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Debbie L. · 11-20-2011, 07:48 AM

Hi Emma,

I can see why you're puzzled about all this (I am too).

I'm no expert. But first of all, it seems to me that there could be a totally non-cancer, non-Tamoxifen reason for heavy periods and that a first stop would be a consult with a GYN. Lots of women have heavy bleeding from, for one example -- fibroids. The older we get (until menopause), the more troublesome fibroids can become. And there are other non-Tamoxifen possibilities.

Then if/when the usual causes are ruled out, you could proceed to figure out the best way to go forward in terms of balancing side effects and endocrine treatment for your breast cancer.

The stats that were quoted to you must be based on what they think is your existing risk of recurrence (very low), and then they are telling you the difference endocrine tx could make to that risk. Each treatment offers the same degree (percent) of relative risk reduction to every person (at least, as far as we are able to break it down at this point). But that risk reduction gets factored into each individual's existing risk, which is taken from the diagnostic details. Of course, these are very rough estimates and cannot guarantee anything for any one individual, but they do give some help when making treatment decisions.

So let's just use round numbers, not necessarily the correct ones (I'm no mathematician). If Sally's risk of recurrence, based on the details of her stage I cancer diagnosis, is 5%, and Tamoxifen offers her a 50% reduction in her risk of recurrence -- then in the end, it is reducing her risk by 2.5% (50% of 5). Which changes her absolute risk of recurrence from 5% to 2.5%.

Then there's Cindy, with a stage 3 diagnosis, and a 60% risk of recurrence (again, just pulling nice round numbers out of my hat -- these are not real people). Tamoxifen offers her the exact same percent of relative risk reduction that it offered Sally -- 50%. But 50% of that initial 60% risk is a 30% risk reduction for Cindy, just from Tamoxifen (her absolute risk would go from 60% to 30% (60 minus 30=30) -- quite a different number.

But again, it seems to me that a basic GYN workup would be the first place to start, before making such drastic treatment decisions.

Keep us posted, and good luck,
Debbie Laxague

11-20-2011, 07:48 AM	#3
Debbie L. Senior Member Join Date: Jul 2006 Posts: 463	Re: What should I do? Hi Emma, I can see why you're puzzled about all this (I am too). I'm no expert. But first of all, it seems to me that there could be a totally non-cancer, non-Tamoxifen reason for heavy periods and that a first stop would be a consult with a GYN. Lots of women have heavy bleeding from, for one example -- fibroids. The older we get (until menopause), the more troublesome fibroids can become. And there are other non-Tamoxifen possibilities. Then if/when the usual causes are ruled out, you could proceed to figure out the best way to go forward in terms of balancing side effects and endocrine treatment for your breast cancer. The stats that were quoted to you must be based on what they think is your existing risk of recurrence (very low), and then they are telling you the difference endocrine tx could make to that risk. Each treatment offers the same degree (percent) of relative risk reduction to every person (at least, as far as we are able to break it down at this point). But that risk reduction gets factored into each individual's existing risk, which is taken from the diagnostic details. Of course, these are very rough estimates and cannot guarantee anything for any one individual, but they do give some help when making treatment decisions. So let's just use round numbers, not necessarily the correct ones (I'm no mathematician). If Sally's risk of recurrence, based on the details of her stage I cancer diagnosis, is 5%, and Tamoxifen offers her a 50% reduction in her risk of recurrence -- then in the end, it is reducing her risk by 2.5% (50% of 5). Which changes her absolute risk of recurrence from 5% to 2.5%. Then there's Cindy, with a stage 3 diagnosis, and a 60% risk of recurrence (again, just pulling nice round numbers out of my hat -- these are not real people). Tamoxifen offers her the exact same percent of relative risk reduction that it offered Sally -- 50%. But 50% of that initial 60% risk is a 30% risk reduction for Cindy, just from Tamoxifen (her absolute risk would go from 60% to 30% (60 minus 30=30) -- quite a different number. But again, it seems to me that a basic GYN workup would be the first place to start, before making such drastic treatment decisions. Keep us posted, and good luck, Debbie Laxague