Alternatives to tamoxifen for premenopausal women

I am 36, diagnosed with Stage 1 breast cancer 3 weeks ago. I felt a lump, not visible on mammogram, seen under ultrasound. Biopsy was done for initial diagnosis, moderately differentiated invasive ductal carcinoma, ER/PR positive and HER-2 negative. I had a lumpectomy with sentinal node biopsy. 2 lymph nodes were removed and they were negative. The tissue is going out for onco type DX testing. I have never been pregnant and would like to have a child before I am 40. I have been told so far that I would take tamoxifen and receive radiation, chemo would depend on the final results. I also did genetic testing, those results are not back yet. Is there other options to taking tamoxifen, should I take something for ovarian suppression? Is coming off tamoxifensfter 2 years for 3-6 months then trying for a pregnancy then returning to tamoxifen for the remaining 3 years reasonable?

[Fernando Roque, MD]

Hi.  Ovarian suppression with LHRH (luteinizing hormone-releasing hormone) agonists like Zoladex is an alternative to using Tamoxifen, but it is unclear at this point if the use of LHRH agonists alone is as effective as Tamoxifen as hormonal treatment for early premenopausal breast cancer.  It is possible to come off Tamoxifen after 2-3 years of treatment to try for a pregnancy, then return to Tamoxifen to complete five years.  In becoming pregnant, a woman shall also achieve a "low-estrogen state", so the efficacy of the hormonal treatment may not be adversely affected by temporarily withholding Tamoxifen.