. It is just difficult when you have 5 different doctors, that work in different clinics, some civilian, and some military. They all have different opinions.

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  • snorkeler
    snorkeler Member Posts: 145
    edited July 2014

    You're very welcome. I also considered going to a gynecologist after I started tamoxifen, but then I did the research and decided that it wouldn't add anything to my care while I'm asymptomatic. I love my PCP and have been going to her for years. She knows me and I have never had a problem getting a referral from her. Now I have multiple doctors and it is frustrating with the different opinions. My surgeon and oncologist are in the same clinic, and even they have different opinions, for example about optimal vitamin D levels. 

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  • Imheretoo
    Imheretoo Member Posts: 217
    edited July 2014

    Also I want to thank snorkeler for posting this answer and thank CeBee for asking the question here so we can all benefit from the info.

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  • CeBee
    CeBee Member Posts: 7
    edited July 2014

    I really wish I could have at least had my surgeon for a year before being turned over to a new doctor. I am going to have to start all over in December when I go in for my mammogram.

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