Tamoxifen we may meet again?

I've been dreading this post.  Basically ATLAS trial showed that 10 years of Tamoxifen offers more benefit than 5 years.  This came out at the San Antonio Breast Cancer Symposium in December.  To review, those who are estrogen receptor positive basically means estrogen feeds our cancer and that is why we take hormone inhibitor pills like Tamoxifen, especially if you're premenapausal.  Dr. H already wanted me to be on it for 10 years.  The visit with Dr. Litton was in September and she was fine with me being on it for just 5 years.  I think I will need to email Dr. Litton.  Also this Medscape article interviewed Dr. Ravdin who came up with Adjuvant! He apparently would recommend 10 years for those grade higher than 1 and node positive.  I'm node negative but grade 2 intermediate grade....grrrrr...so I may still see Tamoxifen once again.  If so, I don't think I want to do it until I completely know I am not going to have a child.  Even with Tamoxifen it comes with a price of quality of life.  For me I think the major culprit was sleep.  I see Dr. H again this summer and hoping to email Dr. Litton within the next week or so.

 "The results of ATLAS are most relevant for younger women," said Peter Ravdin, MD, who moderated the press conference. Dr. Ravdin is codirector of the SABCS and director of the Comprehensive Breast Health Clinic at the University of Texas Health Science Center at San Antonio.

Dr. Ravdin plans on telling his premenopausal patients with ER-positive disease that 10 years of tamoxifen has benefit over the standard of 5 years. "I am going to be comfortable doing that," he said. The risk for endometrial cancer with tamoxifen is "very low" in these younger women, he added. "I think this trial will have a major immediate impact on premenopausal women."

However, tamoxifen beyond 5 years is not for every premenopausal woman.

He explained that he would lean toward recommending it to women who are at high risk for late relapse (those with positive nodes and/or bigger tumors). Women with small grade 1 cancers are not good candidates because their risk for recurrence is so low. Taking tamoxifen comes with quality-of-life issues, such as hot flashes and other effects, he reminded reporters. Many women already struggle to complete 5 years of tamoxifen because of the adverse effects, so taking the drug for 10 years will present challenges.

The study was funded by Cancer Research UK, the UK Medical Research Council, AstraZeneca, the United States Army, and EU Biomed. Dr. Gray and coauthors Dr. Ravdin, Dr. Barlow, and Dr. Powles have disclosed no relevant financial relationships.

Lancet. Published online December 5, 2012. Abstract, Comment

35th Annual San Antonio Breast Cancer Symposium (SABCS): Abstract S1-2. Presented December 5, 2012