No choice for me, I have osteoporosis. So tamoxifen it was (until I noped out of that).

Hi. - I am on Tamoxifen and soon to switch to AI. I was on the boarder of being postmenopausal when DX so MO started me on Tam. I must say, I have no side effects at this moment except for fatigue later in the day, and bad memory - both may be due to just aging and not related to Tam. When I first started on Tam, I had joint stiffness, pain in feet, and Charlie horses at night. However, I also switched my diet to antioxidant and anti inflammatory rich foods, cut down on carbs and sugar, and all my symptoms went away. You can start with whatever you want and then switch if it doesn’t work out. But either way I think your body well get used to it by time and hopefully you will not have a lot of SE. Every person is different

My understanding is that AI's are a bit superior in reducing recurrence. That said, I was put on Tamoxifen to begin with just like edj3 due to already having osteoporosis. I did not do well on Tamoxifen at all and ended up in the ER and immediately taken off of it. I am in my second week of Anastrozole and so far so good. The plan will be to treat with Zometa or Prolia to offset further bone loss. I am a bit uneasy since I don't do well on meds but feel I have to give this my best shot at success. Time will tell if I am able to make it 5 years. Best of luck with whatever you decide.

I was on tamoxifen to begin with and now letrozole. I had problems with tamoxifen. Had my first ever abnormal paps test. Of course that led to more testing and a few biopsies. Nothing was found, but again had an abnormal paps later on. Finally quit the tamoxifen and started letrozole. No uterine issues since. I have not had joint pain or any other issues on letrozole.

Nancy

marinochka, since your diagnosis is DCIS and you had a re-excision to get wide margins, and are also having rads to reduce local recurrence risk, the primary benefit to you of either an AI or Tamoxifen is not so much the prevention of a recurrence, since your risk is already so low, but more so for preventation of the development of a new primary breast cancer in either breast. Anyone diagnosed previously, whether with DCIS or invasive cancer, is higher risk (than the average woman of the same age) to be diagnosed with a new breast cancer.

Thinking about that, I found the following article, which talks about the use of AIs versus Tamoxifen for prevention. It even references those who have had a previous diagnosis of DCIS.

Aromatase Inhibitors in the Prevention of Breast Cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC44640...

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Question 5: What Is, in Your Opinion, the Objective to Prefer Aromatase Inhibiors over Tamoxifen?

Fehm: Tamoxifen has a different side-effect profile than AI. Patients treated with tamoxifen have a higher risk for adverse effects like endometrial cancer, stroke, thrombosis, and pulmonary embolism. Postmenopausal women with risk factors for those events should be treated with an AI.

Schütz: It seems that both tamoxifen as well as AI are able to prevent breast cancer without a benefit in overall survival. However, toxicities of tamoxifen seem to be more severe than those of AI, especially the incidence of other cancer and thrombo-/embolic events. AI toxicities are also well known but do not seem to affect patients as much as tamoxifen although a direct comparison has only been done in the adjuvant setting. Therefore AI should be preferred in postmenopausal patients. Tamoxifen can be used in the premenopausal setting.

Thill: Tamoxifen increases thromboembolic and gynecological adverse events. In the IBIS-I trial the side effects were mainly confined to the active treatment period. Nevertheless, the risk of endometrial cancer and thromboembolic events, although it is low, in my opinion would lead to a preference of an AI over tamoxifen if the woman or patient is postmenopausal. In addition, the reduction of invasive breast cancer is higher with an AI than with tamoxifen.

"Does anyone have an opinion on if an oncologist will listen to the patient's preferences for quality of life when choosing a hormone therapy treatment?"

If the MO doesn't take into account the patient's preferences, then the patient needs to find another MO. Of course if the MO recommends something different than what the patient prefers and believes that the patient doesn't have all the facts, he/she should explain what's behind the recommendation. Patients should factor in their doctor's advice, but the final decision always goes to the patient.

As for Evista, keep in mind that the only reason that DCIS is treated is so as to avoid the progression of the DCIS into an invasive breast cancer. While of course you wouldn't want to develop DCIS again (or a recurrence of the current diagnosis), ultimately the goal of all breast cancer treatment is to avoid the development of metastatic disease, and mets develops from invasive cancer. So if Evista is as effective against invasive cancer and if there are reasons you prefer it vs. Tamoxifen, it seems like a reasonable choice, even though your current diagnosis is DCIS. It would be interesting to hear an MO's perspective on this.