ADH and docs saying Tamox, Lupron and Mirena

My advice is that you see an oncologist.  There are obviously a lot of factors that need to be considered in your decision and an oncologist is in a better position than a surgeon or your gyn to look at the whole picture and make a recommendations on what you should do.

I am actually surprised that your surgeon is recommending Tamoxifen because you've had two fibroadenomas.  I've had two fibroadenomas - those of us who get fibroadenomas often get more than one.  Generally fibroadenomas are not thought to increase the risk of getting breast cancer, although complex fibroadenomas may increase risk slightly. Recommending Tamoxifen because of fibroadenomas is very unusual.  From the American Cancer Society: 

• Non-proliferative lesions: These conditions are not associated with overgrowth of breast tissue. They do not seem to affect breast cancer risk, or if they do, it is to a very small extent. They include: ....simple fibroadenoma...
• Proliferative lesions without atypia: These conditions show excessive growth of cells in the ducts or lobules of the breast tissue. They seem to raise a woman's risk of breast cancer slightly (1½ to 2 times normal). They include: .... complex fibroadenoma....
• Source: What are the risk factors for breast cancer?

ADH, on the other hand, does increase your breast cancer risk.  As risk factors go, ADH is in the middle of the pack. If you have other breast cancer risk factors related to your personal or family health history, then ADH will probably bump you into the 'high risk' category.  But on it's own, it's questionable as to whether ADH creates a high enough risk to warrant taking Tamoxifen (which, like any drug, comes with it's own risks, including the risk of endometrial cancer).  Here is what the ACS says about ADH and about taking Tamoxifen for ADH:

• ...a recent study compared breast cancer risk between women with benign breast conditions and those without. The study found that about 5 of 100 women without any benign breast conditions developed breast cancer within the next 15 years. Among women with a benign condition that increases risk 1½ to 2 times, this would mean that about 7 to 10 out of 100 might be expected to develop breast cancer in the next 15 years. Among women with atypical hyperplasia (ductal or lobular), whose risk is 4 to 5 times normal, about 20 to 25 women out of 100 would be expected to develop breast cancer within 15 years. The risk for cancer then declines after 15 years. For women at increased breast cancer risk 
• If you had atypical ductal hyperplasia (ADH) and are 35 or older: ADH by itself may not raise a woman's risk of getting breast cancer to the level where she might consider taking tamoxifen. But women who have had ADH and who also have other risk factors may have a risk that is high enough to consider taking tamoxifen. Talk to your doctor about all of your risk factors and how they affect your risk, so you can make an informed decision about whether or not to take tamoxifen.  Breast cancer risk assessment: Should I consider taking tamoxifen?

So, clearly, this is a complex issue with a lot of considerations, particularly given that you have endometriosis.  An oncologist seems to me to be your best bet to get answers to your questions and to better understand the options to address both your conditions.

As your surgeon said, with ADH, your lifetime risk probably is in the range of 30%. That's consistent with everything that I've read about ADH. If you take Tamoxifen for 5 years, you can reduce your risk, but only for about the next 10 -15 years.  Five years of Tamoxifen has been proven to provide a benefit well beyond 5 years but it won't provide a benefit for the rest of your life; at some point, the benefit wears off.  So if your lifetime risk (usually this is calculated to age 90) is 30%, then as per the ACS quote that I included in my previous post, your risk over the next 15 years is probably around 20%.  Tamoxifen can cut this by up to 50% - 50% is at the high end of the what the studies have shown.  The most comprehensive study on high risk patients who took Tamoxifen, the NSABP P-1 trial, showed a 44% breast cancer risk reduction for those who took Tamoxifen. You can find the results here (quite a bit down the page): http://www.drugs.com/pro/tamoxifen.html  A 44% reduction of a 20% risk level means that you may be able to reduce your risk by approx. 9%.  This would take your lifetime risk down from 30% to 21%.  This is a significant reduction, but you have to weigh it against the risks that you expose yourself to by taking Tamoxifen.  Each of us has our own benefit/risk equation and we all view this differently - some focus on the benefits, some focus on the risks, etc..  Only you can decide what's the right thing for you to do. 

On the topic of Tamoxifen and Lupron, I found this:  http://www.healthcentral.com/breast-cancer/c/78/17224/zoladex-therapy

I was diagnoised with ALH after having several benign biopsies, my risk of getting bc was 40% (family history etc).  I didn't feel comfortable taking Tamoxifen so I had prophylactic masectomies in May - drastic maybe, but no side effects, no more mammos or MRIs, no worry and risk drops to less than 5%.  Just another idea - my surgeon totally supported me.  Good luck to you -

Hugs, Valerie

mvspaulding -

My mother got breast cancer at age 60 (still living), an aunt (older, deceased), cousin (49, died from breast cancer).  When my mom was diagnoised I was 30 and her surgeon said I needed to get a mammogram every year from then on.  I am 49 and have had mammograms now for 19 years, it seemed I was always called back for something suspicious, have had 4 lumps removed, two years had microcalcifications,(biopsy negative), this year the microcalcifications were clustering, excisional biopsy showed ALH (oncologist said that was precancerous) and wanted me to take Tamoxifen for 5 years.  I have know some ladies on it - they hate it so May 6th I had PBM - my surgeon was supportive and I have been happy with the whole process.  I have TEs which will be replaced with implants in a couple of months.  Because of no cancer I had nipple/skin sparing surgery.  Everything came back negative on the tests after surgery, there were several B9 lumps that didn't show up on the mammograms.  Let me know if you have any other questions.

Valerie

mvspaulding - So for my PBM the breast surgeon was there along with the plastic surgeon.  The breast surgeon removes all the breast tissue, shaving it as close to the skin as possible.  Then the plastic surgeon inserts TEs (tissue expanders) behind the muscle (he makes a pocket for them).  Total surgery time about 4 1/2 hours.  After surgery I went in about every 2 weeks to the plastic surgeon for fills - they inject saline into the TEs to slowly stretch the muscle and skin.  When you get to the desired size a second surgery is performed to remove the TEs and then implants (silicone in my case) will be put in the pocket made by the TEs.  I will probably have my exchange in September, but could have had it in August - so start to finish is about 3 months, or longer if you have fills slower etc.  The PBM surgery really wasn't bad, and the exchange surgery is suppossed to be much easier to recover from.

the only side effect that i'm getting from taking tamoxifin is the hot flashes, was taking at night before going to bed, but i kept waking up turning on my fan, and pushing offthe covers.  now i'm taking it when i ge up in the morning-so far not so bad, but of course, i stay indoors (work outside in the heat-110 degrees)so when i go back to work on wednesda, we'll see how i am. only been on it for a year.

hello Tinkerbell49, I had the same thing happen, ADH on sterotatic biopsy but benign and no ADH or cancer on excisional. Did your doc tell you that you are still high risk for developing B C in the future?

I do know 2 women on these threads that chose no tomox did good til 4 to five years than got dcis. I guess its a roll of the dice. Ughh

I asked the same question ,genetics and mo said it didn't make a difference once it shows up your risk is still higher. I had 2 micro focI which are very tiny and still high risk. Seriously considering pmx and no tomox. I Met with ps I really liked him.

Linpiz - here's a link to the ADH Club that tinkerbell mentioned, in case you'd like to join!

Happy posting!

--The Mods