Hormone therapy for Stage 1A senior with osteoporosis?

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weluvu2
weluvu2 Member Posts: 2
edited February 2019 in Hormonal Therapy - Before, During, and After

I've just completed 5-Day Targeted Radiation Therapy following a lumpectomy. My cancer was Stage 1A; 1 cm with clear margins and lymph nodes. I'm an 81-year old 15 year survivor of osteosarcoma in generally good heath. However, osteoporosis contributed to 2 broken hips and a broken arm from falls in the past 2 years. My oncologist recommends Tamoxifen. Does anyone know where I can research the probability that it will reduce the risk of a recurrence?

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  • Moderators
    Moderators Member Posts: 25,912
    edited February 2019

    Hi weluvu2, We are sorry you are going through this right now. You may find this page helpful as you research Tamoxifen: Tamoxifen

    Warmly,

    The Mods


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  • windingshores
    windingshores Member Posts: 704
    edited February 2019

    If you had an Oncotype Dx done, the reduction in risk numbers are  based on Tamoxifen. I think Tamoxifen would be a good path for you. I have osteoporosis as well and cannot take Tamoxifen due to afib and clot risk. My bones have gotten 7% worse in 4 years on Femara.

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  • Denise-G
    Denise-G Member Posts: 1,777
    edited February 2019

    My mom was 80 at diagnosis - Stage 1 - ER pos PR pos Her2Neg 1.5 cm tumor lumpectomy only.

    She had osteopenia when starting an Aromatase Inhibitor, Anastrozole. Within a year and a half she had

    bad balance issues with it. Her Osteopenia had progressed to Osteoporosis, she did not want to take a bone

    strengthening drug, and she and our Oncologist decided to stop the drugs.

    She is now 85.5 and doing well. GOOD LUCK to you!

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  • AliceBastable
    AliceBastable Member Posts: 3,461
    edited February 2019

    My MO put me on Tamoxifen because the AI + Prolia route had too many possible problems for me. When I had my recent BS follow-up, she mentioned that Tamoxifen helps strengthen bones. I just turned 69, have osteoporosis, and had a hysterectomy in 2008 - so Tamoxifen is perfect for me. And so far, after my first month, no side effects!

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  • weluvu2
    weluvu2 Member Posts: 2
    edited February 2019

    It took a lot of research to find the results of a clinical trial, NSABP B-21, that resembles my situation; a small node-negative tumor (1 cm); ER +ve and HER-2 -ve; treated with a lumpectomy and radiation; evaluating the pros and cons of Tamoxifen.

    I found a helpful editorial on B-21 in Volume 20 of the Journal of Clinical Oncology. It provided information that the overview and abstract did not. In particular, the risk of local recurrence for ER +ve patients is less than the average for all 1,009 patients in B-21 which included ER -ve. For post radiation women like me, the risk at 8 years is estimated to be 5.4% without Tamoxifen reduced to 1.7% with Tamoxifen; a 3.7% reduction. However, my tumor exhibited different factors that are predictive of a decreased risk based other other studies, including age > 50 years, low or moderate grade cancer, and wide margins of excision. In one of the editorial's reference articles, I found that about 20% of the patients in B-21 were < 50 which likely skewed the recurrence risk slightly higher than it is for someone my age.

    I also found the results from NSABP clinical trail B-14 that predicted higher rates of endometrial cancer and thromboembolic events through 5 years of Tamoxifen use; they were 0.6% and 1.3% respectively. The combined 1.9% increased risk due to Tamoxifen is going to be slightly higher when extrapolated out to 8 years for comparison with the 3.7% decreased risk in breast cancer recurrence.

    in advising me that Tamoxifen use was a "no brainer", it appears that my oncologist's office quoted B-14 risk reduction % that were not adjusted for either radiation or ER +ve. They did not quote the increased % risk for endometrial cancer or stroke. I wonder how common this is? Personally, I think this information is important to make an informed decision about Tamoxifen.

    There are other helpful articles on this website about the % of women who don't complete 5 years of Tamoxifen due to other side effects that are not life threatening; and the potential benefits from exercise, diet, stress reduction, and natural remedies.

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