Log in to post a reply
Feb 11, 2018 01:27PM
Feb 12, 2018 12:23PM
Georgia1 (and now also MelissaDallas as I was writing) have made the important point that you have jumbled the side effect profiles of different drugs together (Tamoxifen and Aromatase Inhibitors). The side effect profiles have some commonalities, but can be quite different in other ways. Also, you have not listed some important (if rare) side effects of Tamoxifen.
The question of endocrine therapy (e.g., Tamoxifen, an Aromatase Inhibitor) is within the area of expertise of Medical Oncologists ("MO"). After your surgical pathology is available, you can ask your MO about (a) rare severe adverse effects versus (b) other more common side effects of the specific drug that he recommends for you.
I also agree with dtad, that more information is needed before an informed decision about endocrine therapy can be made. Unfortunately, imaging is not definitive, and the results of the pathology from lumpectomy and sentinel node biopsy may change understanding of your recurrence risk profile and the potential benefits of treatment.
In general, the benefits of endocrine therapy are proportional to recurrence risks and risk of death, such that those at greater risk potentially reap larger benefit. Because of this, in order to make an informed decision about endocrine therapy (e.g., Tamoxifen) requires a case-specific risk/benefit analysis based on information from a Medical Oncologist familiar with your case and risk profile.
This case-specific risk/benefit analysis may include a discussion of:
(a) estimates of your various risks (e.g., risk of death; distant recurrence; local recurrence; new disease in the same or contralateral breast) after all other treatments;
(b) estimates of the potential "absolute benefit" of Tamoxifen in reducing these various risks in your particular case;
(c) information about the various risks of treatment, including the risk of severe adverse effects (in light of your personal medical and family history); and
(d) how the benefit of (b) compares with the risk of (c), in light of one's personal risk tolerance.
For those with a surgery first treatment plan, the information entered into PREDICT should be based on surgical pathology findings, which you do not have yet.
Importantly, Version 2.0 of the PREDICT tool appears to provide information regarding 5-year and 10-year Overall Survival, which is typically a type of mortality assessment (death). Overall survival benefit is important. However, it typically measures whether the study participants are alive or not at a specific time-point, not whether they have remained disease-free or recurrence-free. Those who are alive may be disease-free, or they may be living with metastatic disease, living with a loco-regional recurrence or new disease (i.e., a new primary in the same or contralateral breast). Tamoxifen can potentially reduce the risk of these events. Thus, for patients with invasive breast cancer, consideration is also typically given to the potential benefit of endocrine therapy in reducing the risk of suffering a distant (metastatic) recurrence (which is not provided by PREDICT 2.0).
[Edits: Minor grammatical changes only (deleted a comma; singular to plural)]
Stage IA IDC, 9/2013 BMX. Right: IDC (1.5 mm, grade 2) with DCIS (5+ cm), 0/4 nodes, pN0. Left: DCIS (5+ cm), 0/1 node, pN0(i+).