Reducing risk of breast cancer after one mastectomy

Hi,  

I'm 37, had a right total mastectomy for DCIS w/ a rare focus of microinvasion less than 1 mm - weak ER, strong PR, HER-2/NEU neg., neg. sentinel node, BRCA2 positive, strong family history (5 paternal aunts). Because of my increased breast and ovarian cancer risk, my doctors asked me to consider a prophylactic mastectomy &/or oophorectomy in the near future.

If I don't want another pregnancy and want to reduce my risk of a new cancer in the left breast w/o doing any prophylactic surgeries, do you suggest taking tamoxifen or an LHRH analog (Zoladex or Lupron) or an ERD (Faslodex)?  Which among the three would be more effective, have longer lasting protection and have less side effects?

Also, should women get their estrogen levels or cholesterol levels measured before starting tamoxifen?

One very last question. For studies showing that tamoxifen increases the uterine cancer risk for post-menopausal women, would the same increased risk apply to pre-menopausal women who've had an oophorectomy?

Thanks for taking my many questions.

[CCF-RN,MSN-rf]

Dear chitb:  While suppressing the ovarian function may reduce breast cancer risk, prophyllactic surgeries will often offer the greatest risk reduction possible.  The benefits and risks must be carefully weighed as they pertain to you.  A genetic counselor may be of help in this discussion.  Both zoladex and lupron have been used to suppress ovarian function.  Faslodex is not indicated for premenopausal women.  Tamoxifen is the drug of choice for ER/PR positive breast cancer in premenopausal women.  An oopherectomy would not reduce the risk of uterine cancer associated with tamoxifen, although, in reality the risk is still less than 2%.