I am writing post mastectomy and post chemo for an IDC, estrogen positive, no lymph involvement, clear margins, but with a high oncotype score on one of the tumours suggesting risk of recurrence. I have seen 2 different oncologists who have different views on the next steps of my treatment.
The first says because of my age (48) and impending natural menopause I should take Tamoxifen for 5 years. Possibly switching to AI (Letrozole) after 2 years when I would be heading into menopause naturally. She mentioned only giving Zoladex to much younger women.
The second says I should try Letrozole + Zoladex first to see how I cope with the side effects- and if not too bad I should do that rather than Tamoxifen. And if SE too bad- then go onto Tamoxifen instead.
This is quite confusing and I don’t know what to do. I have a few weeks to think about it but I was wondering if there are any views on this here and any articles you have come across that talk about either the long-term side effects of either (including bone density issues on AIs) or on the effectiveness of one over the other (tamoxifen v. letrozole/zoladex for someone not yet in menopause but close)?
Thanks a lot! I know that side effects are personal so we don’t know how each of us will react until we take that first pill- making this all the more anxiety inducing and confusing…
My oncologist told me that tumors with an intermediate or higher oncotype score, ovarian suppression plus an AI offer lower recurrence rates for pre-menopausal women. Not a ton so if you can’t tolerate it tamoxifen still offers great protection but if you can, it might be worth it to you to start with it first.
I couldn’t comment on the Zoladex but I was diagnosed with a small invasive low grade ER+ HER2 - IDC 2 years ago when I was 55 and they put me on Tamoxifen even though I was quite old! This was because you have to have 2 years clear of no periods to be considered fully post menopausal and I’d had one annoying one that year. Two years are now up and I’m switching to Letrozole this month for a further 3 years. They both work differently and if you’re still having periods then it has to be the Tamoxifen.
Apparently there are some studies that show Letrozole is slightly better at reducing risk of recurrence in post menopausal women so they always suggest that first. If it’s not tolerated we can still go back to Tamoxifen. The difference with Letrozole being it can’t be used pre menopause.
It must be very difficult for you having two differing opinions. I wish you all the best x
Hey lovelies. I was 42 when I got diagnosed with metastatic bc, also took residence in my liver. I was put on straight on to zoladex injections every 4 weeks and letrozole which I take everyday. This combination brought on menopause, instantly stop my periods however I do suffer with most of the symptoms that go with menopause. For me, apart from the menopause symptoms I don’t seem to suffer with much else. The zoladex injections go into your tummy, if you do have these please make sure they don’t inject you to close to your bellybutton. They run the risk of hitting the small blood vessels that are around there and you end up with claret everywhere. Also keep a note of which side you have each time, as they do alternating sides each visit. Everyone is different, I truly hope you get on ok.
Thank you @Frances55 - very helpful - will ask my oncologist again as one of them suggested I could have AI plus zoladex even though am pre-menopausal (before starting chemo my phone would beep to tell me my period would come the next day which it almost inevitably did ;-). Thanks so much
Thank you so much @amyf34 - that is very helpful and if I go onto Zoladex I will take your advice on how it gets administered. Did you get joint pain at all? That is one thing I don’t want- if it stops me from doing sports or other things.
Hate to say it but yes think so. I’m very active, swim, walk, gym and I’m also a small group PT coach. Definitely feel like there’s things I can’t do. Best way for me to get through it is to keep moving, go for walks, swim. I just don’t want it to beat me so adapt. Plus training believe it or not keeps bones strong as it helps with the density. It’s mainly affected my knees, and hands with an achy feeling. But as I say I just keep going. Stay strong lovely.
