For an Appointment Call: 443-287-2778 Search  We hope you find this information helpful. This is a free service done during volunteer hours. If interested in supporting this service so it can be sustained, consider making a donation at: http://jhweb.dev.jhu.edu/eforms/form/surgery. Select JH Breast Center Education, Outreach and Survivorship Fund under the option: Please designate my gift.

Category:

Hormonal Therapy

Pages: [ << 1, 2 3, 4, 5, 6, 7, 8 >> ]

Question:  #61 3/9/2009		Q:	I just had a lumpectomy to remove 3 cm tumor in right breast. estrogen 95% positive, progesterone, 5% positive, HER negative. Patho report shows all clear in lymph nodes and margins. My question is, I am 46 years old, post menopausal (surgical- hysterectomy in 1991, remaining ovary out in 1997 due to endometriosis & recurrence). Did not go on HRT until 1 1/2 years ago - estratest for mainly vaginal dryness, other symptoms. My ob/gyn advised when I was diagnosed to stop taking it. Is there any reason given that I do not produce estrogen that I cannot go back on it or is there another alternative that will do the same thing but not as dangerous? I will be starting radiation soon, possibly chemo - will find out when further study of tumor is done. Thank you.
		A:	Although there are no definitive data re: vaginal estrogens and breast cancer, it is clear that some systemic absorption occurs. Accordingly, we do not recommend taking these if you have breast cancer, especially ER positive like yours. Sorry!
Question:  #62 3/1/2009		Q:	Hi, I''m 48 and was diagnosed with ICD in October. I had a double mastectomy with reconstruction. The invasive component was 2.6cm (left breast). ER/PR+ Her-2/nu neg. I had 0/10 nodes, 9 from cancer side and 1 from non-cancer side. Histologic grade 2, Nuclear grade 2, margins 8mm posterior, 3mm anterior, mib-1 low, no evidence of vascular invasion. Report states" "inflitrates as nests and tubules with neoplasic cells, exhibiting moderately pleomorphic nuceli with low mitotic activity. Oncotypye was 15, oncologist said Tamoxifen alone, and I was happy with that. I thought I should get a second opinion and #2 said I should do chemo, but couldn''t tell me why, but said I should look at my value system. He said we want a cure, knowing the answer I asked him if chemo would cure me, of course he said he didn''t know, and said I could be "cured" now. Well this was very upsetting, my BS took me to the tumor board because she knew that #2 made me doubt #1 and Tamoxifen. Mixed signals since I''m premenopausal, some docs felt chemo was a yes because of size and age, others felt that biology trumps those variables (as a biologist, I tend to be in biology trumps camp), one doctor said chemo helps everyone, so nothing clear. So, in addition to Tamoxifen, I''ve decided to have my ovaries removed. Is this resonable? If estrogen is my bug, don''t I want to reduce it to lowest possible levels?
		A:	so stage 2a. good prognostic factors. you've been aggressive with your surgery. some women want to leave no stone unturned and even for a benefit of just 1% they will embark on chemo. Others want to see a truly measurable and significant benefit (much higher % numbers) before considering these drugs. removing ovaries does reduce risk. the doctor might want to select a different hormonal therapy possibly if you go that route. ask him/her about that.
Question:  #63 2/28/2009		Q:	Dear Lillie... first thank you so much, you really help to confirm therapies, give peace of mind, Double mastectomy stage 1 largest spot 1 c.m. (of 3) sential node neg. 0/2 oncotype 8, on tamoxifen. Bone density good. Question: Zometa,...oncologist says no..study was done before oncotype, with low reoccurance zometa not needed.. I was offered biphosphate study by another oncologist when diagnosised in july 2008.. but did chose that oncolgist, and was to overwhelmed at that time to deal with one more thing...now 6 months out I wonder..why not do zometa anyway??,..just in case?? definitley could help??? I know side effects, but I am dealing with tamoxifen side effects everyday
		A:	you are welcome... thanks for those kind words too. usually for women on tamoxifen, bone building agents like that aren't needed unless bone density is found to be showing signs of osteopenia. tamoxifen technically is a bone building agent, friendly to bone like estrogen but works like an antiestrogen on breast tissue. zometa is more often reserved for women taking an aromatase inhibitor.
Question:  #64 2/28/2009		Q:	I was diagnosed with stage 3 breast cancer 6 years ago and am now cancer free. I completed 5 years of Tamoxifen and am currently on no anti estrogen therapy. I was 50 years old when I was diagnosed and put into permanent menopause by my treatments. Now I am suffering from vaginal atrophy along with prolapsing bladder. Both my gyn and oncologist tell me that vaginal estrogen in the form of Vagifem or estring will help me and will not add greatly to circulating estrogen. I am scared to death of doing this, but I have tried every over the counter product to no avail. I am tired of having the body of a 100 year old woman, especially now with my pelvic wall apparently collapsing. what is your opinion on this?
		A:	they are trying to balance quality of life with treatment needs which makes perfect sense for you. absorption is quite low. great you are 6 years out from diagnisis, well passed the window of greatest concern for recurrence. congrats.
Question:  #65 2/28/2009		Q:	I have been diagnosed with an early stage Breast Cancer at 35+ yrs (Stg 2,ER +ve and PR-ve) ---- Have been advised to go with Chemotherapy since I had 3 sentinel Nodes Positve and then follow it with Radiation. But in addition, have been advised to take harmonal therapy of 5 years on Tamoxifen. My concern - IS HARMONAL THERAPY - MANDATORY - Won''t the Chemotherapy and Radiation Suffice? What exactly is the risk-benefit ratio for this Harmonal treatment? I beleive - Tamoxifen is know to increase the risk of uterine cancer and additionally studies have revealed the reduced effectiveness of the drug over time and possible increased risk for breast cancer, which women are taking it to prevent. (MAYO CLINIC)-- A study published in the July 30, 1999, issue of the journal Science revealed that the anti-estrogen drug, Tamoxifen, may lose its effectiveness in preventing breast cancer - and may even begin to promote the disease - after 2 to 5 years of use. Please advise! and help clarify. Appreciate in Advance.
		A:	do the hormonal therapy. you definitely need both chemo and hormone therapy. chemo is not 100% (if it was then we wouldn't need to operate on people or do radiation or hormonal therapy at all). hormonal therapy provides the additional protection you need. with 3 positive nodes there is considerable concern about recurrence down the road in the form of distant recurrence.the study you are quoting is too old. a decade ago. there are more recent studies (search www.pubmed.com) that demonstrate the power of hormonal therapy and that it may even exceed chemo in some cases.
Question:  #66 2/22/2009		Q:	I have been on femara for a year. I am lucky that the only side effect is a dry vagina. I have tried some lubricants but they appear not to work that well. Are there any supplements that I can take ? Or anything else to help ?
		A:	Astroglide and Replens are favorites. In some special cases oncologists will allow the use of an estrogen vaginal cream. ask about it.
Question:  #67 2/21/2009		Q:	I have been on Tamoxifen for three years as I was diagnosed with Stage 1 in 2005. I am still premenopausal. Recently had spotting between periods and had a transvaginal ultrasound showing a thickening of the uterine lining. A uterine biopsy showed nothing abnormal and have now had a D&C. A polyp was removed and am now waiting for the final biopsy results. Can Tamoxifen contribute to the development of uterine polyps? Should I no longer take the Tamoxifen? Should I consider being put into menopause and taking another medication like Arimidex? Thanks for your response.
		A:	Tamoxifen can contribute to the wall of the uterine lining getting thicker, and thus it did, and biopsy was done to rule out endometrial cancer. polyps happen unrelated to tam. your doctor will probably keep you on it a while longer to see if the uterine lining thickens again or if the D&C took care of the issue.
Question:  #68 2/22/2009		Q:	I am 43 years old, premenopausal, diagnosed with DCIS on core biopsy in November, 2007. Pathology results after lumpectomy in Dec. 2007 showed DCIS, and .55 cm of invasive, ER+ PR-, and HER2+. Also found phyllodes tumor in other part of same breast. Physicians recommended mastectomy, and I elected double mastectomy to treat aggressively. Pathology results showed no other signs of cancer, either DCIS or other. Doctors recommended clinical trial of taxol + herceptin for 12 weeks, followed by herceptin for 1 year. I had a severe allergic reaction to taxol so doctors switched to navelbine + herceptin for 12 weeks. I will be done with herceptin in March. Have been on tamoxifen since June. My question is: in light of what seem to be very favorable results of the Austrian study (Gnant) in 2008 showing that the use of zometa, when given along with drugs to suppress the ovaries, result in a 30% reduction in risk of recurrence in premenopausal women, should I "push" to get ov. supp. and/or zometa? I''m not crazy about the side effects of ov. supp., particularly losing the protective effects on the cardiovascular system of remaining premenopausal (I have high blood pressure, controlled) and doctors have not been able to say how much more, if any, this would reduce my already low risk of recurrence, and neither my primary doctor nor my second opinion doctor has recommended ov. sup. or zometa. Because I''ve been aggressive in my treatment I want to use any other reasonable means to reduce risk further. What are your thoughts on zometa and/or ov. supp. given my history? Also, what is the profile of patients who usually get ov. supp.? Your input will be greatly appreciated.
		A:	Hi Julie, This is Ben Park MD PhD and your question was forwarded to me by Lillie. The study you mention is pretty brand new data and it is a very good trial, but in this country, standard of care for premenopausal women with ER positive disease is still tamoxifen. (BTW, did you have FISH done for HER2 on your tumor?) There is a trial looking at tamoxifen vs. ovarian suppression with tamoxifen vs. ovarian suppression with aromatase inhibitor ongoing, and there are other US trials looking at zometa and other bisphosphonates in the adjuvant setting. As of now, outside of a clinical trial, or unless a woman has reasons she can't take or tolerate tamoxifen, I do not routinely recommend for premenopausal women ovarian suppression. This may change in the future, but tamoxifen is the current standard of care in this setting. As far as zometa, the trial did demonstrate about a 30% relative risk reduction as you state, but this is a RELATIVE risk reduction. The trial only examined data at about 4 years out from the initiation of therapy and the absolute benefit was about 3 to 4%. Time will tell whether other studies can reproduce these data. For small amounts of benefit such as these trials, it is best to wait for confirmation from other studies to see if this will hold out, as well as further follow up in terms of patient years. It may be real, and the benefits would still be statistically significant, but as of now, this would not be something that is routinely recommended. Best, Ben
Question:  #69 2/14/2009		Q:	I took Arimidex for 5 years and just stopped taking it. Are there reactions that I might experience as my body returns to producing estrogen?
		A:	if you were experiencing hot flashes or night sweats these should now subside. congrats on finishing treatment! LS
Question:  #70 2/14/2009		Q:	Hi, on January 2008, when I was only 28, I was diagnosed with breast cancer. On the next day I had my surgery (right side upper hemi-mastectomy) with intra-operatory Hp examination: invasive ductal carcinoma. No lymph nodes were removed. The histopathology result was invasive ductal carcinoma (atypical glanduliform carcinoma), invasion in the peritumoral fat tissue (G2 – pT2pNx). Immunohistochemistry: ER positive 35 – 40 %, PGR positive 45 – 50 %, CerbB2 intensely positive in over 30 % of the tumoral cells (+++), EGFR negative in the tumoral cells, p53 feebly positive, Ki67 positive 55 – 60%. After the surgery I started chemotherapy: 4 series of FAC (Fluorouracil+Doxorubicin+Cyclophosphamide) and 4 series of Taxotere monotherapy. I started Herceptin together with Taxotere and after the 4 series of Taxotere finished, I continued with Herceptin every 3 weeks. I will finish one year of Herceptin in May this year. On September 2008 I made a PET SCAN examination and there was no trace of cancer anymore. After I finished the chemotherapy I started radiotherapy (DT breast + regional ganglionar areas = 5000 CGy, DT former tumoral layer = 6000 CGy (boost 1000 CGy with electrons) ). Then on October 2008 I started also the hormonal therapy (Aromasine and Zoladex). Now my doctor changed my medication to Tamoxifen. I have read a lot about taking Tamoxifen while being HER2 positive and I am very worried because of a possible reoccurrence. I understood that the HER2 positive tumors are resistant to Tamoxifen. I am really very worried.
		A:	this is an important issue to talk through with your doctor. he probably has chosen this drug due to you being premenopausal. you can ask him about the option of putting your ovaries to sleep with shots and taking an aromatase inhibitor.
Question:  #71 2/8/2009		Q:	Hi Lillie.. thank you again, follow up question on endometrial biopsy. The biopsy came back negative,(orginal tranvaginal 7mm to 1.7 cm after tramoxifen from july 08 until now) and my gyn told me that the period I had in Jan must have not been complete. the biopsy shoulded I was "due " to get my period. She said it was important to note that the biopsy showed I was still ovaulating. to review: stage I 1cm idc, estrogen and progesterone positive. had double mastectomy negative SNB..o/2 nodes oncotype 8. do you think tamoxifen would still be safe with these biopsy results, or do you suggest to ask oncologist about ovarian suppression..thank you again.
		A:	probably would be effective and doesn't sound like uterus has any issues of concern that would prevent use of tamoxifen either. good!
Question:  #72 2/9/2009		Q:	I hit my five year mark htis past July. I was diagnosed stage I invasive ductal no lymph nodes involved and er & hr2 negative. I started on Fareston, then was switched to Femara for the last 3 yrs. I was told i could go off of the Femara, but am a little frightened. Is it more beneficial to stay on longer. I have also had a bilat mastectomy and hysterectomy. Thanks.
		A:	Congratulations! You have reached a new step, completion of hormonal therapy. You are at very low risk with early stage cancer, favorable prognostic factors, 5 years out, and bilateral mastectomy. Risk is less than one percent of recurrence. Now is time to go off drug and focus on bone health. ds
Question:  #73 2/8/2009		Q:	My sister, aged 54, has been diagnosed with infiltrating lobular carcinoma T2 (4.4cm), Elston-Ellis grade I, ER+/PR+ (3, 100%), HER2-. Menstruation stopped just after the diagnosis. Mastectomy and axillary clearance were achieved and the cancer was finally rated N0. A radiation therapy followed by an hormone therapy with aromatase inhibitors are planned, but no chemotherapy. I would be interested to know what is the average delay, what is the usual waiting between the end of radiation therapy and the beginning of hormone therapy in that kind of situation (assuming there is no particular problem after surgery nor radiotherapy). Thanks in advance.
		A:	rather unusual for no chemo given size of tumor. ask about oncotypeDX being done to help verify that no chemo is needed. if no chemo needed then radiation starts 3-4 weeks post op.
Question:  #74 1/31/2009		Q:	thank you again lillie,..follow up question , related to endometrial thickening related to tamoxifen. Assuming all is fine with biopsy and I decide to go off tamoxifen, what are my options, 47 years old obivously pre-menopausal..just have a bad feeling about staying on tamoxifen... thanks again
		A:	one option is for the doctor to give you medications to put your ovaries to sleep then you might be a candidate for taking an aromatase inhibitor.
Question:  #75 1/24/2009		Q:	Hi Lillie, thank you for this wonderful website!My question is this: 6months ago I was diagnosed with stage 1 IDC, er+(70%),pr-,her2+++,node negative. The tumor was 1cm,grade2. I elected to have a double mastectomy, did 4 cycles of taxotere and cytoxan, weekly herceptin during chemo, and now receiving herceptin every 3 weeks until finished with the year long requirement. I was told with all I have done, being so aggressive with my diagnosis that I have a 97% survival rate, leaving a 3% risk for recurrence. I hope that my oncologist are accurate. The problem I am struggling with is this: as an RN, I have done extensive reading on TAMOXIFEN, and honestly I just feel that there are so many negative side effects, I just don''t want to take it. I realize the risk are low, but they are real. My onc says it improves your odds by 40-50%. When I am looking at a 3% risk, then 40-50% of that would give me a little more than 1%, am I correct in this? I have had so many different opinions, it is about to drive me insane. My oncs were comfortable with me refusing it, but being an ER nurse allows me to work with lots of doctors and I have been told literally that I would surely be dead in 5 years if I refuse it, one asked me if I was stupid, others have said being (pr-)means the tamox won''t really benefit me anyway, and I actually was even told that doing the chemo was a waste of time and that it didn''t help me at all. That in itself is just ridiculous to hear. I am only 45, I have a very active sex life with my husband and frankly I don''t want to have the quality of life that tamoxifen offers, but on the other hand I don''t want to be "stupid" by refusing it either. I would really appreciate your thoughts on this because I am losing sleep over this tremendous decision. Thank you so very much for your time. God bless, Jennifer PS-one other thing I struggle with is understanding how if I removed the tumor, had clear margins at 1mm from the tumor, the mastectomy, and the SNB plus 2 more nodes were negative, and I did chemo. Am I really at a risk of getting a distant recurrence? If so, do you have a that I can read to undertand how this happens, I''m very curious.
		A:	you have been very very aggressive with your treatment. given that you did bilateral mast for a stage 1 hormone receptor positive tumor too, along with a lot of systemic treatment, i would expect doctors to be comfortable with you forgoing the tamoxifen. you calculated it correctly too. you'd get a 1% benefit. not much... be well dear. feel well. LS
Question:  #76 1/23/2009		Q:	I am 56, d/x with DCIS, left side, 3 tumors, 8x5 cms, 2 3x3 cms. Had lumpectomy and f/up surgery to get 3x3x3 wide clear margins. I am half way thru prone-breast, accelerated rads (thanks to you for info on that, you may have saved me a heart event down the road!) I have spoken to 6 docs about tamoxifen or other drugs. Half say take and half say don''t. Pls be the tie-breaker for me. thanks
		A:	you are welcome... the decision should be based on the hormone receptor status. if ER positive then tamoxifen would be usually what is recommended. If ER negative then there may not be much if any benefit.
Question:  #77 1/18/2009		Q:	Hi Lillie, I was diagnosed with stage I, ER/PR+/HER- ILC (pleomorphic) at age 47 in 11/2007 following a reduction mammoplasty. Had SNB, bilateral mastectomy, TRAM reconstruction and started on Tamoxifen in 6/2008. This past November, I had 3 pulmonary embolisms, and was taken off the tamoxifen. I am premenopausal, 49 years old. Started on Zoladex. Should I be on an AI, or is the ovarian suppression enough? Thank you so much for the service you provide!
		A:	Your question is a good one, and one that currently has no clear answer. There is an ongoing trial called SOFT (suppression of ovarian function trial) that will be comparing tamoxifen, ovarian suppression with tamoxifen and ovarian suppression with an AI to see which is the best hormonal regimen for premenopausal women. That said, you cannot be on tamoxifen because of your clotting risk, so probably most oncologists would recommend ovarian suppression with an AI. Talk to your doctor about this, and get a formal second opinion as well if need be.
Question:  #78 1/17/2009		Q:	Hi i was on tam for two years the six month ago I switched to femara, ocasionally a muscle would be very painful to move for a couple of days then suddenly be fine. Is this related to Tam or Femara or something else. Could Tam still cause blood clotting after so long. Thanks
		A:	tamoxifen would not contribute to blood clots anymore since you've been off for 6 months. joint and muscle pain are common complaints when taking an AI, which femara is. LS
Question:  #79 1/18/2009		Q:	Hi: I''ve been on Aromasin for 2 years this month. Pleural effusion and subclavicular positive node were resolved with this drug and I have remained without symptoms and able to work full time as a gardener, hike and otherwise have a great life. My oncologist told me the most time I can expect hormonal therapy to work is five years. I am thinking of getting a new oncologist. What do you think? You told me that some women have survived for decades on hormonal therapy alone. Why can''t I be one of them?
		A:	he's merely giving you the stats for the majority. your goal of course is to be in the minority. he doesn't want you disappointed if it only lasts 5 years. second opinions are always helpful.
Question:  #80 1/12/2009		Q:	Been taking Tamoxifen for 5 years. Switched to Femara in July 2008. Had bad dryness and pain with Tam so used Replens - 16 a day sometimes. No toruble with Femara so have cutback drastically. Noticed since doing that that I have had a small brown discharge maybe once during the day. When I increase the replens again, it goes. Is this normal.
		A:	No way to tell whether this is normal or not based just on your deion. Either way, definitely see your doctors regarding this as it is not something you want to take a chance with.
Question:  #81 1/12/2009		Q:	I really appreciate your continued kindness to all of us. I finished treatement for stage 2 bc seven months ago. I am 47 and on 20mg of tomoxofen each day. The side effects are not so good, dry eye, hot flashes and insomnia. I have not had a period since 1/08 and my estrogen is at 17. Soon I will be switching to a post-menapause preventative. I am worried because I had horrible bone pain during TAC chemo and I must work full time (three kids..two headed to college plus a ten year old!). Is there anything to do to prevent bone loss (I have a bad disc in my neck) or bone pain...diet, exercise, etc? I took pain meds during chemo and don''t want to go that route. I am also depressed a bit and don''t want that to get worse. Is one med better than the other? Do anti-depressents work with the meds?
		A:	Anti-depressants can be used with medicines, but need to be carefully chosen as they can have drug-drug interactions that can affect the effectiveness of either drugs. Therefore, these decisions need to be made carefully with your doctors. There are certainly medicines that can prevent bone loss, such as the class of drugs called bisphosphonates. These are usually given infrequently (eg once every 3 months), but again, they can have side effects and therefore should only be given under a physicians careful monitoring.
Question:  #82 1/12/2009		Q:	Thanks so much for this great service!! I have been on Tamox. since April of ''07 & had a D&C in Oct. ''08. A 5 cm polyp was removed as well as endometrium material - everything was benign. I haven''t had a period since the D&C. I just had a 3 month gyn exam & an ultrasound showed a 2cm thickening of my endometrium lining. My gyn doc. ordered some bloodwork to see if I might be menapausal & may do a biopsy. I''m aware that if I am menapausal - I can take an AI. She mentioned giving me some progesteron to stimulate shedding of the lining but my breast cancer was 50% PR+. If I''m not menapausal (my gyn doesn''t think I am)should I consider suppressing my ovaries & going on an AI? Do you have any other suggestions of what should be done at this point? I really appreciate your time & your insights!
		A:	Sounds like you need to see an oncologist in conjunction with your gynecologist about these results and potentially switching therapies. Being on Tamoxifen can give rise to endometrial cancer as I'm sure you are aware. The risk is small but real. There are other alternatives such as you mentioned with ovarian suppression and an AI, so these are now things to talk to your doctors about given what is happening with your uterus.
Question:  #83 1/4/2009		Q:	I''m having trouble tolerating Tamox, which I have been on for two years and want to move on to Arimidex. I had no periods for 13 months and my oncologist agreed to switch me to Arimidex. However, just as I was going to start Arimidex, I got a period so continued with the Tamox. After three monthly periods, my periods stopped again. It''s been 3 months since my last period. Do I have to wait a full year again of no periods before I can go on the Arimidex or can I rely on blood tests to confirm that I''m post menopausal. I don''t want to remove my ovaries.
		A:	Dear Barbara, This is Ben Park MDPhD from Johns Hopkins and I was forwarded your question by Lillie. Usually oncologists like to wait at least 1 year of no menstrual periods before declaring a woman to be postmenopausal and a candidate for aromatase inhibitors (like Arimidex). That said, if your side effects with Tamoxifen are intolerable, there are other alternatives such as ovarian suppression through medications with Arimidex. Though this is not yet proven therapy, it is being studied in a clinical trial and biologically makes sense, and many oncologists feel comfortable prescribing this regimen for their patients who can't receive tamoxifen for whatever reason. Talk to your doctors about these options as well as consider getting a 2nd opinion. HOpe that helps. Ben
Question:  #84 12/28/2008		Q:	I recently had a lumpectomy on my right breast. It was 1.5cm, grade 1,stage 1, ER 95%,RP and HER2 negative and lymph nodes were negative. I''ve received 4 mamma site radation treatment and now in the process of having 28 whole breast radation treatment. What would the the precentage of reoccurring if this was the only treatment I received.All other test on the tumor were negative. This is an Stage T1cNOMX tumor. Homonal therapy and cemo have been mentioned. This seem to be too much to me. I need some advice on the next step of treatment.
		A:	mammosite remains part of clinical research and there isn't longitudinal data to tell us the local recurrence rate long term yet.
Question:  #85 12/28/2008		Q:	42 years old, previously diagnosed of DCIS,lumpectomy and on Tamoxifen for 15 months. After New Year, I will have bilateral mastectomy and ovarian removed. I wonder do I continue to take Tamoxifen after surgeries?
		A:	no, would be highly unlikely that you'd continue hormonal therapy.
Question:  #86 12/29/2008		Q:	i am 51 yrs old. with er/pr receptor positive breast cancer. i had a 1.5 cm lump removed from my breast 6 months ago, and two sets of lymph nodes removed, because i had a small spec of cancer cells in one of the nodes that was removed during my lumpectomy. I’m considered very early stage 2. i had 4 rounds of chemo and 34 radiation treatments. the chemo has pretty much shut down my ovaries and uterus. i haven’t'' had my period in 3 months. I’m sure they will not recover. my oncologist wants me to take tamoxifen for 5 years. standard treatment for my cancer. i just want to know what r my chances of reoccurrence if i don''t take it. i have no history of cancer in my family. i think i may have gotten it because, i had no children and i was on birth control pills for 3 years for endometriosis. my sex life with my husband right now is zero because of my menopause, my vaginal area is already atrophied. I really want to try some natural hormone replacement to relive my symptoms, and improve my sex drive like maybe some topical hormonal creams or progesterone. But my oncologist says I’m taking a big chance of reoccurrence of my cancer. Do you have an opinion on this, you must get this kind of question frequently.
		A:	Dear Ginger, This is Ben Park MD,PhD from Johns Hopkins, and I received your question from Lillie. In general, most oncologists, including myself, do not recommend even topical hormone creams, as there can be systemic absorption, and as your oncologist suggests, this could potentially stimulate breast cancer growth. In general, hormone therapies are far more effective for treating breast cancer than chemotherapies if the breast cancer expresses ER and/or PR, so taking tamoxifen for five years is recommended. However, if after a year or two, if you've truly achieved menopausal status (and it sounds as if you have), taking another class of hormonal therapies would also be indicated (aromatase inhibitors), and you may not experience the side effects you currently are with tamoxifen, though new and different side effects could appear. Also, taking an aromatse inhibitor AFTER five years of tamoxifen would also be acceptable. Finally, many women experience relief from tamoxifen's side effects after being on it for a year. Talk to your oncologist about potential other options for hormonal therapy as well as things to abate the side effects, and if your are not satisfied with the answers, I always advocate getting a 2nd opinion. Best wishes, Ben -- Ben Ho Park, M.D., Ph.D. Associate Professor of Oncology Assistant Director, Medical Oncology Fellowship Training Program The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins 1650 Orleans Street CRBI Room 1M42 Baltimore, MD 21231 410-502-7399 office 410-614-8397 fax 443-287-4480 Lab Please do not seek formal medical advice/second opinion via email/internet. The responses to questions posted on the Hopkins website are not to be used as medical advise or construed as a second opinion. We want you to seek appropriate medical care and consultation as you need to. Thank You.
Question:  #87 12/29/2008		Q:	I had 4 cm infiltrating breast CA mass in 5/05at age 43. 4 rounds of AC beginning 5/26/05 decreased size to 2 cm for lumpectomy in 8/05. Sentinal node done on 3 nodes and was negative. ER+, don''t know about PR but was HER2-. Also had 12 rounds of taxol and 37 radiation tx after surgery. Radiation finished in 1/06 and started tamoxifen in 1/06. Had regular periods until 6/05 then no bleeding until spotting in 12/07, had uterine biopsy and no problem found. Happened again 11/08, had biopsy with resultant complex hyperplasia. I am still premenapausal at 46 y/o. Had a d & c in 12/08. I had one lupron (sp) injection (cost $200 for my part of insurance) then went to get the arimidex filled and had a $120 copay with insurance! I can''t afford a $400 increase per month! I don''t know if I should just have a hysterectomy then I can take the tamoxifen with no problems with the uterus or if there is something else I can try! Please give me your opinion.
		A:	Dear Sharon, This is Ben Park MD,PhD from Johns Hopkins, and I received your question from Lillie. There is currently no other approved therapies for the adjuvant hormonal treatment of breast cancer in premenopausal women other than tamoxifen. Even ovarian suppression combined with arimidex is still under research evaluation, though most oncologists, including me, believe it will be helpful if not superior to tamoxifen in this setting, but we don't know that for sure, and we also don't know the long term side effects of this regimen. Outside of a clinical tria, we generally reserve this for women who for whatever reason can't take tamoxifen, which sounds like this could be the case for you, given the possible cancerous effects to the endometrium. Raloxifene is a cousin of tamoxifen and doesn't stimulate the endometrial lining to the same degree as tamoxifen. HOWEVER, it is not approved for treating breast cancer, only for preventing it in high risk women and this has only been studied in the postmenopausal setting. Biologically, it is plausible that it could work for treatment, but again, this is under research investigation. It is also quite expensive. SO the bottom line is that a hysterectomy, assuming you don't want to have any future children, is an option, but that is a personal choice and should be discussed with your physicians. Hope that was helpful. -- Ben Ho Park, M.D., Ph.D. Associate Professor of Oncology Assistant Director, Medical Oncology Fellowship Training Program The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins 1650 Orleans Street CRBI Room 1M42 Baltimore, MD 21231 410-502-7399 office 410-614-8397 fax 443-287-4480 Lab Please do not seek formal medical advice/second opinion via email/internet. The responses to questions posted on the Hopkins website are not to be used as medical advise or construed as a second opinion. We want you to seek appropriate medical care and consultation as you need to. Thank You.
Question:  #88 12/21/2008		Q:	I am searching for ways I can protect myself after completing arimidex next month. I understand weight loss, exercise and fruits and vegs helps keep estrogen levels low. How much weight loss is necessary to see a reduction in estrogen levels? I am not overweight now but could lose 10 or 15 lbs. heathfully if that would make much difference.
		A:	you don't want to become thin. that's not healthy either. you want to be within your normal weight based on your height. there are lots of charts on this. go to any weight loss website. that said, being overweight results in extra body fat and we store estrogen in your body fat. that's the connection. so low fat diet, exercise 2-3 times a week, diet rich in fruits and veggie.
Question:  #89 12/21/2008		Q:	I have read in the artemis journal from Dec. 2008, about tamoxifen and the ability to determine if one is resistant to it. How can I find out if tamoxifen is still working for me?
		A:	a special blood test. your medical oncologist will be familiar with it.
Question:  #90 12/21/2008		Q:	Hello,I am 50 years old. 4 years ago i was operated for breast CA. I had 6 chemo circles and 30 radiotherapy. I used Tamoxafen for 2 years but my womb started to enlarge so for over a year i have been on arimedex. I was on enantone for 3 years and my oncologist told me to stop for 6 months. After 6 months my tests showed that my hormones were started to rise so once again i am on Enantone. Since I have restarted Enantone I am having bad side effects that I didnt have before. I no longer sleep. Terrable headaches. My oncologist said there is not much to do about it, as i have got to continue for another 2 years with enantone and arimidex. He did say that there is an anti depresive which does help with these symptoms. Please can you tell me if this anti depresive has side effects. I have put on a couple of KG since i restarted with Enantone, Im worried that I would put on more wait if I take this anti depresive. Would it be better to take sleeping pills? Thank you for your help.
		A:	he's probably referring to effexor. side effects are low. ask him about it.