My wife is 46 years old, and was diagnosed with Breast cancer last
summer.
Her 1.3cm cancer was nonpalpable and was picked up on a screening
mammogram as a 1 year interval cancer.
She underwent a lumpectomy at a NY hospital and there were 2/22 nodes
positive.
The tumor was found to be
Estrogen receptor >80% positive,
Progesterone receptor >80% positive and
Her2/Neu+ as well.
The rest of her workup was unremarkable for distant disease.
She has undergone a course of chemotherapy :
Dose Dense Adriamycin and Cytoxan chemotherapy 4 cycles (every 2 weeks)
then Taxol and Herceptin weekly for 12 weeks
then Herceptin was switched to every 3 weeks for 40 weeks and
she began radiation to the lumpectomy site 33 sessions over 6.5 weeks
when the Taxol stopped.
Now the issue is the direction of her hormonal therapy :
AI vs Tamoxifen.
Her current lab values show:
estradiol is 7 postmenopausal <10-50pg/ml
FSH is 65.3 prepuberty <5.0mIU/ml
postpuberty <15.0
postmenopausal > 20.0
LH is 29.0 prepuberty <2.0
My wifes onc. wants to give her an AI and monitor her blood values over time to see if she is still menopause. He feels that an AI is appropriate because:
1. An AI is more effective in postmenopausal women
2. An AI may be more effective in Her2 breast cancer.
However I have read in two papers that there is a possibility that menses may resume after using AI:
Inadvertent use of aromatase inhibitors in patients with breast cancer with residual ovarian function: cases and lessons.
Burstein HJ,Mayer E, Patridge AH, O'Kane H, Litsas G, Come SE, Hudis CA, Goldstein DF, Muss HB, Winter EP, Garber JE.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrie ve&list_uids=16800976&dopt=Abstract
Adjuvant aromatase inhibitors for early breast cancer after chemotherapy-induced amenorrhoea: caution and suggested guidelines.
Smith IE, Dowsett M, Yap YS, Walsh G, Lonning PE, Santen RJ, Hayes D.
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16735701
We are not sure what the best way is to proceed.
The options seem to be:
1 Tamox
2. AI and monitor blood values
3. Remove the ovaries and take an AI
4. ovarian suppression and take an AI
Thank you very much for your help.
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