What's after tamoxifen, if still having period?

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Question from DeeC: If you have had breast cancer and are on tamoxifen for 5 years, what is next after that if you are still getting your period?
Answers - Lynn Schuchter That is an excellent question. I would say there is some controversy about how to best manage that individual and there is not a consensus on how to manage that patient because we don't have clinical trials to specifically guide us in treatment recommendations. One possible option is to take a medication called an aromatase inhibitor like Arimidex (chemical name: anastrozole) or Femara (chemical name: letrozole), in conjunction with a medicine to put the patient in menopause, like Zoladex (chemical name: goserelin acetate) or Lupron (chemical name: leuprolide acetate). The difficulty here is that women who are postmenopausal who have taken 5 years of tamoxifen can then be offered an aromatase inhibitor and there is clear data that those women benefit from an additional five years of this hormonal therapy. This approach is associated with improvement in outcome. However, the mechanism of aromatase inhibitors in terms of its effectiveness against breast cancer is only useful for women who have gone through menopause. We have no data on efficacy of using these medications in premenopausal women and they would not be as effective in premenopausal women. One possibility is to put the patient into menopause, and that can be done with medicines or by taking the ovaries out and then using aromatase inhibitors. But this is not completely supported by data, so one would need to look at the woman's overall situation — would she benefit from 5 additional years of hormonal therapy? Are there other competing issues, such as not putting her into menopause for health issues? So this is an excellent question, and one you should definitely speak to your doctor about.
Jennifer Armstrong, M.D. I think Dr. Schuchter's detailed response really reflects our current situation. As she stated, we do not currently have evidence that anything after 5 years of tamoxifen benefits women who have had breast cancer and remain premenopausal. Dr. Schuchter elegantly described the reasons why we hypothesize and consider chemical ovarian oblation to bring premenopausal women into a menopausal state in order to change the hormonal milieu and potentially increase benefit from aromatase inhibitors. For most women who remain premenopausal after 5 years of tamoxifen, they will be considered as having completed their adjuvant therapy. (Adjuvant therapy is therapy given after surgery with curative intent.) They can certainly applaud themselves for their accomplishment.

The Ask-the-Expert Online Conference called Young Women and Breast Cancer feautred Lynn Schuchter, M.D. and moderator Jennifer Armstrong, M.D. answering your questions about the special concerns of young women who have been diagnosed with breast cancer.

Editor's Note: This conference took place in April 2006.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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