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Category:

Hormonal Therapy

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Question:  #1741 02/11/2003		Q:	I was done all treatments for breast cancer in March 2002 and my hair has still not totally come back. The crown is still pretty bald. I consulted a dermatologist and she has told me that this is a little known side effect of tamoxifen - happens to very few people? She seems to think the hair will re-grow after I'm done taking the tamoxifen. Any comments?
		A:	it is highly rare for a woman to lose her hair associated with tamoxifen. more common for women who take megace actually-- an anti-progesterone drug for breast cancer. For women having had chemo, they need to give their hair adequate time-- even as long as a year-- to return-- avoid hats that will smother your scalp and prevent it from breathing-- this can stunt the growth of new hair. consider talking with your doctor about tamoxifen and other options of perhaps another SERM similar to it if the doctor feels that tam is the culprit.
Question:  #1742 02/11/2003		Q:	I had a lumpectomy and radiation 12 years ago. I was also on tamoxifen for five years following my lumpectomy. I had a mastectomy on my other breast last month. My doctor recommends me taking femara. How much does femara reduce the risk of me getting breast cancer in my other breast? What are the the side effects of femara?
		A:	Your doctor should be providing you information specific to your situation as to how much femara will reduce your risk-- it is individual for each person based on many factors associated with their prognostic factors, path results, age, etc. Most patients don't complain of side effects but again, ask your doctor for something in writing that outlines what to expect when taking this drug. Your pharmacist will also provide you a sheet of information on it as well. There aren't any published studies right now that show the survival outcomes for women having taken tamoxifen and now taking femara to my knowledge. Doeesn't mean it is wrong-- just means there is lack of data to refer to..
Question:  #1743 02/06/2003		Q:	My receptor tests came back estrogen negative but progesterone positive. My oncologist wants to prescribe tamoxifen. Is this the norm even with er neg. tumors?
		A:	There are some oncologists who would recommend it and some who won't. The benefit may be less effective than for someone who is estrogen receptor positive-- it is always useful to get another opinion from a medical oncologist who specializes in breast cancer though some consider that. also, other factors play into the decision-- your age, other prognostic factors from path results, size of tumor, nodal involvement, medical history, etc.
Question:  #1744 01/31/2003		Q:	yes ive been having a problem since i was 12years old i started to get hairs on my nipples and i dont know if its normal.Im actually really embarrassed of even going to the doctor and talking about it. thank you
		A:	It is normal to have hairs around the nipple growing as part of the aerola. You are just 18... some women pluck them but this can cause infection sometimes. try to ignore them and know that they merely belong there..
Question:  #1745 01/27/2003		Q:	Is tamoxifen perscribed before or after radiation?
		A:	usually after radiation.
Question:  #1746 01/24/2003		Q:	After the removal of my uterus and both ovaries when I was 24, I was placed on premarin 1.25 mg. I have taking this level of hormone replacement therapy for almost 28 years. I am now 51. The end of December I stopped taking premarin. I am now having extreme vaginal and vulvular dryness and hot flashes. I am on Lopressor for high blood pressure and I know that there are things I should not take in combination with a beta-blocker. I would like to try some of the alternatives such as soy, but do not know where to begin. I do not feel safe continuing on premarin since I have taken it for such an extensive period of time. I do not have confidence in my doctor since he did not feel I should make any changes in my hormone therapy. Because I have been on hormone replacement for such an extensive amount of time I would appreciate your opinion about continuing it. Thank you for this service.
		A:	Women with the help and guidance from a gyn doctor they see and trust, need to evaluate the pros and cons of taking HRT. You have been on it a long time but didn't mention any specific risk factors for yourself such as history of breast cancer in your family or personal history of BC or abnormal breast biopsy findings in the past. Quality of life is important. Some women do stay on it for a long time; others choose other alternatives. Some women choose to take an estrogen vaginal cream that contains a low dose and is not considered to increase the risk of developing breast cancer for women at increased risk. Over the counter products like Astroglide are also good possibilities. Soy products vary and some women report success while others don't. Hopkins has done some research with Revival Soy. You may want to talk with their medical director , Aaron Tabor, at 800-500-2055
Question:  #1747 01/23/2003		Q:	Is there a history of or studies in progress of the use of leuprolide (lupron) as an alternative hormone treatment in breast cancer? Where is more information available ?
		A:	Check with the cancer information service about it at 1-800-4-CANCER.
Question:  #1748 01/23/2003		Q:	I am a 41 y.o. woman who was diagnosed with DCIS last June. I had one 3mm tumor just outside left breast toward underarm, which was not tested for receptor status (too small). Cribiform cell type. I chose a bilateral masectomy with reconstruction. Despite my request for lymph nodes to be taken, the doctor did not agree and performed simple masectomies. No cancer was found in breast tissue. I also had a hysterectomy with ovaries removed last summer. I have 2 questions. Should I be concerned that cancer cells may have migrated to lymph nodes because of location of DCIS, and if so, what should I do now? 2nd question: should I take tamoxifen or are the masectomies combined combined with my low post-hysterectomy estrogen count good enough protection against a recurrance? I have 2 small children and will do anything to reduce my risk of recurrence.
		A:	You have clearly done the maximum treatment for ensuring that your specific breast cancer situation doesn't revisit you. The reason for no nodes being taken is that your DCIS was tiny and being noninvasive, there is no way anatomically for it to get to the lymph nodes so remove that from your worry list. Most women having had DCIS and bilateral mastectomies and a hysterectomy would forego tamoxifen as your particular risk of recurrence of this disease is extraordinarily low.
Question:  #1749 01/21/2003		Q:	Does the use of Tamoxofen increase the risk of endometrial carcinoma in a postmenopausal woman treated for DCIS ? Should hysterectomy be considered if there is endometrial thickening that is persistent(interval ultrasound testing) without evidence of vaginal bleeding?
		A:	yes, tamoxifen does carry a small risk of developing uterine cancer. Hysterectomy is usually not needed for endometrial thickening but instead an endometrial biopsy to rule out evidence of early stage precancer/cancer changes. 6 out of 6600 women developed uterine cancer in the clinical trials but 3 out of 6600 got uterine cancer taking a placebo which means that some women are destined to get uterine cancer unrelated to taking this drug. So biopsy is the diagnostic method of choice right now.
Question:  #1750 01/21/2003		Q:	Can tomaxifan be used for an indefinite period of time?
		A:	it is not recommended for longer than 5 years and hasn't proven to be more effective by taking it for longer than that period of time. for women who have taken it for longer, their risk of complications goes up as time goes by.
Question:  #1751 01/17/2003		Q:	Have been on tamoxifen for 6 mths following a mastectomy, no chemo or radio therapy.My oncoligist has now put me on monthly injections of Zoladex,why do i need the 2 forms of hormonal therapy
		A:	not sure so ask him. Your doctor needs to be communicating with you the rationale for any treatment that you are receiving so that you are an informed patient, and an empowered patient too.
Question:  #1752 01/17/2003		Q:	I am 48 yrs old, and a recent hormone test showed my estrogen is in mid-normal range, as well as my testosterone. However, my progesterone is very low. I am concerned that I may be at higher risk for breast cancer due to this imbalance. Should I be on a progesterone replacement? I am pre-menopausal.
		A:	The risk for getting breast cancer isn't so much in what your natural blood levels are but instead about taking supplements that increase those levels. Talk with your gyn doctor about your concerns and if you have a family history of breast cancer consider being evaluated in a high risk program so that a plan of care can be provided for you to potentially reduce your risk further.
Question:  #1753 01/14/2003		Q:	What are the best forms of birth control after having breast cancer? I had ER+ breast cancer with + lymph nodes, surgery, chemotherapy, and radiation, and am now taking tamoxifen I was 44 & premenopausal before treatment; I'm now 46 and with no menstrual periods. My gynecologist recommended spermicide and condoms, but I am concerned at how effective that is.
		A:	The word "best" is a tricky word--- most effect mehod of birth control of course is no sex. That clearly isn't the solution though! BC pills is a no no for the obvious reason-- they contain hormones and we want to keep you away from that. Spermicide along with condoms (the most expensive condoms from lambskin seem to be more durable) is a reasonable recommendation. The key to their success is following directions for usage and being diligent in using both methods at the same time as a safeguard-- ie, if one fails the other one hopefully takes care of any risk exposure for pregnancy.
Question:  #1754 01/14/2003		Q:	Is it possible for Tamoxifen to cause memory and language problems? I am 42, pre-menopausal and started taking Tamoxifen (20mg/daily) on Nov. 13, 2002 to cut my risk of recurrence of DCIS. Over the last six weeks or so I have forgotten several routine tasks and find myself confusing words (i.e. verbally using a 'wrong' word to describe something while thinking another). Thanks for any light you can shed.
		A:	This type of side effect hasn't been reported in literature that I'm aware of and you haven't been taking this drug very long either to cause such significant side effects to be drug induced. If you had chemotherapy however there is something called "chemo brain" that relates to what you describe. What is also interesting though is that women who only had surgery for their breast cancer have also reported memory problems which makes us suspect that breast cancer diagnosis and treatment can be similar to the effects of post traumatic syndrome.. your body has been through its own war of sorts... the healing now can begin.
Question:  #1755 01/09/2003		Q:	I have been diagnosed with Infiltrating Lobular Carcinoma. Estrogen positive. Tamoxifen has been suggested. I have a history of hormone induced migraines. I have a cousin with late state uterine cancer. Diabetes and heart problems run in my family. I am 46 and pre-menapausal. I am afraid the side effects outweigh the benefits of Tamoxifen for me, what do you think? Someone told me that Evista might be better, what is your thoughts?
		A:	It would be wise to get a second opinion formally from another medical oncologist who can outline for you based on your specific situation (stage of disease, risk factors, prognosis, family history) what statistically are the pros and cons of taking tamoxifen. Seek out a medical oncologist who specializes in breast cancer for this purpose. Evista is a SERM, selective esrogen receptor modulator, and there is a clinical trial comparing tamoxifen with it but the study isn't complete. An issue is that though it may have less side effects, it also might be less effective in preventing recurrence--- the study needs to go for a longer period of time to determine this.
Question:  #1756 01/07/2003		Q:	I am 44 years old. I am have been off tamoxifen for 4 months. My periods seem to be returning to normal. Both my mother and sister have been diagnosed with osteopena. Would Raloxifene be beneficial for prevention of reoccurence and bone loss?
		A:	the raloxifene studies are still underway to see what benefit they are in preventing recurrence so right now we don't know their true benefit. This drug is effective in preventing osteoporosis and has been FDA approved for that purpose though. Talk with your medical oncologist before embarking on it though. we don't know a great deal about taking tam followed by raloxifene.
Question:  #1757 12/27/2002		Q:	March discovered lump April had core biopsy, then excisional biopsy - 1.5 cm invasive, sentinal node clear, ER+ (97%)PR+ (37% May lumpectomy followed by A/C and 34 weeks rads ending December 2. Have not started Tamox yet (it's 12/26) - wanted an intermission during the holidays. How long can I "safely" wait to begin Tamox?
		A:	There aren't published studies that look at comparing time frames for starting tamoxifen, but it isn't uncommon for women to a month post radiation before they do. Look at the new year as your time to begin hormonal treatment that should greatly help prevent revisiting of this disease.... great news that you were highly hormone receptor positive too. Happy and healthy new year to you dear.
Question:  #1758 12/23/2002		Q:	I am 55y.o.,6years post lumpectomy,lymph nodes negative and subsequent radiation therapy. I received tamoxifen for five years which was discontinued about 1 year ago. Still having mammograms performed every 6months. I am fit,work as a teacher but have absolutely no sexual drive or interest, it is frustrating to not be able to have orgasms any longer. What role would HRT play in this situation. Are there any other alternative treatments?
		A:	HRT is considered medications breast cancer survivor should steer clear of, once diagnosed- especially those who were hormone receptor positive as I assume you were. From a libido perspective, HRT can help with vaginal dryness but so can many other products that doesn't involve estrogen. It may be beneficial to see a psychotherapist and talk through what has changed in your life that is now producing this decrease in libido. Tamoxifen can reduce it some but being off of it now for a long enough period of time tells me that something else is going on. More foreplay may be needed or other means ot stimulation to get you in the mood, and there is nothing wrong with that! If vaginal dryness is part of the cuprit consider trying astroglide available over the counter in drug stores.Talk with your partner about what you like and don't like and look at the new year as a time to experiment in bed that can rekindle that which has been made dorment by the treatment of this disease.
Question:  #1759 12/19/2002		Q:	I had surgery for a .5cm invasive lobular tumor of the left breast three years ago and am taking Tamoxifen. Is this still standard protocol or is Arimidex considered more appropriate now?
		A:	tamoxifen is still the standard at this point in time so you have 2 years left-- you are over your half way mark . Good for you!
Question:  #1760 12/19/2002		Q:	Please compare efficiency and side effects of femara and arimidex thanks
		A:	Both are being used in the form of clinical trials and side effects vary from patient to patient. Ask your doctor for a print out of patient education literature to help you determine which might be best for you, assuming you are being offered both options.
Question:  #1761 12/04/2002		Q:	I am 56 years old and have been on Tamoxifen for two years and am experiencing a lot of trouble with my nerves, seem to be very weepy for no reason. Just like when I was going through menopause. I used to have a couple of days like this maybe once a month just like when in menopause but now it is lasting for weeks and I am having a very difficult time dealing with it. It this a normal side effect and how do I deal with it?
		A:	It is a relatively common side effect for some women and many have had success in taking medications like Effexor to combat/prevent it. talk with your doctor who prescribed tamoxifen so that you can get on some medications to balance the side effects as you continue your hormonal therapy.
Question:  #1762 12/03/2002		Q:	I was diagnosed with dcis...no invasion reported, however, my doctor performed a sentinel node injection and we found 14 tumor cells in that particular node. She also removed 5 additional nodes which were clear. I am er+ and am on tamoxifen.......thankfully with only one side effect that I notice. My doc decided that research shows that in cases like mine, the tumor cells may have entered into the sentinel node as a result of being "jarred" loose from a previous biopsy. Do you concur based on this basic info? Also, I have been told that taking tamoxifen can limit the use of chemotherapy drugs used if I need them in the future.....is this correct? LAST.....do you know a web site that lists all the possible problems that can occur using tamoxifen? One of my anesthesiologists said that it can "fry" your veins? Never heard of this.....have you?
		A:	Wow.. you've gotten some unusual information. 1) no, the cells can't be jarred lose to go into the sentinel node. If there were cancer cells in the sentinel node then somewhere hidden in the DCIS is invasive ductal cancer. Have you pathology slides re-reviewed by experts in pathology who specialize in breast cancer, either at Hopkins or another large comprehensive cancer center. 2) side effects of tamoxifen-- www.astrazeneca.com is a reasonable site for review of this information; 3) fry your veins? nope. not true. there is increased risk of developing blood clots, especially for smokers, but the risk is low.; 4) can't take chemo or limits chemo choices for future? nope, hormonal therapy is totally different than chemotherapy.
Question:  #1763 12/01/2002		Q:	My Mother is taking Tamoxifen to prevent her breast cancer from returning for over a year now. She is so fatigued. Blood tests show that her blood is low in red blood cells. Her doctor said her blood was 3 pints low in August, but in October it had improved--only 2 pints low. Have you heard of anyone else experiencing these side effects?
		A:	no, this is unusual and probably not related to tamoxifen. sounds like she needs an internal medicine work up to determine the cause of her anemia. Talk with her family doctor about arranging this. If she has had chemotherapy in the last 6 months then it may be residual from that treatment. hope she gets her energy back soon.
Question:  #1764 11/26/2002		Q:	dx with dcis high grade comedo type with foci of microinvasion pr +, her2 + had mastectomy. would you advise taking tamoxifen. i was told that it decrease sour chance of recurrance 48%. however it was brought to my attention that since with dcis you only have a 5% chance of getting a recurrance or invasive cancer in the other breast the percentage of this drug helping is 2%. is this info correct because the side effects of the drug wouldnt seem beneficial for a 2% advantage.
		A:	sounds right. You may want to get a second opinion from another medical oncologist to decide. Some women want to do everything and anything available to reduce risk and other patients choose to do less, based on their concern about side effects. Side effects from tamoxifen can vary from person to person so don't assume that you will have problems either.
Question:  #1765 11/18/2002		Q:	I was diagnosed in Oct. 2000 at age 39 w/a 1 cm er+/pr+, node negative, HER2-, invasive ductal ca. My therapy: radiation(6 weeks), tamoxifen(5 yrs.), and zoladex injections(3 yrs.). Next year, I will be off of the zoladex injections. Any early data available on the ZIPP or ZEBRA studies? Does zoladex look as effective as chemotherapy in pre-menopausal pts? I am anxious about stopping zoladex. I know that Nancy Davidson at Hopkins is an expert in breast ca and hormonal therapy and would like to get her take on zoladex vs. chemotherapy. Also, should I be concerned about osteoporosis? Thank you.
		A:	Dr. Davidson is excellent and the majority of our medical oncologists in the breast center are experts with hormonal therapy. Your request really requires a formal consultation here to best serve your needs and answer your questions and you are welcome to come and see us for that purpose. to schedule an appointment just call 410-955-8964 and the oncology referral office (either Judy or Machelle) will get you scheduled. I'm not aware of data available yet on these studies that is ready for public consumption but the research in this area is promising and exciting.
Question:  #1766 11/17/2002		Q:	I'am 50 years old. 6 months ago I found a medullary atypical breast mm 17 x 13, no lymph nodes and estrogen - and progesterone+( 60%) c-erb - Do I need Tamoxifen and Enantone? I haven't menstruation after chemotherapy
		A:	Sorry. this question requires a formal medical oncology consultation to help determine this. If you are doubting your doctor's advice or simply need more assurance that the course of action is right, seek another opinion at another breast center from a medical oncologist who specializes in breast cancer.
Question:  #1767 11/17/2002		Q:	I am high risk for breast cancer. I am considering going on Tamoxifen, but I had a TIA in 2000. A thorough cardio and neurological work up found no signs of TIA. Should I consider taking tamoxifen?
		A:	It depends on how high risk you are. See a medical oncologist who specializes in high risk women. At Hopkins, that doctor is Dr. Deborah Armstrong. Usually doctors steer patients away from tam with a known history of TIA but it sounds like you have no residual effects from it. Get an opinion from a high risk expert who can look at how high risk you are and put together a plan of action for you that may or may not include tam but might include a different SERM drug.
Question:  #1768 11/17/2002		Q:	I was diagnosed with breast cancer in year 2002. No family history of breast cancer. I had taken hormones for 10 years. My diagnosis is ER/PR positive, HER-2/neu negative postmenopausal T1,NO,MO-stage1, status pos TAH/BSO. I am now taken tamoxifen. My question: Since there is no history of breast cancer, was my breast cancer caused by me taking hormones for years?
		A:	No. first keep in mind that only 12-15% of women diagnosed have a family history. HRT doesn't cause breast cancer but might contribute to it growing once it has gotten itself established in your breast. Don't kick yourself for taking HRT. hinesight is always 20/20.
Question:  #1769 11/07/2002		Q:	I AM PRESENTLY TAKING ESTRADIOL AND PROGESTERON. I WAS DIAGNOSED WITH DUCTAL INSITU. SHOULD I STOP TAKING. MY BIOPSY REVEALED 1-2MM MASS WITH WIDE EXCISION NO RESIDUALS.
		A:	The standard of care is that anyone diagnosed with breast cancer, including ductal carcinoma insitu disease, should not take HRT. don't be surprised if the doctor recommends tamoxifen post op.
Question:  #1770 11/06/2002		Q:	For someone who has DCIS, is the hormone receptor test necessary to determine whether or not Tamoxifen will be effective? Why or why not is the hormone receptor test necessary in DCIS cases?
		A:	it isn't considered to be terribly accurate in all cases. Th studies done with tamoxifen though have proven that women with DCIS benefit from taking this drug to prevent recurrence, as long as there aren't contraindications for taking it (ie, history of blood clots for example)