Everyone, please meet my new friend "Tamoxifen"

I left Dr. MacCormick's office with that feeling of uncertainty that I have become accustomed to through all of this. Once again, I had no idea where fate would lead me and found myself wondering what Dr. Pritchard would say. I thought that if she suggested chemotherapy, I would definitely want to call and scream in her ear for an hour or two. But, then I realized that if she suggested chemo there would probably be a good reason, and if it could save my life I would take it. It just killed me to think that with so little chances of this cancer recurring, the doctors may still suggest chemo. It killed me to know that the same situation in a 40 year old woman would mean no chemo. Does my age really make any difference? I by no means want to play with fire here -- chemotherapy is a poision and can cause detrimental short- and long-term health effects. If this will not benefit me well as far as risk of recurrence goes, I do not want to take it. However, if the benefits outweighed these risks, there would be no doubts in my mind. I just really hoped that the doctors would consider my health outside the cancer and be sure that if chemo would be a recommendation, it would be a crucial one.

I thought back to the appointment, and realized that all my preparations paid off. I understood just about everything the doctor spoke to me about and was able to ask many educated questions to get the most out of the appointment. So, I would continue on this path. The next thing I wanted to learn was WHO exactly Dr. Pritchard is (???). It would be nice to know something about this renowned breast cancer doctor who is playing a large part in the decision-making process for my case. I found that she is quite highly respected in the cancer research community, does a great deal of clinical trial research, and has been a 'first' to discover quite a few things having to do with treatment for breast cancer. If you'd like to know more about her click here. At least I would have someone who is recognized and dependable giving her opinions.

Second, I decided to do some further research on Tamoxifen, since this was the drug which Dr. MacCormick prescribed to me. I was to assume, at this point, that I would be taking Tamoxifen for 5 years and no chemo and was, therefore, to start the Tamoxifen immediately. If a change in decision occured, then this drug may simply be given in combination with something else, or it would be halted and administered at a later date (i.e. following chemo).

Turns out that Tamoxifen is one of the oldest and most widely used hormonal treatments for breast cancer. Tamoxifen is administered for women whose cancer cells have estrogen receptors, which mine did. Basically, Tamoxifen is a drug that mimicks estrogen. Thus, it travels through the body and binds to cells with estrogen receptors so that natural estrogen can no longer get at them. This, in turn, slows or stops the growth of the cancer cells that are fed by estrogen.

The side effects of Tamoxifen are much less severe than most cancer treatments. The major side-effects are similar to those of menopause due to a lowered amount of estrogen working in the body. Some of these symptoms include: hot flashes, nausea, weight gain, and lighter periods. Some of the more serious and less common side effects include: blood clots and uterine cancer (I know, I know). I spoke to Dr. MacC about this and he informed me that the benefits of Tamoxifen far outweigh the risks. If the breast cancer was to recur, it could be potentially lethal, whereas a new uterine cancer can be removed and treated. In other words, it would be better to get uterine cancer than a second breast cancer, and the chances of getting uterine cancer are low. A final side effect worth mentioning is fertility. Tamoxifen has been used to increase fertility, so it increases the risk of getting pregnant. This poses 2 problems: 1) I can never take the birth control pill again (because it contains estrogen and progesterone, which can cause breast cancer); 2) Tamoxifen can be harmful to an unborn child, so if I were to get pregnant on Tamoxifen, I would then have to be taken off the drug. But again, these side-effects are much more desirable than any side-effects chemotherapy would yield.

Many studies I read also showed that hormone-therapy (i.e. Tamoxifen) alone may be just as effective as chemotherapy and hormone-therapy together in low-risk women with hormone receptor positive breast cancer (i.e.: ME!). Dr. Mac Cormick suggested the same thing, saying that the Tamoxifen would decrease the risk of the disease coming back from 20% to approximately 12% or lower. Chemotherapy would only change these numbers by about 1%. However, this was BEFORE the second pathology report that stated the cancer was grade 2.
Also, the studies are usually largely based on women who are older than me (again, suggesting the need for more research in younger women!)

Complicated, isn't it?

For more info. on Tamoxifen, visit the following sites:
http://www.breastcancer.org/tre_sys_tamox_idx.html

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