long-term effects of adjuvant, including tamoxifen, therapy

A very recent study in the Journal of the National cancer Institute found that breast cancer survivors who had not had adjuvant therapy (chemotherapy and/or tamoxifen) had the most favorable scores in global quality of life, general health, physical functioning and social functioning. On the physical functioning scale used in this study, women who received adjuvent therapy were 3 standard deviations below the mean of the general population and of the breast cancer survivors who received no therapy.  The women in the study were between 5 & 10 years post-initial diagnosis.

This raises the very real question of whether tamoxifen therapy should continue to be recommended for women like myself, who underwent lumpectomy and radiation for DCIS. What are your thoughts?

The study is in the Jan. 2, 2002 issue of the journal.

[CCF-RN,MSN-rf]

Dear lobake:  Interesting article.  One point of clarification, the article mentions that the group that was most impacted on the physical functioning scale was the group that received systemic chemotherapy.  It also mentions, that, at the time, tamoxifen was not given to premenopausal women.  This practice has changed.  Tamoxifen is recommended in estrogen receptor positive tumors in premenopausal women.  Certainly, risks versus benefits should always be discussed as they relate to the individual.  Given that Tamoxifen has been shown to prevent 2nd primary breast cancers in as many as 49% of high risk women, I would be cautious in trading potential cancer recurrence with a modest long-term difference in QOL.  The article states that 6% of these "low risk women" had reported recurrences and their quality of life (QOL) scores were lower yet, as expected (I don't think they reported what follow-up treatment had been given to this group).  As the article mentions, further investigation is needed.  Perhaps, if we could know in advance, who would recur or develop second primary breast cancers, it would be much easier to make these treatment decisions.  I think this article mentions some very good points but it is premature to abandon standard medical practice on the assumption that recurrence rates would remain low (6% as this study reported) and long-term QOL would improve.  This adds credence to having adjuvant therapy discussions with very knowledgable individuals who can factor in an individual's risk and consider QOL.