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I do hope the extensive discussion about choices in treatment is more helpful than confusing or frightening.
It is hard to know what is best for treating humans who are so strongly premenopausal, and harder still to figure it out when you are one of them... especially since there are so many variables that come with each person's situation. The choices are difficult for HER2's especially because as a group we are younger and have to give up a lot more QOL to live longer.
If the average age of bc has been assumed in general to be 61 (which is not exactly child-bearing age) then there would have been a tendency to just see tamoxifen as protection for most patients even though that may not be the case for a subset of patients that happen to be primarily younger. Tamoxifen has a much longer documented history than the AI's. Even just 5 years ago the AI's were not available except in clinical trials.
Because testing for HER2 has not been done across the board until recently and there have been problems with accuracy of testing, it has taken a while for the questions about tamoxifen for HER2's to be considered.
As I understand it, taking an AI like Arimidex or Femara or Aromasin is useless if you are not menopausal, but is more effective than tamoxifen if you are menopausal. There also seems to be some information to the effect that tamoxifen may not be a good choice in particular for HER2's. The result is that a lot of HER2's who are young enough to still be possibly premenopausal are going for ovarian suppression/ablation so that then an AI can work for them.
Now that Herceptin is an option for HER2's, do we even know whether a course of that in combination with chemo is enough to keep cancer at bay without any SERM like tamoxifen or AI for those who are HR+?
A.A.
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