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Feb 20, 2016 10:09AM
Feb 20, 2016 10:16AM
I would like to note that a person who has received a bilateral mastectomy may have a different risk profile than a person who has received lumpectomy alone, for example, with respect to the risk of ipsilateral or same-breast recurrence. Age and specific pathology findings may affect risk profile. A pre-menopausal 41-year old receiving lumpectomy alone may be in a different position than a post-menopausal 52-year old receiving bilateral mastectomy.
In my personal opinion as a layperson, the decision regarding endocrine therapy is a complex medical decision, which each patient should make in consultation with their expert Medical Oncologist (MO). This is because the MO is familiar with the specific details of their diagnosis and the treatments received, and with their personal risk of loco-regional and distant recurrence or risk of new disease, in light of all applicable factors. The MO should have expert understanding of the available endocrine therapy options, such as tamoxifen or an aromatase inhibitor, their side effect profiles, and the magnitude of the risks of such side effects.
The question entails a complex risk / benefit analysis. Factors such as one's personal risk of local and distant recurrence, risk of new disease, menopausal status, and overall health and presentation, including specific risk factors that may be potentially relevant to the side effect profiles of a specific drug, are all considerations.
Genetic testing results may provide further information that are pertinent to personal risk of new disease, and certain test results could separately warrant consideration of risk reduction endocrine therapy.
Patients should not hesitate to inquire with their MO about the specifics of risk / benefit in their own case.
Anecdotal second or third-hand information about a condition experienced by someone may highlight a risk, but can be an unreliable indicator for many reasons. For example, there is no way to know for certain whether a different drug(s) received by a person, either for treatment of breast cancer or for another co-morbid condition, could explain the condition. Lifestyle risks are not verifiable, and a person may not be willing to share such details. Perhaps a person was at increased risk of a conditions for known or unknown reasons of personal medical or family history.
As indicated by Melissa, anecdotal experience does not speak to the actual magnitude of a risk either in the general case or in the specific case. A person who would like to learn more about (a) serious known drug-related risks of tamoxifen, such as uterine malignancies, stroke, and pulmonary embolism; (b) what is currently known about the specific incidence of each such risk; and (c) whether they have any personal factors which might increase such risk in their case, should consult their medical oncologist in the interest of obtaining current, case-specific expert professional medical advice. Then, the possible benefits of treatment in terms of potential risk reduction must be weighed against the possible risks of serious side effects, in light of one's personal "risk tolerance". In some cases, the potential benefit of treatment may not outweigh the risks. In others, the opposite may be true.
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+).