Post menopausal… changing from letrazole to tamoxifen…recurrence risk difference?


Im 55 and post menopausal. I was diagnosed in Sept 2018… ER+/Her2-/node negative but had high risk of distant recurrence through oncotype score. This meant I had to have chemo and radiotherapy on top of mastectomy.  
I started tamoxifen in Apr 2019 and changed to Letrazole in May this year. I had hot flushes on tamoxifen but have so many side effects on letrazole. The worst of which for me is hair thinning which I’m finding devastating to be honest.

I know that Aromatase inhibitors are recommended for post menopausal ladies as they have lower rates of recurrence but do you have facts and figures for this? Am I putting myself for all these side effects for the next 6.5 years for just a slight increase in recurrence free survival or is there a substantial increase that makes it worth it? I would love to swap back to tamoxifen but will persevere if doing so puts me at a lot higher risk

I really look forward to your reply 

thanks, Angela

Below is a general consensus on what most people feel they are looking at with AI’s versus tamoxifen treatments.

“Aromatase inhibitors reduce recurrence rates by about 30% (proportionately) compared with tamoxifen while treatments differ, but not thereafter. 5 years of an aromatase inhibitor reduces 10-year breast cancer mortality rates by about 15% compared with 5 years of tamoxifen, hence by about 40% (proportionately) compared with no endocrine treatment.”

But there’s no right answer. It’s what you feel you can do and are willing to personally risk. As far as hair loss, has there been suggestions? My oncologist says she can prescribe me something for both recovery of my eyelashes and hair. Also, maybe you should try another AI besides letrazole? There a few and you might not have as many side effects on another one. A lot of people do that and find some relief in it. 

Hello Angela

Thanks for posting.

It’s understandable that you want to know more about the percentage benefit from taking an aromatase inhibitor in your situation, so you can weigh this up against the side effects, such as hair thinning that you’re experiencing.

As you can see from Milly 15’s post that you responded too, many women who experience hair thinning find it devastating, especially as you say, you need to take it for a further 6.5 years. As @Kay0987   says, it’s worth talking to your treatment team about your hair thinning to see if they can suggest anything that may help.

You may also find the organisation Cancer Hair Care of help, they are a specialised organisation that offer support and advice for people who experience hair loss from cancer treatment. And as K0987 also says, some women find using a different brand, or a different aromatase inhibitor drug can suit someone better and sometimes reduce some of the side effects they experience.

You may find it helpful to see what other people have tried by also posting in the hormone therapy section of the Forum.

Your treatment team are the best people to talk to you about what your individual percentage benefit from endocrine treatment is. They may use a tool called Predict, to help explain your individual benefit at 5 and 10 years. You can ask how the percentage benefit is likely to differ if you were to change back to tamoxifen. It might also help to talk to your breast care nurse about this.

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Best wishes


Breast Care Nurse

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