Is Tamoxifen no longer first choice vs. AIs for younger women?

Going through breast cancer treatment Hormone therapy
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Hi all, I am in my late 30s and currently going through treatment for stage 3 er/pr+ BC. According to my initial research, I was under the impression that tamoxifen was given to pre-menopausal women like myself, and aromatase inhibitors were more often prescribed to post-menopausal women.

From my recent online research, I’m noticing that many younger women are being put straight onto letrozole or equivalents after their treatment ends, alongside long-term ovarian suppression. This removes all circulating estrogen from the body, yet the lessened recurrence risk seems to be relatively marginal vs. that of tamoxifen alone.

Right now, I am on ovarian suppression. I don’t want children and didn’t freeze my eggs. However, after research told me that chemotherapy risked inducing menopause and goserelin lessened that risk, I had to back track on what I’d said in previous meetings with my drs and fib about wanting to “leave the door open” for children in the future (after affirmatively saying I didn’t want them!)

I can’t imagine taking the full on blockers for the long-term hormone therapy portion of treatment, especially not for 10 years. I read of a woman in her 50s who ended up in a mobility scooter, and another who had 60 hot flashes a day. Intolerability seems to be the norm rather than exception. I am struggling a bit even with the ovarian suppression, which is making me extremely depressed most days.

In my mind, a SERM like tamoxifen sounds like a more common sense approach for those who’ve committed to systemic and surgical treatment (and even that is difficult to tolerate for many). The downside is that tamoxifen can’t be taken alongside the CDK 4/6 inhibitors, which was also floated as a treatment approach for me.

I am surprised that some of my fellow age mates are willing to trial the hard line treatment approach and remove all their estrogen. I understand survival is paramount, but recurrences do happen on AIs even, and I just feel disappointed, depressed and worried about the fact that this seems to be the go-to treatment nowadays rather than something that works reasonably well, without as many long-term health implications.

I wondered if anyone else had noticed this trend, and how they feel about this subject?

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AI’s do have better long term survival rates for people with more aggressive tumors. If you don’t have one then tamoxifen offers the same rates. But there are many of us chasing any percentage points off we can in order to increase our chances of survival and that’s probably accounting for the shift. I’ve used both letrozole and tamoxifen and personally I like letrozole better.

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Thanks for your reply. It’s interesting to hear that you are doing better with letrozole vs. tamoxifen. Did you make the change after experiencing side effects or was the transition always part of the treatment plan for you? My tumour is grade 2 so I’m in the middle in terms of aggressiveness.

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It wasn’t part of my treatment plan but my estrogen went up so tamoxifen ended up being the only viable choice.

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I think it totally depends on your specific cancer type and situation tbh…. I am ER/PR positive (scored 8 for both) and HER2 positive and was diagnosed at 36. I had my chemo, surgery and radio last year and the chemo immediately put me into a menopause. I am having a preventative chemo now, and whilst tamoxifen will make a decent difference to me percentage wise, I have been told that the difference between that and letrozole is so negligible in my case that it isn’t worth the potential different side effects/difference to quality of life. I’m getting on well with tamoxifen and the plan is to keep me on them for 10 years. Ovaries are still shut down, but if they do happen to wake up I’ve to get ovarian suppression for 5 years as I’ll need that regardless. I had a good conversation with my oncologist about it and he explained it all to me so I am happy with that decision, as I’ve taken everything I’ve been recommended, so if I was told that letrozole was worth it I’d have given it a go but he felt this was unnecessary :smiling_face:

If you’re on instagram, Dr Eleanor’s Teplinski (DrTeplinski) done a couple of good videos in June explaining endocrine therapy and directs you to the latest trials/papers. I found her through Dr Liz Oriordan and she explains stuff well if you fancy checking it out

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Hello, hope you don’t mind me jumping in. I have just been through all of above and have ER/PR 8. I’ve been put on tamoxifen and 3 weeks in the hot flushes started, just break out in a sweat about five times a day. They prescribed venoflaxin which is an antidepressant to help but it’s made me anxious.

Anyway, they want to move me to letrozole with injections and Abemaciclib.

I’m worried about moving onto letrozole as I’m already getting join pain in my hands and I just feel like it’ll age me.

Can anyone explain the differences between side effects? I am thinking about just staying on tamoxifen alongside Abemaciclib.

Thanks