Artista, it's going to be interesting to see what my docs come up with.

Theway2muxia, I had a complete hysterectomy in 2010 so I don't have that to worry about butI've enjoyed the past 7 years with no hot flashes so I'd like to skip that SE if I could? Think it'll work? If I say pretty please?

Adding this here also, for anyone that may be interested.

Interesting studies I found regarding Tamoxifen efficacy/overall survival related to premeno women & BMI (body mass index). I'm going to do more searching and see if there is anything more current than 2014 on this subject. For now this is what I've found....

See table below -- under Tamoxifen "contraindicated" for BMI > 25 kg/m

My MO never mentioned this, and though I am not obese, I am overweight and this is something I will be asking her about when I see her in 2 weeks.

https://www.michigancancer.org/PDFs/Publications_Products/MCCExclusiveProd/PharmacologicIntervention.pdf

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2018

Third-generation aromatase inhibitors have been widely used in postmenopausal women for the adjuvant treatment of hormone receptor-positive breast cancer. As aromatase inhibitors work by inhibiting the conversion of androgens to estrogens in adipose tissue, we hypothesized that anastrozole may be more effective in women with a high body mass index (BMI). The Arimidex, Tamoxifen Alone or in Combination (ATAC) study was a double-blind randomized clinical trial in which postmenopausal women with early-stage breast cancer were randomly assigned to receive oral daily anastrozole (1 mg) alone, tamoxifen (20 mg) alone, or the combination in a double-blind fashion. Analyses were based on the 100-month median follow-up for women with hormone receptor-positive breast cancers (estrogen [ER] and/or progesterone [PgR] positive). Here, we investigate the impact of BMI on recurrence and the relative benefit of anastrozole versus tamoxifen according to baseline BMI. Results Overall, women with a high BMI (BMI > 35 kg/m(2)) at baseline had more recurrences than those women with a low BMI (BMI < 23 kg/m(2); adjusted hazard ratio [HR], 1.39; 95% CI, 1.06 to 1.82; P(heterogeneity) = .03) and significantly more distant recurrences (adjusted HR, 1.46; 95% CI, 1.07 to 1.61; P(heterogeneity) = .01). Overall, the relative benefit of anastrozole versus tamoxifen was nonsignificantly better in thin women compared to overweight women. These results confirm the poorer prognosis of obese women with early-stage breast cancer. Recurrence rates were lower for anastrozole than tamoxifen for all BMI quintiles. Our results suggest that the relative efficacy of anastrozole compared to tamoxifen is greater in thin postmenopausal women and higher doses or more complete inhibitors might be more effective in overweight women, but this requires independent confirmation.

Effect of body mass index on the efficacy of adjuvant tamoxifen in premenopausal patients

2014

https://www.ncbi.nlm.nih.gov/pubmed/27061527

RESULTS:

In both normal weight and overweight patients, the baseline clinicopathologic properties and the treatment history with radiotherapy and chemotherapy were similar and no statistical significant difference could be detected. Tamoxifen in combination with luteinizing hormone-releasing hormone (LHRH) agonist was used in 33% (136/408) of the patients in Arm A and in 22% (91/418) of patients in Arm B (p<0.001). Three-year disease free survival (DFS) rates were 89% and 87% in arm A and arm B, respectively (p=0.39). Three-year overall survival (OS) rates were 99% in arm A and 94% in arm B which appeared to be of significance (p=0.028). In univariate analysis no statistical significant effect of LHRH agonist usage on DFS (p=0.58) and OS (p=0.96) was found.

CONCLUSION:

Although BMI had no negative effect on recurrence risk, poor OS was observed in overweight and obese premenopausal breast cancer patients with hormone-receptor positive tumors who were treated with tamoxifen.

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Effect of body mass index on recurrences in tamoxifen and anastrozole treated women

2010

https://www.ncbi.nlm.nih.gov/pubmed/20547990

https://www.researchgate.net/publication/44673163_Effect_of_Body_Mass_Index_on_Recurrences_in_Tamoxifen_and_Anastrozole_Treated_Women_An_Exploratory_Analysis_From_the_ATAC_Trial

Results: Overall, women with a high BMI (BMI > 35 kg/m(2)) at baseline had more recurrences than those women with a low BMI (BMI < 23 kg/m(2); adjusted hazard ratio [HR], 1.39; 95% CI, 1.06 to 1.82; P(heterogeneity) = .03) and significantly more distant recurrences (adjusted HR, 1.46; 95% CI, 1.07 to 1.61; P(heterogeneity) = .01). Overall, the relative benefit of anastrozole versus tamoxifen was nonsignificantly better in thin women compared to overweight women.

CONCLUSION:

These results confirm the poorer prognosis of obese women with early-stage breast cancer. Recurrence rates were lower for anastrozole than tamoxifen for all BMI quintiles. Our results suggest that the relative efficacy of anastrozole compared to tamoxifen is greater in thin postmenopausal women and higher doses or more complete inhibitors might be more effective in overweight women, but this requires independent confirmation.

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The predictive impact of body mass index on the efficacy of extended adjuvant endocrine treatment

https://www.nature.com/articles/bjc2013367

2013

Results:

In all, 634 patients (177 normal weight, 307 overweight, and 150 obese) patients were included in this analysis. Normal weight patients with additional 3 years of anastrozole halved their risk of disease recurrence (disease-free survival (DFS) HR 0.48; P=0.02) and death (HR 0.45; P=0.06) and had only a fifth of the risk of distant metastases (HR 0.22; P=0.05) compared with normal weight patients without any further treatment. In contrast, overweight+obese patients derived no benefit from additional 3 years of anastrozole (DFS HR 0.93; P=0.68; distant recurrence-free survival HR 0.91; P=0.78; and OS HR 0.9; P=0.68). The possible predictive impact of BMI on extended endocrine treatment could be strengthened by a Cox regression interaction model between BMI and treatment (P=0.07).

Conclusion:

Body mass index may be used to predict outcome benefit of extended AI treatment in patients with receptor-positive breast cancer.

9lives70...very interesting study. IMO it will make the decision whether or not to take Tamoxifen when experiencing serious QOL issues a little easier. That is not to say that all should reject it. Those that can tolerate it have a leg up. Good luck to all navigating this complicated disease.