Tamoxifen

Initiation of hormonal therapy is commonly begun after the completion of chemotherapy (and after completion of radiation therapy if you receive both). In terms of actual timing, hormonal therapy will typically begin approximately four to six weeks following completion of chemotherapy. A preference for sequential timing of chemotherapy and hormonal therapy, i.e., adjuvant chemotherapy followed by hormonal therapy, was suggested by a clinical trial, in which sequential versus concurrent chemo/hormonal therapy were directly compared and sequential treatment had superior outcomes for disease free and overall survival.

I would add that there are limited clinical data and no consensus on the use of concurrent hormonal therapy and radiation therapy, thus some medical oncologists advise overlap of hormonal therapy with radiation and others advise waiting until radiation is complete. I generally advise waiting until radiation is complete. Initiation of hormonal therapy is commonly begun after the completion of chemotherapy (and after completion of radiation therapy if you receive both). In terms of actual timing, hormonal therapy will typically begin approximately four to six weeks following completion of chemotherapy. A preference for sequential timing of chemotherapy and hormonal therapy, i.e., adjuvant chemotherapy followed by hormonal therapy, was suggested by a clinical trial, in which sequential versus concurrent chemo/hormonal therapy were directly compared and sequential treatment had superior outcomes for disease free and overall survival.

I would add that there are limited clinical data and no consensus on the use of concurrent hormonal therapy and radiation therapy, thus some medical oncologists advise overlap of hormonal therapy with radiation and others advise waiting until radiation is complete. I generally advise waiting until radiation is complete.

There were some early reports in the literature that soy foods may reduce the effectiveness of Tamoxifen in animal studies, but at least one study from the Univ of So Cal (wu, JCO, 2007) showed that soy food consumption had no effect on the active metabolites of Tamoxifen in Asian American breast cancer survivors. There were some early reports in the literature that soy foods may reduce the effectiveness of Tamoxifen in animal studies, but at least one study from the Univ of So Cal (wu, JCO, 2007) showed that soy food consumption had no effect on the active metabolites of Tamoxifen in Asian American breast cancer survivors.

This is really a common side effect with Tamoxifen treatment and all too frequently leads to discontinuation of a really helpful drug. Recommendations that are at the top of the list include regular exercise and a Mediterranean diet. Do those first. Next I would consider acupuncture. There was a study in the Journal of Clinical Oncology a couple of years ago that compared acupuncture to an antidepressant drug commonly used for hot flashes called Effexor. Acupuncture was just as effective in decreasing hot flashes and patients reported increased libido, and improvements in energy, clarity of thought, and sense of well-being with acupuncture. Side effects for the Effexor group included dry mouth, nausea, constipation,and decreased appetite. Black cohosh is another option. I won’t go into all the weaknesses of the big studies that have been done on black cohosh and hot flashes but I’ll summarize by saying the preponderance of the evidence shows that black cohosh is effective in treating hot flashes. It is not a phytoestrogen as some have believed in the past. Many of the common herbal preparations used for hot flashes do contain phytoestrogens so I would avoid those and stick with plain black cohosh. This is really a common side effect with Tamoxifen treatment and all too frequently leads to discontinuation of a really helpful drug. Recommendations that are at the top of the list include regular exercise and a Mediterranean diet. Do those first. Next I would consider acupuncture. There was a study in the Journal of Clinical Oncology a couple of years ago that compared acupuncture to an antidepressant drug commonly used for hot flashes called Effexor. Acupuncture was just as effective in decreasing hot flashes and patients reported increased libido, and improvements in energy, clarity of thought, and sense of well-being with acupuncture. Side effects for the Effexor group included dry mouth, nausea, constipation,and decreased appetite. Black cohosh is another option. I won’t go into all the weaknesses of the big studies that have been done on black cohosh and hot flashes but I’ll summarize by saying the preponderance of the evidence shows that black cohosh is effective in treating hot flashes. It is not a phytoestrogen as some have believed in the past. Many of the common herbal preparations used for hot flashes do contain phytoestrogens so I would avoid those and stick with plain black cohosh.

No, I did not begin taking Tamoxifen until after my son was born. Tamoxifen is harmful to fetuses and should not be taken while pregnant. No, I did not begin taking Tamoxifen until after my son was born. Tamoxifen is harmful to fetuses and should not be taken while pregnant.

I will not recommend, but share experience. My partner chose not to take Tamoxifen, and instead opted for use of bio-identical hormones, including 2-methoxyestadiol, progesterone, DHEA and testosterone. 2-methoxyestradiol has been shown in various studies to have cancer fighting potential, acting both as an selective estrogen receptor modulator like Tamoxifen but also anti-carcinogen. See http://lib.bioinfo.pl/pmid:15156405 as an example. Please review this option with your oncologist, hopefully an integrative one. It would be unethical for me to take someone off their medications. Often it's not an "either-or" situation (either drugs or alternatives), but a "both-and". Each has its place. Whether the ones you are on are the best for you, I can't address here, as that requires a more detailed and in-depth understanding of your health. There are many things which help the body clear excess estrogens: first, avoid exposure to them (buy safer/chemical-free home, personal care, garden and beauty products without hormone-like compounds in them); avoid any hot foods or fatty foods in plastic or styrofoam (hormone disruptors/estrogenic), as the packaging melts into the food when heated or when in contact with fats; eat only organic animal products (animals are allowed to be given estrogen, progesterone & testosterone to grow them faster and fatter. We ingest these if we eat them in meat, eggs, butter, cheese, yogurt, etc.); keep a low glycemic diet which reduces sugar and insulin in the blood, both of which are cancer growth triggers; add many of the foods I mentioned earlier; add exercise, which reduces blood sugar and has many cancer-protective/heart-healthy/spirit-lifting benefits; get sufficient sleep to help your immune and endocrine systems (melatonin, the sleep/immune hormone is made in the dark, so sleep with all lights out); b vitamins (as supplement and/or greens &/or whole grains) help the body clear estrogens; high fiber & and good liver function help the body clear estrogens; pro- & pre-biotics help the immune system (they make some of the b vitamins & vitamin k) and support digestion; and keep a calm mind/spirit, which will reduce the body's stress hormone, cortisol, production. Cortisol is a cancer growth factor. Enjoy your life and yourself as much as possible!

My partner is also premenopausal, and has refused taking Tamoxifen, despite being ER+. Instead, she has opted for use of bio-identical hormones. 2-methoxyestradiol has been demonstrated to have the SERM like qualities of Tamoxifen, however, with no side effects. In addition, it has specific anti-cancer properties. We reference http://lib.bioinfo.pl/pmid:15156405 as one study among many. Good luck with your choice! I didn't tolerate Tamoxifen either and I am premenopausal. My doctor suggested ovarian supression with Lupron injections or having the ovaries removed. I have not done either because my gyn. suggests this can cause problems with bone and heart health in young women who still need some levels of estrogen. My oncologist told me that in my particular case, being heavily her2+++, that Tamoxifen offered me about only a 3% reduction in recurrence and that the her2+ was my larger risk factor. I have decided to not look back and stop obsessing about it all. I have had chemo and mastectomy.

There is a small numerical advantage, on average, associated with the use of aromatase inhibitors over tamoxifen. However, that does not mean that every single patient must use the AIs. If the AIs are intolerable it is reasonable to use tamoxifen instead. There is a small numerical advantage, on average, associated with the use of aromatase inhibitors over tamoxifen. However, that does not mean that every single patient must use the AIs. If the AIs are intolerable it is reasonable to use tamoxifen instead.

Be very conscious about your food choices, and compose a delicious yet low/moderate glycemic diet for yourself. (you can have organic dark chocolate over 65% cocoa, too. but not more than an ounce a day).Choose the cancer-protective foods while you're at it (listed earlier today). Plus, you'll need to exercise in some fashion that suits you--walking 1/2 hour a day or tai qi or Pilates or yoga. All you need is 1/2 hour a day of movement. More is even better. In addition, green/white tea is a bit stimulating to your metabolism and has anti-cancer activity. Make sure your thyroid is working well (TSH @ 2.5 or less is what I like to see), and your vitamin D-OH25 is over 55 (I like to see it between 55-80ng/ml). And you need to sleep well at night to maintain good sugar balance. All this helps. Dale Be very conscious about your food choices, and compose a delicious yet low/moderate glycemic diet for yourself. (you can have organic dark chocolate over 65% cocoa, too. but not more than an ounce a day).Choose the cancer-protective foods while you're at it (listed earlier today). Plus, you'll need to exercise in some fashion that suits you--walking 1/2 hour a day or tai qi or Pilates or yoga. All you need is 1/2 hour a day of movement. More is even better. In addition, green/white tea is a bit stimulating to your metabolism and has anti-cancer activity. Make sure your thyroid is working well (TSH @ 2.5 or less is what I like to see), and your vitamin D-OH25 is over 55 (I like to see it between 55-80ng/ml). And you need to sleep well at night to maintain good sugar balance. All this helps. Dale

Thanks for your question. Melasma can also be called hyperpigmentation, and basically, it means the skin gets darker in places. Usually, the darker skin doesn’t occur all over, like a nice tan, but in blotches and spots. Scientists aren’t sure why chemotherapy causes hyperpigmentation. (Aside from Tamoxifen, culprit drugs include Alkeran®, Myleran®, Cytoxan®, 5-FU, Adriamycin®, and more.) It may have something to do with inflammation, stimulation of skin-color cells, or toxicity. Radiation, of course, can cause it at the treatment sight. Like most side effects, it typically fades within 10-12 weeks of the last treatment, but sometimes, it becomes a long-term, unwelcome guest. I would suggest the following steps for you:

1) First of all (especially now that you are no longer undergoing treatment) add serious exfoliation to your daily routine. You need to loosen up the dead cells on the top layer of skin so that new, younger cells can come forward. Try natural facial scrubs or enzyme peels like Eminence Yam and Pumpkin Enzyme Pee or microdermabrasion at your local spa, or an organic at-home scrub.

2) Next, become obsessed with protecting yourself from the sun. UV rays trigger the production of melanin, the pigment that produces skin color—and darkened areas are particularly susceptible—so cover up with clothing and physical sunblock (chemical-free), like zinc and titanium oxide of at least SPF 30.

3) Now, you asked me for a cream to fade the spots and that is the next step. Unfortunately, many include the bleaching agent “hyroquinone,” basically, because it does lighten. However, the Environmental Working Group has assigned a “hazardous” warning to this ingredient. It has shown mutagenic (potentially cancer-causing) activity in lab studies, has been found to contain traces of mercury, and has been banned in the European Union and in Japan. In rare cases it can lead to a skin disease called ochnronosis, and prolonged use can thicken collagen fibers and damage connecting tissues, making your situation worse.

Instead, try one of the many hydroquinone-free products out there, most of which use kojic acid, alpha-hydroxy acids, vitamin C, arbutin, and niacinimide (a form of vitamin B) to lighten. Some clean and safe products I like are Miessence Probiotic Lightening fluid, Naturopathica Botanical Skin Brightener or Suki's Targeted Bio-Brightening Face Serum.

4)Supplementation can also help you with the discoloration from the inside out. GliSODin Skin Nutrients has extensive research behind their product. Check them out.

Make sure you give any product at least 2-3 months to work. Wear your sunblock diligently and exfoliate twice a week.

Let me know how you do!
Thanks Thanks for your question. Melasma can also be called hyperpigmentation, and basically, it means the skin gets darker in places. Usually, the darker skin doesn’t occur all over, like a nice tan, but in blotches and spots. Scientists aren’t sure why chemotherapy causes hyperpigmentation. (Aside from Tamoxifen, culprit drugs include Alkeran®, Myleran®, Cytoxan®, 5-FU, Adriamycin®, and more.) It may have something to do with inflammation, stimulation of skin-color cells, or toxicity. Radiation, of course, can cause it at the treatment sight. Like most side effects, it typically fades within 10-12 weeks of the last treatment, but sometimes, it becomes a long-term, unwelcome guest. I would suggest the following steps for you:

1) First of all (especially now that you are no longer undergoing treatment) add serious exfoliation to your daily routine. You need to loosen up the dead cells on the top layer of skin so that new, younger cells can come forward. Try natural facial scrubs or enzyme peels like Eminence Yam and Pumpkin Enzyme Pee or microdermabrasion at your local spa, or an organic at-home scrub.

2) Next, become obsessed with protecting yourself from the sun. UV rays trigger the production of melanin, the pigment that produces skin color—and darkened areas are particularly susceptible—so cover up with clothing and physical sunblock (chemical-free), like zinc and titanium oxide of at least SPF 30.

3) Now, you asked me for a cream to fade the spots and that is the next step. Unfortunately, many include the bleaching agent “hyroquinone,” basically, because it does lighten. However, the Environmental Working Group has assigned a “hazardous” warning to this ingredient. It has shown mutagenic (potentially cancer-causing) activity in lab studies, has been found to contain traces of mercury, and has been banned in the European Union and in Japan. In rare cases it can lead to a skin disease called ochnronosis, and prolonged use can thicken collagen fibers and damage connecting tissues, making your situation worse.

Instead, try one of the many hydroquinone-free products out there, most of which use kojic acid, alpha-hydroxy acids, vitamin C, arbutin, and niacinimide (a form of vitamin B) to lighten. Some clean and safe products I like are Miessence Probiotic Lightening fluid, Naturopathica Botanical Skin Brightener or Suki's Targeted Bio-Brightening Face Serum.

4)Supplementation can also help you with the discoloration from the inside out. GliSODin Skin Nutrients has extensive research behind their product. Check them out.

Make sure you give any product at least 2-3 months to work. Wear your sunblock diligently and exfoliate twice a week.

Let me know how you do!
Thanks

I wish that my physician (who is no longer my physician) had explained the relationship between steroids (the reason for pre-medicating with steroids) and the chemo drugs. I am the type of person that wants to know the reason behind everything. It is important to me to understand why I am taking a medication. I like to know as much as possible about the medication and the possible side effects. (I.e., I am probably a pain in the butt for a patient).



What I feel I missed out on was having an understanding about the purpose of the steroids (to allow my body to take the chemotherapy drugs without having an allergic response).


When I had my first chemo round I was told what doses of the steroids to take prior to my first infusion. I followed the directions carefully and exactly. I did pretty well with the Herceptin and not too bad with the Carboplatin. But, when I started getting Taxotere (Docetaxel) I began to experience pain in my chest and a lot of tightness in my chest. I also began to feel hot all over. Since it was my first infusion, I was being watched pretty closely for any reactions. My nurse slowed the rate of infusion and administered additional steroids (solumedrol was one of them). This improved my situation and I was able to complete the first chemo round.


My nurse (who was fabulous through all of my treatments) told me that because I had a reaction to Taxotere - I would need to have my doctor change the premedication doses prior to my next chemo round. I am sure she made note of this in my file as well. But, she told me to follow up with my doctor about it.


So, I did. I kept asking about the premedication dose, that I was told it needed to be different for the next chemo round. When I finally heard back (you will see why I fired my first oncologist) I was told not to take any pre-medications (other than the emend - anti-emetic - the morning of chemo). So, being the good patient I was (and sadly, not understanding what the steroids were used for) I followed the directions given by my doctor and did not take any steroids prior to my second chemo round.


My nurse administered steroids just prior to my infusion (as they had done before) but, I did not have the proper pre-medications (the steroid pre-medication dose should have been increased, not eliminated based upon my reaction to Taxotere during my first chemo round). I got through the Herceptin okay and also the Carboplatin. But, very quickly after Taxotere was administered, I went into anaphylactic shock and stopped breathing. It was horrifying.


It happened so fast. One second I was feeling okay, the next I felt that same pain coming on and heat and then very quickly I could no longer speak or breathe. I was in a semi-private room, with one other patient. No one else. The other patient was listening to music with ear phones and so I could not get her attention. But, incredibly, her daughter came back into the room (she had gone on a Starbucks run for her mom). And, even more luck, she just happened to be a chemo nurse as her profession. She saw me in distress and quickly got my amazing nurse who literally saved my life. They stopped the chemo fast, administered a lot of steroids and luckily I came out of it. I never saw people move so fast and work so fast. I am so incredibly grateful for the fact that my nurse was so very competent and talented. She truly saved my life.


So, I wish the reason for steroids had been explained to me. If it had, I would have known that decreasing the dose (to zero) the day preceding chemo was a mistake.


When I met with my oncologist (the one who i later fired) my first impression was that he felt I was taking up too much of his time and that my questions were annoying to him.


I also did not like the answers I was getting. I did not like the fact that he made me feel like my questions were somehow irritating to him and that he felt I should just trust him and not question him about why I would be taking one thing versus another. But, I really wanted to understand what I was going to go through.


As a result, I started seeing an oncologist out of pocket up at UCLA. She is amazing. After the anaphylactic shock incident, my insurance offered to pay for the oncologist of my choice (at UCLA) and allow me to continue treatment locally in Orange County under her supervision.


After that I felt prepared and informed about my treatment. I was one of those patients that seemed to react to everything. I had to have very slow chemo infusions as my body just wouldn't tolerate it. So I know that I was not/am not the typical patient with the typical reactions to drugs. But, I really wish I had been informed of the reason WHY I was taking the steroids. If I had, I would have realized that I needed an increase, not a decrease, in the steroid dose prior to the second chemo round. It would have been nice to have avoided the anaphylactic shock experience :)


Fortunately that is past. But, it taught me a huge lesson - to ask questions, even if your doctor doesn't seem to be in the mood for it that day. You are the only person in your body and the only person experiencing what is going on in your own body. You have to listen to that.


My current oncologist is excellent. She relies on me for information about my symptoms and she treats our relationship almost like it is a team effort (and, it truly is a team effort: patients have to cooperate, listen and ask questions and doctors need to listen to their patients and be responsive). I am fortunate now to have the right kind of doctor-patient relationship.


I am still struggling with Tamoxifen. I had a hard time adjusting to taking it. But, I feel that I was well informed about the drug and about other possible options (lupron and arimidex).


I hope this (very long winded) answer is helpful.


Incidentally, I found my pharmacist to be the most helpful when it came to explaining medications, interactions and side effects. I loved my pharmacist! She was so helpful to me! I wish that my physician (who is no longer my physician) had explained the relationship between steroids (the reason for pre-medicating with steroids) and the chemo drugs. I am the type of person that wants to know the reason behind everything. It is important to me to understand why I am taking a medication. I like to know as much as possible about the medication and the possible side effects. (I.e., I am probably a pain in the butt for a patient).



What I feel I missed out on was having an understanding about the purpose of the steroids (to allow my body to take the chemotherapy drugs without having an allergic response).


When I had my first chemo round I was told what doses of the steroids to take prior to my first infusion. I followed the directions carefully and exactly. I did pretty well with the Herceptin and not too bad with the Carboplatin. But, when I started getting Taxotere (Docetaxel) I began to experience pain in my chest and a lot of tightness in my chest. I also began to feel hot all over. Since it was my first infusion, I was being watched pretty closely for any reactions. My nurse slowed the rate of infusion and administered additional steroids (solumedrol was one of them). This improved my situation and I was able to complete the first chemo round.


My nurse (who was fabulous through all of my treatments) told me that because I had a reaction to Taxotere - I would need to have my doctor change the premedication doses prior to my next chemo round. I am sure she made note of this in my file as well. But, she told me to follow up with my doctor about it.


So, I did. I kept asking about the premedication dose, that I was told it needed to be different for the next chemo round. When I finally heard back (you will see why I fired my first oncologist) I was told not to take any pre-medications (other than the emend - anti-emetic - the morning of chemo). So, being the good patient I was (and sadly, not understanding what the steroids were used for) I followed the directions given by my doctor and did not take any steroids prior to my second chemo round.


My nurse administered steroids just prior to my infusion (as they had done before) but, I did not have the proper pre-medications (the steroid pre-medication dose should have been increased, not eliminated based upon my reaction to Taxotere during my first chemo round). I got through the Herceptin okay and also the Carboplatin. But, very quickly after Taxotere was administered, I went into anaphylactic shock and stopped breathing. It was horrifying.


It happened so fast. One second I was feeling okay, the next I felt that same pain coming on and heat and then very quickly I could no longer speak or breathe. I was in a semi-private room, with one other patient. No one else. The other patient was listening to music with ear phones and so I could not get her attention. But, incredibly, her daughter came back into the room (she had gone on a Starbucks run for her mom). And, even more luck, she just happened to be a chemo nurse as her profession. She saw me in distress and quickly got my amazing nurse who literally saved my life. They stopped the chemo fast, administered a lot of steroids and luckily I came out of it. I never saw people move so fast and work so fast. I am so incredibly grateful for the fact that my nurse was so very competent and talented. She truly saved my life.


So, I wish the reason for steroids had been explained to me. If it had, I would have known that decreasing the dose (to zero) the day preceding chemo was a mistake.


When I met with my oncologist (the one who i later fired) my first impression was that he felt I was taking up too much of his time and that my questions were annoying to him.


I also did not like the answers I was getting. I did not like the fact that he made me feel like my questions were somehow irritating to him and that he felt I should just trust him and not question him about why I would be taking one thing versus another. But, I really wanted to understand what I was going to go through.


As a result, I started seeing an oncologist out of pocket up at UCLA. She is amazing. After the anaphylactic shock incident, my insurance offered to pay for the oncologist of my choice (at UCLA) and allow me to continue treatment locally in Orange County under her supervision.


After that I felt prepared and informed about my treatment. I was one of those patients that seemed to react to everything. I had to have very slow chemo infusions as my body just wouldn't tolerate it. So I know that I was not/am not the typical patient with the typical reactions to drugs. But, I really wish I had been informed of the reason WHY I was taking the steroids. If I had, I would have realized that I needed an increase, not a decrease, in the steroid dose prior to the second chemo round. It would have been nice to have avoided the anaphylactic shock experience :)


Fortunately that is past. But, it taught me a huge lesson - to ask questions, even if your doctor doesn't seem to be in the mood for it that day. You are the only person in your body and the only person experiencing what is going on in your own body. You have to listen to that.


My current oncologist is excellent. She relies on me for information about my symptoms and she treats our relationship almost like it is a team effort (and, it truly is a team effort: patients have to cooperate, listen and ask questions and doctors need to listen to their patients and be responsive). I am fortunate now to have the right kind of doctor-patient relationship.


I am still struggling with Tamoxifen. I had a hard time adjusting to taking it. But, I feel that I was well informed about the drug and about other possible options (lupron and arimidex).


I hope this (very long winded) answer is helpful.


Incidentally, I found my pharmacist to be the most helpful when it came to explaining medications, interactions and side effects. I loved my pharmacist! She was so helpful to me!

Breast cancer survivors can have pain that lasts for several years after treatment. There are many factors that play into this, including the type of treatment (surgery and chemo) and the use of hormonal drugs like tamoxifen. (http://www.ncbi.nlm.nih.gov/pubmed/21656272). You don't say where the pain is, but generic versions of tamoxifen have been associated with joint pain (arthralgia). Interestingly, the brand name drug (Nolvadex) does not seem to cause those symptoms(http://www.ncbi.nlm.nih.gov/pubmed/20347307). The other hormonal drugs,called aromatase inhibitors, are also associated with arthralgia (http://www.ncbi.nlm.nih.gov/pubmed/21249443). Breast cancer survivors can have pain that lasts for several years after treatment. There are many factors that play into this, including the type of treatment (surgery and chemo) and the use of hormonal drugs like tamoxifen. (http://www.ncbi.nlm.nih.gov/pubmed/21656272). You don't say where the pain is, but generic versions of tamoxifen have been associated with joint pain (arthralgia). Interestingly, the brand name drug (Nolvadex) does not seem to cause those symptoms(http://www.ncbi.nlm.nih.gov/pubmed/20347307). The other hormonal drugs,called aromatase inhibitors, are also associated with arthralgia (http://www.ncbi.nlm.nih.gov/pubmed/21249443).

Hi,
I may have addressed this in your other question about taking Tamoxifen longer term/taking aromatase inhibitors, but I've been very lucky in that I really haven't noticed any side effects. My family doctor had me take a bunch of clotting tests before starting it since that can be an issue. When I read the pages and pages of side effects and warnings I almost scared myself out of even trying it, but I'm glad I did. The endometrial stuff seemed a bit scary but my oncologist told me that's so rare he's never seen it. But I am back to yearly pap smears just to make sure everything's normal; before my family doctor was going to back me off to every couple of years and then when I started Tamoxifen he said we should stick to annual check-ups. Hi,
I may have addressed this in your other question about taking Tamoxifen longer term/taking aromatase inhibitors, but I've been very lucky in that I really haven't noticed any side effects. My family doctor had me take a bunch of clotting tests before starting it since that can be an issue. When I read the pages and pages of side effects and warnings I almost scared myself out of even trying it, but I'm glad I did. The endometrial stuff seemed a bit scary but my oncologist told me that's so rare he's never seen it. But I am back to yearly pap smears just to make sure everything's normal; before my family doctor was going to back me off to every couple of years and then when I started Tamoxifen he said we should stick to annual check-ups.

We have not discussed taking Tamoxifen longer than 5 years or taking an aromatase inhibitor. I had asked him about aromatase inhibitors awhile ago and he said they don't have the clinical trial history that Tamoxifen has. I see him again next month so I may ask him whether an AI drug makes more sense now that I have officially hit menopause. I'm perfectly fine continuing on Tamoxifen though. I'm lucky to not have any side effects, and I read recently that the benefits can last up to 15 years. I just finished year three on Tamoxifen so I have another couple of years to go. We have not discussed taking Tamoxifen longer than 5 years or taking an aromatase inhibitor. I had asked him about aromatase inhibitors awhile ago and he said they don't have the clinical trial history that Tamoxifen has. I see him again next month so I may ask him whether an AI drug makes more sense now that I have officially hit menopause. I'm perfectly fine continuing on Tamoxifen though. I'm lucky to not have any side effects, and I read recently that the benefits can last up to 15 years. I just finished year three on Tamoxifen so I have another couple of years to go.

This is a difficult issue - if your breast cancer was estrogen-receptor negative, then removal of the ovaries will not necessarily reduce the risk of recurrence, but might reduce the risk of a new breast cancer developing over time. If your breast cancer was estrogen-receptor positive, then the goal is to reduce the amount of estrogen that your breast tissue is exposed to in order to help reduce the risk of recurrence or new disease developing. Years ago, removal of the ovaries was a standard part of breast cancer treatment. Most often now it is performed in women that carry the BRCA 1 and 2 mutations, as they have a significantly elevated risk of developing ovarian cancer.

As with any prophylactic surgery, removal of the ovaries is a difficult decision, especially in a premenopausal woman. Menopausal symptoms can sometimes be severe, and bone loss is a real concern as well. And once the ovaries are removed, they can't be put back...you may want to ask your doctor about other options, such as a trial of lupron (which will induce a "chemical menopause" - but at least it's reversible if you don't do well on it). This is a difficult issue - if your breast cancer was estrogen-receptor negative, then removal of the ovaries will not necessarily reduce the risk of recurrence, but might reduce the risk of a new breast cancer developing over time. If your breast cancer was estrogen-receptor positive, then the goal is to reduce the amount of estrogen that your breast tissue is exposed to in order to help reduce the risk of recurrence or new disease developing. Years ago, removal of the ovaries was a standard part of breast cancer treatment. Most often now it is performed in women that carry the BRCA 1 and 2 mutations, as they have a significantly elevated risk of developing ovarian cancer.

As with any prophylactic surgery, removal of the ovaries is a difficult decision, especially in a premenopausal woman. Menopausal symptoms can sometimes be severe, and bone loss is a real concern as well. And once the ovaries are removed, they can't be put back...you may want to ask your doctor about other options, such as a trial of lupron (which will induce a "chemical menopause" - but at least it's reversible if you don't do well on it).

Seek out a naturopathic doctor within your area and inquire about Helixor or Iscador. They are both injectables which has been used with great clinical success in patients with cancer.

You could also inquire about a few herbals/neutraceuticals which can strengthen your body & decrease the side effects of the chemotherapeutics.

In terms of diet, it is important to support optimal hormone function - and yes, this can come down to bowel movements. If you do not have daily regular bowel movements, hormones that your body has metabolized sits in your colon & can be released back into your system. To avoid this, I encourage the use of professional grade probiotics, 2 TBL of freshly ground flax seeds & 1 TBL of chia seeds daily, in addition to keeping well hydrated (water, sugar-free organic coconut water instead of pop/juice) throughout the day.

Additional naturopathic alternatives should be discussed with you ND as they can tailor a protocol specific to your needs. Seek out a naturopathic doctor within your area and inquire about Helixor or Iscador. They are both injectables which has been used with great clinical success in patients with cancer.

You could also inquire about a few herbals/neutraceuticals which can strengthen your body & decrease the side effects of the chemotherapeutics.

In terms of diet, it is important to support optimal hormone function - and yes, this can come down to bowel movements. If you do not have daily regular bowel movements, hormones that your body has metabolized sits in your colon & can be released back into your system. To avoid this, I encourage the use of professional grade probiotics, 2 TBL of freshly ground flax seeds & 1 TBL of chia seeds daily, in addition to keeping well hydrated (water, sugar-free organic coconut water instead of pop/juice) throughout the day.

Additional naturopathic alternatives should be discussed with you ND as they can tailor a protocol specific to your needs.

I was on Tamoxifen before Femara. My biggest problems were nausea and joint aches and pains. I do not remember having any cough with it though. This is just my experience though. I was on Tamoxifen before Femara. My biggest problems were nausea and joint aches and pains. I do not remember having any cough with it though. This is just my experience though.

A side effect of Tamoxifen may include neuromuscular & skeletal pain and that includes bone pain also called arthralgia.
This adverse effect has been reported in approximately 6% of patients according to Lexicomp's Drug Information Handbook for Oncology.

Two websites that may interest you regarding side effects of Tamoxifen are:
- http://www.rxlist.com/nolvadex-drug.htm
- http://www.mayoclinic.com/health/drug-information/DR601293/DSECTION=side-effects
A side effect of Tamoxifen may include neuromuscular & skeletal pain and that includes bone pain also called arthralgia.
This adverse effect has been reported in approximately 6% of patients according to Lexicomp's Drug Information Handbook for Oncology.

Two websites that may interest you regarding side effects of Tamoxifen are:
- http://www.rxlist.com/nolvadex-drug.htm
- http://www.mayoclinic.com/health/drug-information/DR601293/DSECTION=side-effects

A respiratory side effect of Tamoxifen can include coughing which has been reported in approximately 4% of the patients according Lexicomp's Drug Information Handbook for Oncology.

- It is important to consult with your health care provider about the coughing as it may be a sign of infection as Tamoxifen may alter your body's ability to ward off infections.
- It is also important to take precautions around people with colds or infections.

Other less common side effects are listed on these two websites:
- http://www.rxlist.com/nolvadex-drug.htm
- http://www.mayoclinic.com/health/drug-information/DR601293/DSECTION=side-effects A respiratory side effect of Tamoxifen can include coughing which has been reported in approximately 4% of the patients according Lexicomp's Drug Information Handbook for Oncology.

- It is important to consult with your health care provider about the coughing as it may be a sign of infection as Tamoxifen may alter your body's ability to ward off infections.
- It is also important to take precautions around people with colds or infections.

Other less common side effects are listed on these two websites:
- http://www.rxlist.com/nolvadex-drug.htm
- http://www.mayoclinic.com/health/drug-information/DR601293/DSECTION=side-effects

I have been on Tam since 2007, and in the fall of 08, I found that I could not sit without tremendous pain. I know that one of the side effects of Tam is bone and joint pain, but never did I make the connection that my pain could be related to Tam. However, in the past few months I have heard many stories that matched mine. I am surprised that none of my doctors picked up on this, but it is something that all users of Tam should be aware of. To read more, please visit:
http://elynjacobs.blogspot.com/2011/07/tamoxifen-friend-or-foe.html
I have been on Tam since 2007, and in the fall of 08, I found that I could not sit without tremendous pain. I know that one of the side effects of Tam is bone and joint pain, but never did I make the connection that my pain could be related to Tam. However, in the past few months I have heard many stories that matched mine. I am surprised that none of my doctors picked up on this, but it is something that all users of Tam should be aware of. To read more, please visit:
http://elynjacobs.blogspot.com/2011/07/tamoxifen-friend-or-foe.html