Hi Hope,
I was a similar age to you when I was diagnosed with a fair sized invasive ductal carcinoma lump (plus a separate patch of DCIS). They didn’t carry out the oncotype test as standard 6 years ago, however I was told I was borderline chemo but that it was not recommended by my onc, hence op and 20 x radio including boosters plus hormone therapy since oestrogen positive.
I was prescribed Tamoxifen, initially for 5 years. With the results of further research coming out at the 5 year check up point it was recommended that I have a further 5 years of hormone therapy. Periods had gone a bit gappy within a few months of starting Tamoxifen (which I understand is quite common). By the time of my 5 year review, the gap had been rather ever extending, so I was told I would need to change to Letrozole instead (by a locum I had never seen before, who knew less about the studies re pro’s and con’s of taking Tamo for the extra 5 years than I did).
Having done 5 years of Tamoxifen and considering that a further 5 years of hormone therapy at that stage of treatment would give some, but for me, statistically not mega amounts of benefits re bc, I wasn’t keen on taking Letrozole due to the risk of impact on bones (impacts on bone being high on my radar after having had a secondary cancer scare (highly suspicious…thankfully turned out to be old fractured ribs).
After telling the locum my periods had been mega gappy for the 5 years on Tamoxifen, he somewhat begrudgingly sent me off for a blood test to check my hormone status. Which came back showing I was not menopausal and therefore was best continuing to take Tamoxifen (rather than Letrozole). Personally, I was relieved to hear that.
Perhaps try to get more info from your onc as to why they recommend Letrozole over Tamoxifen for you.
- As far as I’m aware Letrozole doesn’t ‘switch off’ ovaries (see last line of extract from BCN leaflet below - link as attached)
- Letrozole works better than Tamoxifen at reducing oestrogen produced by cells in your body such as fat cells from reaching your breast tissue in women who are post menopausal.
- Whereas Tamoxifen is better at blocking oestrogen from latching onto receptors in your breast tissue and hence generally seems to be thought best for women who haven’t gone through the menopause i.e. where the prime source of oestrogen is the ovaries.
If that’s where the hesitation and change of oncologists mind from Tamo to Letrozole is, it might perhaps be worth asking if they think it would be helpful for you to have a blood test to determine hormone levels re which is best?
Or are they planning on giving you a different combination of med’s to close down your ovaries, as well as giving you Letrozole - see links below and extract from the last leaflet on oestrogen suppression. (These are all from the main BCN website - info, publications, search)
Hormone therapy - general
breastcancernow.org/information…. treatment…/ hormone - therap
Re Tamoxifen
breastcancernow.org/….treatment…/hormone-therapy/tamoxifen
Re Letrozole
breastcancernow.org/…treatment/hormone-therapy/letrozole-femara
Re ovarian suppression
breastcancernow.org/information-support/facing-breast-cancer/going-through-breast-cancer-treatment/hormone-therapy/ovarian-suppression-breast-cancer
Extract - ** 5. Different types of ovarian suppression**
Ovarian suppression can be achieved by:
- hormone therapy (drugs) – usually monthly injections
- surgery
Your specialist team should help you decide which is best for you. Using hormone therapy is the only way of achieving ovarian suppression that may not be permanent. This may be something to consider when making your decision, especially if you want to have children.
Hormone therapy
Some drugs stop the ovaries from making oestrogen. They interfere with hormone signals from the brain that control how the ovaries work.
- Goserelin (Zoladex) is the most commonly used drug. It comes as an implant (a very small pellet) in a pre-filled syringe. It’s given as an injection into your abdomen (tummy) once a month. Find out more about how goserelin is given.
- Leuprorelin (Prostap) is given as an injection once a month, or sometimes every three months.
-
Triptorelin is given as an injection once a month.
Ovarian suppression combined with tamoxifen or aromatase inhibitors
If you are having one of the above injection for ovarian supression this is often combined with another hormone therapy such as tamoxifen or drugs known as aromatase inhibitors. Research has suggested this may reduce the risk of the breast cancer coming back for some premenopausal women who have had chemotherapy.
There may be a small extra benefit having an aromatase inhibitor over tamoxifen but there might be different side effects to consider that can affect your quality of life. Your specialist will help you discuss the possible benefits and side effects.
_Aromatase inhibitors are not used on their own as hormone treatment in premenopausal women because they are not an effective treatment while the ovaries are still making oestrogen, but they can be given alongside goserelin, leuprorelin or triptorelin. _Your specialist team will discuss with you what they recommend and why.
I the above helps and would be interested to know which path of treatment you end up on.
Sending a hug - I know all this can be a tad confusing at times re what/why! All I can say is the locum would have put me on Letrozole (if I hadn’t pushed that I didn’t think I was menopausal and the blood test been done). Should add that’s been my only negative experience, usual onc’s great.
x Seabreeze (Now over 6 years on and doing ok)
