Another thing researchers have just discovered is that taking tamoxifen for 10 years actually gives a woman stronger protection against recurrence than taking it for 5 years, which has been the standard of treatment. There's a caveat to that, however. The likelihood of endometrial cancer increases the longer a woman takes tamoxifen; and studies have yet to go out far enough to show just how much higher that likelihood is 10 years post-treatment. In addition, some women develop resistance to tamoxifen; and in some cases, it was shown that tamoxifen reversed its effectiveness with time, actually activating the cancer it was supposed to prevent.
Q. So what’s the tamoxifen routine? My oncologist said I’d take a pill every day, but he didn’t really tell me how long I’d be on it.
A. Yes, you’ll take a 20mg pill every day (or two 10mg pills). EVERY day, please. Studies have shown that women who don’t fill all of their tamoxifen prescriptions–those who aren’t diligent in taking it, once it’s prescribed–show an increased risk of recurrence. Just throw it into the daily dispenser with your other medications. Or, if you’re not taking anything else, put it with your daily vitamin; it doesn’t need to be taken at any specific time, but it’s good to take it the same time every day. Leaving it on the breakfast table will remind you to do just that.
As for how long you’ll take it, the reason your oncologist wasn’t specific is because if you’re postmenopausal, (s)he probably doesn’t know. Studies and clinical trials researching the optimal length of time to take tamoxifen are ongoing. Originally, it was prescribed for 5 years for all ER/PR-receptive survivors. Now, while premenopausal survivors are continuing this 5-year treatment, many postmenopausal women are switching to an aromatase inhibitor (an AI: Arimidex, Aromasin, or Femara) after 2 or 3 years. And some are even skipping tamoxifen altogether, and going to an AI right out of the gate. AIs have been routinely prescribed for postmenopausal survivors since 2002, and there’s now sufficient evidence to show that they’re better at preventing recurrence than tamoxifen alone. In fact, the ongoing ATAC trial, a huge study begun in 1999 and scheduled to officially end in 2011, shows that Arimidex by itself is significantly better than tamoxifen, or tamoxifen followed by Arimidex, for preventing recurrence.
Q. So, I guess we’ll just play “how long” by ear. In the meantime, I’m starting tamoxifen soon. Tell me about the side effects of tamoxifen.
A. Thankfully, tamoxifen’s side effects are generally pretty mild. We all have our own personal body chemistry; there’s no telling how YOU will react to any particular treatment, including tamoxifen. That said, here’s a list of side effects you MAY encounter. PLEASE don’t think all of this will happen to you! I’ve known plenty of women on tamoxifen, and while most report hot flashes, vaginal issues, and weight gain, the other side effects seem less common.
• hot flashes;
• vaginal discharge, and/or dryness, and/or itching, and/or pain;
• fluid retention and/or weight gain;
• irregular periods;
• headache;
• nausea/vomiting;
• skin rash;
• fatigue;
• increased fertility*
*Yes, INCREASED fertility; ask your doctor about appropriate forms of birth control if you’re premenopausal. Birth control pills are no longer an option, as they alter the effects of tamoxifen.
In addition, there are possible serious side effects that are, thankfully, quite uncommon (under 1.5% of women taking tamoxifen are likely to encounter these):
• increased blood clots;
• uterine or endometrial cancer;
• stroke;
• cataracts.
As with the decision to take any drug, you’ll want to consider the side effects. But realistically, based on decades of real data, taking tamoxifen to prevent breast cancer recurrence is pretty much a no-brainer. Good luck!
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