I promised a “final” update after my oncology visit so I will keep my promise to those who still have any interest in this seemingly never-ending story of mine.
I shared a lovely drive to Victoria (takes about 3 hours) to see my oncologist yesterday with my sister Anne. She likes to drive so I was thrilled to sit and enjoy the spectacular vistas of “earth’s rebirth” on Vancouver Island on what was a sterling spring day.
The visit was about reviewing my options in the oral hormone/chemotherapy category. The Tit-o-Whirl rides slows but never really stops. I did a bit of reading before the trip so as not to appear uninterested to my oncologist. If you recall, I was not filled with warm fuzzies from my medical oncologist when we first met, so I wasn’t really looking forward to having this chat. But I was determined to at least have some REAL hard questions for him that I would not let him pass on answering.
My tumour was a hormone-receptor-positive (fed on estrogen) little bastard.
So for those who have taken Tamoxifen (or who have read up on it), you can skip this little educative bit if you like.
Since its approval in 1998, tamoxifen has been used to treat millions of women (and men) diagnosed with hormone-receptor-positive breast cancer. Tamoxifen can (so we are told) reduce the risk of breast cancer coming back by 40% to 50% in postmenopausal women (me) and by 30% to 50% in premenopausal women. It can reduce the risk of a new cancer developing in the other breast by about 50%. And most importantly (especially for me…..) if any breast cancer cells escaped past my lymph nodes and are lurking elsewhere in my body, Tamoxifen can slow or stop their growth. It is usually taken for 2-3 years (followed by an aromatase inhibitor for another 2 years) in Canada. In the US and Europe, it is now common for a 10 year treatment of oral hormone therapy for cancer treatment.
What I didn’t know is that it can also be taken by those who have not actually been diagnosed with cancer, but are at high risk of developing it!
Tamoxifen offers other health benefits that aren’t related to treating cancer. Because it’s a selective estrogen receptor modulator or SERM, it selectively either blocks or activates estrogen’s action on specific cells. While tamoxifen blocks estrogen’s action on breast cells, it activates estrogen’s action in bone and liver cells. So tamoxifen can: help stop bone loss after menopause and lower cholesterol levels! YAY!
However, as you may be sure….there is always bad with the good, right? So Tamoxifen, along with the potential for a MYRIAD of shitty, annoying fuck-with-you side effects (like weakness, memory loss, vaginal discharge or extreme dryness, vision problems, mood swings, depression to name ONLY a few) also brings the risk of blood clots, stroke and cervical cancer. YAY!
So after Cousin Tammi has her way with you, you move on to an aromatase inhibitor for 2-3 years.
The ovaries, while they are our main source of estrogen, are not the ONLY source. Our adrenal glands, located at the top of each kidney, make small amounts of estrogen and so does fat tissue and brain tissue through the activity of an enzyme called AROMATASE. So even us old peri and post menopausal dames are capable of making enough estrogen to feed those cancer cells that thrive on it. (Some factors known to increase aromatase enzyme activity include age, obesity, insulin, and alcohol…. YAY! That covers most of us peri and post menopausal dames!!)
So the smarty-pants scientists decided to develop an aromatase enzyme inhibitor (Aromasin, Anestrazole or Letrozole) which are meant to stop your body from producing ANY estrogen through enzyme activity. Because these meds lower the amount of estrogen in the body, less estrogen reaches bone cells, which can lead to significant bone thinning and weakening and a higher-than-average risk of broken bones. It also has a long list of side effects that mirror Tamoxifen, especially heart problems (27% higher risk).
Because I am osteoporitic (already have shown bone density loss), and I have had NO side effects from the Tamoxifen, my oncologist feels that I should continue with “cousin Tammi” for the full 5 years and likely continue for another 5 after that. And that the results will be virtually the same as if I had switched to an aromatase inhibitor.
I am happy to stay with the “known”. I am happy to have me back.
So dear reader, my ride seems to be done for now, and so am I. Thank you for sharing and bearing it with me.