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Karen, I agree with Becky that it's a huge gray area of menopausal-or-not and with an AI that is crucial information. However, it is not that easy to figure out. Hormone levels fluctuate quite amazingly from day-to-day and most of the experts that I've been listening to have been burned so many times, even when relying on two or three sets of blood tests, that they are quite wary of prescribing AI's to someone who is not clearly menopausal (has been without periods for two years before chemo, etc). It seems to me that they favor ovarian suppression with an AI if there is any doubt (and there is almost always doubt, in your 40's and even for some in theit 50's). And as we know from other recent threads, there is no evidence yet that ovarian suppression and AI is the same as menopause and an AI, although it seems logical.
Another interesting result recently, somewhat overshadowed by the zoledronic acid news from the same study, is that they are seeing no difference at all in that study between Tamoxifen and the AI, given to premenopausal women who are also suppressing their ovaries. Which is of course a surprise as logic would suggest they'd get the same results as the postmenopausal T vs AI studies. So many shades of gray, and of course we don't want to make any decisions based on just one study. But still, it raises interesting questions (as if we need more questions, arggg).
I thought that one of the most interesting things at SABCS last year was the question of whether Tamoxifen might not be just as good as an AI for those who metabolize it properly. A guess was hazarded in one of the Q&A sessions that if they were able to take the nonmetabolizers of T out of the stats in studies that compare Tamoxifen to an AI, the increased benefit from an AI might disappear. I cannot remember who said this but it was one of the big names (Winer, Allred, ...?).
This is not helping much with your decision. But since you're liking the idea of sticking with Tamoxifen, maybe it would be worth waiting until after SABCS (12/11-14) to make a final decision, in case there's new evidence either way.
When they first began looking at AI's, there was discussion that an AI seemed to be better overall but especially for HER2+ cancers, while Tamoxifen often met with resistance in same. As I understand it, since then, they do not still think that, especially in the presence of Herceptin. It seems to be more that HER2+ cancers are more likely to be somewhat resistant to hormonal treatment in general. Whether that is simply because they also tend to have lower levels of receptor positivity or if there are other things going on in addition does not seem to be clear yet.
When there is a decision to be made and no clear answer(s) upon which to make that decision, I advise trusting your intuition, or gut, or still small voice - I know that will be the right decision, for you.
Debbie Laxague
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