Advice on adjuvant homone treatment

[LD Trax]

Hi everyone,

I am a 39 year old mother of two and married. In 3/06 I was diagnosed after requesting a mammogram from my GYN. My GYN starts baseline mammograms at 40. My tumor was a grade III/Her2 3+/ER 5/PR 4.3, classed T1c,NO(i+). I was very very glad I followed my female intuition.

I have gone through 4 AC, just finished my 11th of 12 Taxol/Herceptin and will be starting radiation in early November. Now we have to make the decision on hormonal treatment. My Dr. has suggested Tamoxifen or have my ovaries removed and take Arimidex. (I already nixed the monthly shot to shoot me into menopause.) He mentioned that Arimidex is showing signs of working better on women who are Her2 +, but it is still early info.

I am really struggling with being shoved into early menopause and the effects of menopause. With being ER positive at only 5% and the PR borderline I am questioning this line of treatment. I haven't really been able to find an alternative and would love any advice you might offer up. Thank you.

LD

[Bev]

LD, Try the search key and try to read the studies. In general being post menopausal is helpful for prognosis. I'm highly PR+ which somehow if I've digested the studies right, makes staying on tamox OK for a year or 2 before switching to an AI. I guess the easiest way is to get a 2nd opinion. Ai's won't work if you're not post-menopausal. If you want more children, Lupron seems to be the way to go. If not an oophrectomy will accomplish the same thing. Not much of a choice. I'm of the opinion I do not want this back and go with the most aggressive. I'll deal with the fall-out later, when I'm 90 I hope. BB

[LD Trax]

Thanks Bev for your input. We haven't planned on more kids...I think it is being afraid of body, skin, sex drive changes that are getting to me. Plus I had my thyroid removed several years ago and it took a long time for me to feel like my hormones were in working order. I guess I was looking for away around that. I'll check in the search section. Thanks again.

LDT

[Bev]

Hi again, Ac pushed me into chemopause. I was going to be there in a couple of years anyways so I've accepted it. Yes there are subtle changes in the areas you mentioned. Tamoxifen will give you hot flashes but I don't know if it will necessarily throw you into menopause. I still think your risk of recurrence is higher when not in menopause. I'm hoping someone else will post that has a situation close to yours or has a more scientific understanding of it. BB

[mts]

Hello LD Trax,

Just caught your post (albeit a few months old). I am ER + 10% and PR - and Stage 1, neg nodes, HER2+ and 41 at dx. I am now 44.
My onc suggested tamoxifen because he said even a low ER+ like mine "could benefit" with Tamoxifen. He then said that it was up to me to decide. At first diagnosis I was gung-ho to take everything I could that would add up to a lesser recurrence rate. I will say that I hate Tamoxifen and still battle with the thought that I really don't benefit all that much from it. Its like a 1% to 3% less chance of recurrence... But I continue to take it because I feel all the trials and experience of previous Tamoxifen takers warrant giving it a chance. I guess if I were a higher stage, then I would need those percentage points...
I would certianly weigh every element necessary to take or not take hormonal treatment. Have you had any genetic testing to see if you carry the breast cancer gene?

I also had my ER/PR checked twice at two different labs because the first lab results were only at 5% ER+

In the end, as we all have figured out, the onc makes suggestions and when those suggestions are based on insufficient or lack of data, then options are provided for us to make the final decision. As much as I think I don't need Tamoxifen, I still end-up rationalizing that I do. As much as I hate it -I will continue to take it and when I am done with my 5 years I will get on an AI and deal with the side effects. Unless of course, something better comes along.

My best to you!

Maria (MTS)