Should I begin Tamoxefen

[frend]

I have had three biopsies on my left breast. The results are as follows:
1999: neddle core biopsy: Mild ductal hyperplasia with microcalcifications.
2001: excisional biopsy: focal atypical lobular hyperplasia involving ducts. Fibrocystic changes.
2003: needle core biopsy: focal intraductal hyperplasia, fibrosis, microcalcifications.
All were done in the area of 2oclock in the left breast.

Risk factors: mother and two maternal aunts with breast cancer (post menopausal. mother and one aunt had suregery and were placed on Tamox. Other aunt had mastectomy, chemo/rad and placed on Tamox). I am 47 years old. Pregnant one time but miscarried at ten weeks.
Healthy otherwise. Exercise 3-4 times per week.

Questions:
Should I take Tamoxefen prophylactically? (surgeon who did biopsy number two "strongly" reccomended it.) I have not done so yet b/c I am afraid of the risks of Tamox (endometrial ca and stroke)
If I take Tamox will taking an aspirin qd decrease risk of blood clots?
Is there another alternative drug for me if I need to be on one?
Will Tamox decrease the number of calcifications that like to multiply in my breast or will it just decrease the chance of atypia turning into cancer?

Thank you in advance for your response!

[sjo]

I had breast cancer in 1992 and had a mastectomy.  I took Chemotherapy  and Cytoxan for one year.  The worst year of my life, but I am glad that I did because I am still here.  My doctor told me if I could afford to take Nolvadex (the name brand) instead of Tamoxifen that he would rather I took the name brand.  I don't know the difference, I just did everything the doctor told me to do.  I took my last Nolvadex 8/18/00 and I was really scared to quit taking the medication.  I felt secure taking it and I truly believe that it does help prevent breast cancer.  I had hot flashes, weight gain, swollen feet and legs, and I slept very little while taking the drug, but I felt secure taking the drug.  I just had a tumor marker test done and it was 20.6.  I was told it was good but I forgot to ask what the normal numbers were for this test.  Good Luck to you.  sjo

[mabelwabel]

Have you thought about taking tamoxifin and seeing how it effects you?  There are people who have little side effects.  Your family history is strong.   please look at www.facingourrisk.org.

Have you heard of the BRAC gene.  There is a BRAC 1 and BRAC 2 gene, the site will tell you more.  

I have BRAC 2 gene, strong family history. All cancer in family occured 40 years plus.   I am 32 and wishing I had a prophylactic mastectomy and taken ANYTHING  I could to prevent this.   If you think the side effects from Tamoxifin look bad, you should look at the ones from Chemotherapy.

Please understand that my life is now at risk so my hindsight view is extremely clear (to me).   If I could turn back the  clock knowing what I know now, I would do anything to prevent.  

Please watch yourself very closely, the second best thing to trying to prevent cancer is catching it really really early.

[frend]

What is the difference between ductal and lobular atypical hyperplasia? (doesn't my second biopsy report suggest that I had atypia in the ducts as well?)
Could you also comment on "cancer risk model" which evaluates risk for developing breast cancer. (I had a 9% risk over 5 years and a 45% risk over lifetime)

Thank you for the referenced article. It was helpful. I have elected not to take Tamoxifen for now.

Thank you for your reponse and your referenced article.

[surgeon]

I'll chime in again to point out that your path report was atypical LOBULAR hyperplasia, not DUCTAL, and there's a difference: the former being much less of an issue. Which is why I said there's nothing in your report that denotes significant risk.

[esri12]

Hi, I was reading your post with a lot of interest because my situation is very similar to yours. If you want to read my post, please scroll down the page till you reach my post on 7/27/03 under the name esri12 "What should I expect in the future, prognosis-wise?".
Anyway, if you want to e-mail me I will be happy to share my experience with you and viceversa:)
My e-mail address is  ***@****
I know how confused you are right now!!

[CCF-RN,MSN-JS]

Dear frend, 1)There is no definite answer to your question, it is a matter of weighing risks and benefits.  In studies using tamoxifen for prevention, women with atypical ductal hyperplasia who took tamoxifen for five years had an 86 percent decrease in subsequent breast cancers.  On the risk side are side effects of tamoxifen hot flashes etc, the risks of endometrial cancer and blood clots are rare, but increase in women over the age of 55.  

2)There is no data that I could find that indicates taking a daily aspirin would alter the risk of blood clots from taking tamoxifen.  

3) There is currently a ongoing trial (STAR trial) looking at comparing tamoxifen vs. raloxifen as prevention - this however is for post-menopausal women.  

4) Calcifications or microcalcifications are small calcium deposits found within the breast tissue.  A large percentage of microcalcifications have nothing to do with cancer and probably the result of normal wear and tear on the breast.  growth and interfere with death of cells.

The theory of use of certain drugs for prevention of breast cancer is to interfere with the possible actions of precancerous cells.  For example some actions of a cell are; it can proliferate or grow and create more cells, or it can die on it's own.  Estrogen increases proliferation and decreases cell death.  Tamoxifen works by blocking estrogen, so in theory should be helpful in preventing breast cancer.

[surgeon]

It's a controversial subject: the main focus has been in women with known breast cancer gene. Your family history is such that  you might have it, but it's much more suggestive when the family members who get cancer are premenopausal. You could consider being tested for the gene; however, it remains an open question as to what is the best path to follow if one has the gene.

Nothing in your biopsy reports suggest significant risk. The findings you list are not uncommon, and have minimal association with cancer risk over time. Calcifications per se are not a problem; it depends on what the cause is. Tamoxifen has no effect of decreasing calcifications from benign causes. It is clearly not a generally accepted recommendation that all women take tamoxifen prophylactically. When it's a consideration, the criteria are few and not wholly agreed-upon. You might find this article thought-provoking: http://www.womenshealthnetwork.org/advocacy/fulltext/ttamox.htm