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Can You Take Tamoxifen After Menopause

What Is Hormone Therapy

One Thing You Shouldn’t Be Taking on Tamoxifen

Hormone therapy slows or stops the growth of hormone-sensitive tumors by blocking the bodys ability to produce hormones or by interfering with effects of hormones on breast cancer cells. Tumors that are hormone insensitive do not have hormone receptors;and do not respond to hormone therapy.

Hormone therapy for breast cancer should not be confused with menopausal hormone therapy treatment with estrogen alone or in combination with progesterone to help relieve symptoms of menopause. These two types of therapy produce opposite effects: hormone therapy for breast cancer blocks the growth of HR-positive breast cancer, whereas MHT can stimulate the growth of HR-positive breast cancer. For this reason, when a woman taking MHT is diagnosed with HR-positive breast cancer she is usually asked to stop that therapy.

Re: Tamoxifen And Side Effects After Completing 5 Years

64 yo here – I went on Tamoxifen for 5 years after lumpectomy, chemo and radiation.; Five years later the cancer returned, diagnosed just weeks after an ugly divorce.; Back on Tamoxifen after mastectomy, etc. and coming up on 5 years again.; I’m willing to go the full 10 years, despite side effects similar to yours b/c I have 3 kiddos who care about me.; I’m working full-time again, but fatigue and fuzzy brain do make it difficult at times.

Drinking Coffee Is Okay Too

There have been a few studies that suggest drinking coffee can help prevent tamoxifen resistance. One study, published in the Cancer Causes & Control Journal, reported that tamoxifen-treated patients with ER+ breast cancer who drank 2 5+ cups of coffee per day had significant decreased risk for cancer recurrence. However, we need to be cautious in interpreting this finding. The researchers further went on to state that more research is needed to confirm this.

So, if you like to drink coffee, go ahead and drink coffee. If you dont drink coffee, there is no reason to start the habit just yet.

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Its Only Effective For Some Types Of Cancer

Studies have shown that tamoxifen can reduce the risk of cancer in high-risk women by more than 30%. But because the drug affects estrogen receptors in the body, it only works against cancers that are estrogen-receptor-positive or progesterone-receptor positive. Together, these make up about two-thirds of all breast cancers, according to BreastCancer.org.

The way tamoxifen works is youre depriving your cancer cells of estrogen, which is their nutrition, says Dr. Shah. So that will only work for the cancers that are estrogen-fed or progesterone-fed.

Menopausal Hormone Therapy After Breast Cancer

There, but for the Grace of   Girl vs Tamoxifen

Taking post-menopausal hormone therapy , also called hormone replacement therapy , to help with menopause symptoms may not be safe for women who have had breast cancer. If you are bothered by menopause symptoms, talk to your doctor about other ways to get help.

Many women have menopause symptoms such as hot flashes after treatment for breast cancer. This can happen naturally as women get older, but it can also be caused by breast cancer treatment. Some pre-menopausal women have menopause symptoms as a result of chemotherapy or from hormone therapy drugs used to treat breast cancer . Women who are past menopause might also get symptoms if they had to stop taking PHT.

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Five Years Of Tamoxifen Continues To Benefit Women 15 Years After Treatment

Summary

In a large randomized clinical trial, women with early-stage breast cancer who received 5 years of adjuvant treatment with tamoxifen had better outcomes up to 15 years after the start of treatment than those who received 2 years of tamoxifen therapy. Risks of cancer recurrence, of cancer in the other breast, and of death from breast cancer were all lower in women who took tamoxifen for 5 years than in those who took it for 2 years.

Journal of Clinical Oncology, published online March 21, 2011 .

Background

The drug tamoxifen, a type of hormone therapy, is a standard treatment for women with estrogen receptor-positive breast cancer. A 2005 meta-analysis indicated that 5 years of tamoxifen treatment is better than 1 to 2 years of treatment at preventing breast cancer recurrence and death in women with early breast cancer. However, these studies had a mean follow-up of 5 years, and the long-term benefits or risks of 5 versus fewer years of tamoxifen have not been clear.

The Study

The Cancer Research UK Over 50s clinical trial enrolled 3,449 women aged 50 to 81 years with early-stage breast cancer that could be removed surgically. The study recruited participants between 1987 and 1997 from 71 hospitals in Europe and Asia. Just over half the women had already gone through menopause.

Results

Limitations

Looking After Your Bones While Taking An Aromatase Inhibitor

Aromatase inhibitors can reduce bone density. This may increase the risk of breaks in the bones. To keep your bones healthy while you are taking this medication, your doctor may recommend that you:

  • have a bone density test before and during treatment
  • do regular weight-bearing exercise
  • maintain a healthy intake of calcium
  • ensure a healthy intake of vitamin D
  • take other prescription medications to build up your bones if your bone density is already low

If you do show signs of bone thinning or weakening you may need to see your GP or specialist for special treatment for your bones.

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General Rules Of Thumb

Hi, Megan –

In general, if you’re premenopausal, you take Tamoxifen after completing active treatment — if you’re postmenopausal, you take an aromatase inhibitor .

As with everything in Cancer Land, there are exceptions — I’ve seen some postmenopausal women on this board who were unable to take an AI for one reason or another, so their doctors switched them to Tamoxifen.

There’s a second situation: Tamoxifen was originally developed and approved for the treatment of metastatic breast cancer — back then, it wasn’t given to early-stage women. And it’s still often used for that same reason now, whether the woman is pre- or post-menopausal. I think I remember that ChenHeart is taking Tamoxifen for this reason, and my aunt is, as well.

Hope that helps explain things a little better?

Traci

Prevention And Treatment Strategies

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When it comes to bone loss, prevention truly is your best defense. Whether testing shows any evidence of bone loss or not, the following strategies can help keep your bones strong:

  • calcium at 1,200 mg/day, taken through a combination of diet and supplements. Good sources of calcium include:
  • low-fat dairy products such as milk, cheese, and yogurt
  • goods such as leafy green vegetables, almonds, and beans
  • calcium-fortified foods such as fruit juices and cereals
  • vitamin D at 800-1,000 IU/day or more. Multivitamins typically include 400 IU, so you may need an additional supplement.
  • quitting smoking
  • weight-bearing exercises that help strengthen bones
  • maintaining a healthy body weight
  • limiting alcohol use
  • If bone density testing shows that you have worsening osteopenia or osteoporosis, your doctor may recommend you take a bisphosphonate. Bisphosphonates interfere with the activity of bone cells known as osteoclasts, which reabsorb bone tissue . This helps to reduce bone turnover and boost bone density. Common examples include Fosamax ; Actonel ; Boniva ; and Zometa and Reclast .

    Besides bisphosphonates, other medications that may be used to treat osteoporosis in women whove had breast cancer include:

    • Evista : Evista is a selective estrogen response modifier that can be used to treat osteoporosis in post-menopausal women.
    • Prolia : Prolia helps stop the development of cells that are responsible for removing old bone. As a result, the rate of bone loss slows.

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    How Is Hormone Therapy Used To Treat Breast Cancer

    There are three main ways that hormone therapy is used to treat hormone-sensitive breast cancer:

    Adjuvant therapy for early-stage breast cancer:Tamoxifen;is FDA approved for adjuvant hormone treatment;of premenopausal and postmenopausal women with ER-positive early-stage breast cancer, and the aromatase inhibitorsanastrozole, letrozole, and exemestane are approved for this use in postmenopausal women.

    Research has shown that women who receive at least 5 years of adjuvant therapy with tamoxifen after having surgery for early-stage ER-positive breast cancer have reduced risks of breast cancer recurrence, including a new breast cancer in the other breast, and reduced risk of death at 15 years .

    Until recently, most women who received adjuvant hormone therapy to reduce the chance of a breast cancer recurrence took tamoxifen every day for 5 years. However, with the introduction of newer hormone therapies , some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common .;

    Some premenopausal women with early-stage ER-positive breast cancer may have ovarian suppression plus an aromatase inhibitor, which was found to have higher rates of freedom from recurrence than ovarian suppression plus tamoxifen or tamoxifen alone .;

    Men with early-stage ER-positive breast cancer who receive adjuvant therapy are usually treated first with tamoxifen. Those treated with an aromatase inhibitor usually also take a GnRH agonist.

    What Types Of Hormone Therapy Are Used For Breast Cancer

    Several strategies are used to treat hormone-sensitive breast cancer:

    Blocking ovarian function: Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. Blocking ovarian function is called ovarian ablation.

    Ovarian ablation can be done surgically in an operation to remove the ovaries or by treatment with radiation. This type of ovarian ablation is usually permanent.

    Alternatively, ovarian function can be suppressed temporarily by treatment with drugs called gonadotropin-releasing hormone agonists, which are also known as luteinizing hormone-releasing hormone agonists. By mimicking GnRH, these medicines interfere with signals that stimulate the ovaries to produce estrogen.

    Estrogen and progesterone production in premenopausal women. Drawing shows that in premenopausal women, estrogen and progesterone production by the ovaries is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which then causes the pituitary gland to make and secrete LH;and follicle-stimulating hormone . LH and FSH cause the ovaries to make estrogen and progesterone, which act on the endometrium .

    Examples of ovarian suppression drugs that have been approved by the U.S. Food and Drug Administration are goserelin; and leuprolide;.

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    Who Should Use Tamoxifen

    Tamoxifen can help women and men with hormone receptor-positive breast cancer. The drug can lower the risk of breast cancer in:

    • Women who are high-risk of breast cancer due to a family history of disease or mutated breast cancer genes.
    • Women and men who have already been diagnosed with breast cancer to prevent recurrence of cancer, including:
    • Development of breast cancer in the opposite, untreated breast.
    • American Cancer Society. Accessed 10/10/2020.Breast Cancer Hormone Receptor Status.
    • American Cancer Society. Accessed 10/10/2020.Hormone Therapy for Breast Cancer.
    • American Cancer Society. Accessed 10/10/2020.Tamoxifen and Raloxifene for Lowering Breast Cancer Risk.
    • BreastCancer.org. Accessed 10/10/2020.Low-Dose Tamoxifen May Be an Option to Reduce Risk of Recurrence, Invasive Disease After Non-Invasive Breast Cancer.
    • BreastCancer.org. . Accessed 10/10/2020.Tamoxifen
    • National Breast Cancer Foundation. Accessed 10/10/2020.Hormone Therapy.
    • National Cancer Institute. Accessed 10/10/2020.Hormonal Therapy.
    • Susan G. Komen. . Accessed 10/10/2020Side Effects of Tamoxifen
    • Susan G. Komen. . Accessed 10/10/2020.Tamoxifen
    • Susan G. Komen. Accessed 10/10/2020.Tamoxifen and Raloxifene to Reduce Breast Cancer Risk.
    • Susan G. Komen. Accessed 10/10/2020.Tumor Characteristics: Hormone Receptor Status.

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    Hormone Therapy For Breast Cancer

    Breast cancer recurrence after stopping tamoxifen, breast ...

    Some types of breast cancer are affected by hormones, like estrogen and progesterone. The breast cancer cells have receptors that attach to estrogen and progesterone, which helps them grow. Treatments that stop these hormones from attaching to these receptors are called hormone or endocrine therapy.

    Hormone therapy can reach cancer cells almost anywhere in the body and not just in the breast. It’s recommended for women with tumors that are hormone receptor-positive. It does not help women whose tumors don’t have hormone receptors.

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    How Long You Should Take It

    Based on clear evidence from two large randomized phase III clinical studies , a 10-year rather than a 5-year adjuvant treatment with tamoxifen is associated with a smaller risk of recurrence and a reduction in breast cancer mortality.

    This reduction in breast cancer recurrence must be weighed against potential side effects for each person. For example, if your cancer has a relatively high risk of recurrence , the benefit of longer treatment may clearly outweigh the risk. In contrast, if your tumor has a very low risk of recurrence, the potential adverse effects of tamoxifen may outweigh the potential benefit.

    For men with early-stage breast cancer, tamoxifen is recommended for 5 years, with the option of continuing the medication for another 5 years for those at high risk of recurrence.

    Estrogens Promote Growth Of Some Breast Cancers

    Over 70% of breast cancers respond to the female hormone,estrogen.; The estrogens stimulate thecancer cells to grow and replicate, making tumors bigger and spreading thecancer to other areas of the body.; So,doctors are always trying to reduce a breast cancer patients estrogen levelsor response to estrogen.; There are a fewtechniques that oncologists use to do this, but by far tamoxifen is one of themost common.

    There are millions of people taking tamoxifen to prevent estrogen responsive breast cancer growth and recurrence.; It is the most widely prescribed hormonal drug for cancer patients on the market.;

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    Does Insurance Cover Tamoxifen

    While costs vary, tamoxifen is usually less expensive than an aromatase inhibitor because it is a generic medicine. If you have health insurance, check with your insurance company to see if and how much of the cost of tamoxifen is covered. If you don’t have health insurance or your insurance doesn’t cover the cost of tamoxifen, ask your doctor or nurse about programs in your area that may be able to help.

    Soltamox is available to patients who qualify at the same co-pay cost as generic tamoxifen. Patients can download a $10 co-pay per prescription card for unlimited use.

    You can also read Breastcancer.org’s;Paying for Your Care section for information on additional types of financial assistance and cost-lowering tips.

    Side Effects Of Tamoxifen

    How to Combat 3 Common Side Effects of Tamoxifen

    Tamoxifen’s selective estrogen activation effects can cause some serious side effects, including blood clots, stroke, and endometrial cancer. If you and your doctor are considering tamoxifen as part of your treatment plan, tell your doctor if you smoke or have a history of blood clots or heart attack. If you’re taking tamoxifen, call your doctor immediately if you have any of these symptoms:

    • abnormal vaginal bleeding or discharge
    • pain or pressure in the pelvis
    • leg swelling or tenderness

    Hot flashes or night sweats from taking tamoxifen can be troubling. But a 2008 British study suggests that women who experienced hot flashes and night sweats while taking hormonal therapy medicine were less likely to have the breast cancer come back . Knowing that this side effect might indicate a reduced risk of the cancer coming back may help some people stick with treatment despite the side effects.

    Some women on tamoxifen have reported memory problems while taking the medicine. While no definitive results are available yet, the ongoing Co-STAR trial is looking at the effects tamoxifen and raloxifene have on memory and thinking.

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    Support Your Body Through Its Cancer Journey

    Coping with cancer is stressful, even without the added questions of treatment side effects. Whether you opt for treatment with tamoxifen or decide on something else, support your body with good nutrition, plenty of pure water, and ample rest. Take time to care for yourself body, mind and spirit as you follow a path back to wellness.

    National Cancer Institute. Hormone therapy for breast cancer. Available at .

    Lumachi F, Brunello A, Maruzzo M, Basso U, Basso SM. Treatment of estrogen receptor-positive breast cancer. Curr Med Chem 2013;20:596-604.

    Lumachi F, Santeufemia DA, Basso SM. Current medical treatment of estrogen receptor-positive breast cancer. World J Biol Chem 2015;6:231-239.

    Esserman LJ, Yau C, Thompson CK. Use of molecular tools to identify patients with indolent breast cancers with ultralow risk over 2 decades. JAMA Oncol 2017; Published online June 29, 2017. doi:10.1001/jamaoncol.2017.1261.

    Vogel VG, Costantino JP, Wickerham DL, et al. Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene P2 trial. JAMA 2006; 295:27272741.

    Cuzick J, Sestak I, Cawthorn S, et al. Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial. Lancet Oncology 2015; 16:67-75.

    Breast Cancer Treatments And Bone Loss

    Many breast cancer treatments increase the risk of bone loss by lowering estrogen levels in the body. If youre premenopausal when youre diagnosed with breast cancer, the following treatments can accelerate bone loss:

    • certain types of chemotherapy that cause either temporary or permanent menopause
    • medications known as luteinizing hormone-releasing hormone agonists, which shut down the ovaries production of estrogen temporarily or permanently in some cases
    • surgical removal of the ovaries, which is recommended for some women
    • the hormonal therapy tamoxifen, which blocks the effects of estrogen in cells throughout the body and, as a result, can interfere with bone density in premenopausal women
    • aromatase inhibitors . If youre diagnosed with hormone-receptor-positive breast cancer after menopause, you might be prescribed aromatase inhibitors that can cause bone loss. These include Arimidex , Aromasin , and Femara . AIs stop the production of estrogen in your body. The main sources of estrogen in postmenopausal women are the adrenal glands and fat tissue, not the ovaries. If youre postmenopausal and take tamoxifen, on the other hand, it actually can help build bone density. For postmenopausal women, tamoxifens effects on bone is similar to the effects of the estrogen you used to have in your body naturally.

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