Need info/thoughts on Tamox vs Oophorectomy vs Shot + AI

Artista928 · January 2016

I have 2 more Taxotere chemos and radiation to go so I have time to figure out what route to take with this being ER+ deal. I'm 51, 52 end of Sept. My mom went into menopause at 52. Apparently they go by your menstrual status when you started chemo when deciding Tamox or AI. So I thought it's a no brainer, Tamox since they want you to be having no periods for a year before they put you in the menopause status. But yesterday seeing my MO she presented me with 3 options. I have to decide?? Thus far the only thing I've had to decide was the bmx with tissue expanders. This other stuff is over my head so how do you decide??

I'm 95% ER and 50% PR, HER2 neg. My tumor was 7 cm. Ki67 is 50. I have a small lung nodule which may or may not be mets. If it disappears after I'm done with chemo, I could be stage IV. No way to test it cuz it's so small so the best I could be in certainty is a could as it could have been something else. I'll know the CT scan result in March after chemo and before 6 weeks of rads next on tap.

1) Tamoxifen for 10 years.

2) Oophorectomy- Need more info on this please. Not sure if the sx would make a big difference at my age since I am closing in on menopause. I thought this would save me from popping pills but I found out in another thread that it's not the case. So what's the point at my age? Just that it decreases estrogen production while I have it even more? Is there a time when you never produce estrogen or do you in some small amounts until you die? Does insurance even pay for this or is it elective since you can just do the pills?

3) Some sort of shot + AI - I hadn't heard of this until yesterday. I guess this came out last year so it's relatively still new. I assume you administer the shot yourself or can you have your doc do it? I hate shots, needles really so I assume this would be monthly for 10 years as well. I have a port but shots aren't administered in it I'm guessing?

How on earth do you figure this stuff out? Thanks much in advance!

Goodie16 · January 2016

The shot your doc is talking about is Lupron. It shuts your ovaries down, effectively placing you in menopause and thus allowing you to take an AI.

I am starting with the Lupron injections on Wednesday. I haven't been able to tolerate Tamoxifen very well and I'm not ready for another surgery, so I've opted for the Lupron injections. I'll get them once a month, at my onc's office. After a month on Lupron, I'll start on an AI.

I'm also 51 and figured that the ooph was a bit un-needed, as I would be gong into menopause soon anyhow. I'll do the Lupron injections until that time. You will produce estrogen for the rest of your life. While the majority is produced in the ovaries, it's also produced in the brain and in your fat cells. That's why the AIs are necessary even after an ooph.

Hope that's helpful!

Artista928 · January 2016

Oh thank you so much! I like how we are the same age. Really helps. Please let me know how the Lupron shot goes. I think I read somewhere there's one shot in which it really hurts and some have stopped because of how it's administered. Do you do it yourself or go in to an office? Please let me know how it's done. I have a port but I doubt they can put it there. Don't know.

Best wishes and please keep me posted here on this new journey for you. Really appreciate it as I'm in the exact same boat and with our ages too! xoxo

Goodie16 · January 2016

I have to go to the office for the Lupron shot. I don't have a port, but my onc told me that it's administered intramuscular, so I doubt you can have it thru your port.

I'm glad I could help. I'll let you know how the injections are for me.

LM070917 · January 2016

Hi Arista928, I have similar stats to you and face a similar dilemma. I've read that people who take tamoxifen alone, have a 1 in 3 chance of getting recurrance, whereas AL and ovarian suppressor is superior and gives a 1 in 6 chance of getting a recurrance, so for me it's a no brainer, the latter is what I've decided to go with particularly as I am 34. These stats are based on the SOFT trial conducted in 2014.

Artista928 · January 2016

Thank you ladies. Appreciate it!

vlnrph · January 2016

What I chose, being also around the age you describe when diagnosed, was to do the least invasive option: tamoxifen. Then, once menopause is confirmed by blood test of hormone levels, switch to an aromatase inhibitor.

Another approach would be to try the injection & AI first. You can always stop if problems arise and reassess the situation. By that time, you may decide that oopherectomy, typically an "easy" outpatient type surgery, is the way to go. You would still take an anti-estrogen therapy (they work by different methods - either blocking receptors on cells or stopping the enzyme that converts other molecules to our favorite female factor!)

For lottemarine, being so young, have you been referred to a genetic counselor?

teresablue · January 2016

I have read about Oophorectomy on the web it is a surgical procedure to remove both of the ovaries, to avoid the ovarian cancer. I am glad that I got to know more about Oophorectomy and Tamox through this thread, as these will really help other women to stay alert aware if such symptoms arise they can consult with their doctor immediately.

LM070917 · January 2016

Hey vlnrph, yeah I've been referred to a genetics councillor, but apparently in Australia it can take a quite (up to a year) to get seen and carry out. I have no one in my immediate family with cancer, but in my extended two ladies who are closely related had Bc, which is interesting, so may have potentially been passed down my fathers line and of course, he wouldn't necessarily know if he had the gene. Hoping for an appointment in the next few months 😀

ElaineTherese · January 2016

Hi!

I'm doing the shots + the AI, though I'm doing Zoladex not Lupron. I started last February and will continue to get monthly shots until I'm 50 (I'm 48 right now). Then, my OB/GYN will check to see whether I'm post-menopausal. If I am, I will stop getting the shots but continue for another eight years on Aromasin. Yes, ovulation suppression + AI is increasingly recommended because of the SOFT study results, which showed greater survival rates for OS+AI than for Tamoxifen alone. I could have my ovaries removed (my OB/GYN left it up to me), but OB/GYN said that women who keep their ovaries tend to live longer than women who have them removed (they're not sure why). So, I decided to go with OS+AI. By the way, my AI is Aromasin, and it hasn't had many side effects (hot flashes, moodiness that disappeared with Celexa) for me. Good luck!

knittingPT · February 2016

I had the oophorectomy so I wouldn't have to go to the doc so often and so there would be absolutely no risk of pregnancy (I was 39 at diagnosis so a slightly different situation than yours). It was a very easy outpatient procedure and I was back to full speed with about a week. I also decided to do it early since my out of pocket maximum had been met for the year.

jdot · March 2016

This is all very helpful input, everyone. I'm 49, and after 4 1/2 months thinking I'm in menopause, my period starts again. I'm leery of Tamoxifen and it's good to know there are other options. Right now I'm getting through radiation and won't meet with my oncologist for another 4 weeks.

Need info/thoughts on Tamox vs Oophorectomy vs Shot + AI

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