Hormone replacement and breast cancer

[Suziejane]

I had lobular cancer in lft breast.  Estrogen & progesterone sensitive.  After chemotherapy MRI and PET show absolutely no cancer.  I am having bilateral mastectomies and reconstruction to prevent any reoccurence.  I am now in menopause due to chemo.  Three questions - 1. How much will taking Tamoxifen or Arimidex cut my chances of reoccurence?  I really do not want to take them. Are there studies with percentages?  2. Could I take Indole 3 Carbinol instead?  It's supposed to work in the same way.     3. Can someone in my case take natural/plant estrogen supplements without worry about reoccurence.  Some things that I have read say that these supplements provide estrogen that work in a different way and will not "feed" estrogen sensitive cancer.

[CCF-RN,MSN-JS]

Dear suziejane:  1)In hormone receptor positive breast cancer many studies over the years have shown survival benefit with the use of hormone therapy.  The earlier studies had shown this benefit with Tamoxifen.  More recently with the advent of aromatase inhibitors (such as Arimidex) this benefit was seen with these medications in post-menopausal women. The percentage improvement depends on your baseline risk of recurrence but, in general, the hormonal treatment prevent close to half of the recurrences that otherwise would have occured.  

2) Indole 3 Carbinol is a substance that is being studied to see if it can help prevent cancer. It is found in certain types of vegetables. These include broccoli, cabbage, cauliflower and Brussels sprouts.  There are no data to support using it in place of hormone therapy for treatment of breast cancer.  

3)  The jury is still out on the answer to this question.  Estrogen-like substances that are found in plants such as soy, are much weaker than the estrogen found in the body.   However, how much would be too much is not clear. Some oncologists feel that normal dietary sources of plant estrogen-like substances are probably safe, however, supplements containing these products are often avoided as the dosages of estrogen-like substances may not be known or controlled given that supplements are not regulated by the FDA.

[carme]

You need to have a good talk with an oncologist. Sometimes you may have to sacrifice being totally safe ie. no hormone replacement vs. a little hormone replacement, to get some quality of life back...especially if you are suffering alot from hideous hot flashes etc. They can diminish your daily "quality of life".

My mother took Tamoxifen for 5 years and her breast cancer came back as ovarian cancer 13 years after that. I took  it in the trial because I have 3 daughters and had seen many family members die from breast cancer,  to see if it prevented breast cancer. My cancer showed up 8 years after I stopped the Tamoxifen. My younger sister had it 1 year before me, she was 48. She had not taken any drugs. Turns out, we have the BRCA2 mutation. She and I chose bilateral mastectomies and I had total hysterectomy.  We choose to fight and live.

[Suziejane]

Yes, the side effects from the chemo are bad enough.  The hot flashes are awful.  I can't sleep very well and if I do much of anything, I get them.  I feel so hot I feel like my head's going to explode.  I just feel really old.  My mother, her best friend and a co-worker all took Tamoxifen and all had reoccurences in the liver at about 9 years. I'm dreading taking it because it will most likely make the hot flashes worse.  I was just hoping that there was something that would help with the hot flashes but not increase the estogen and risk of reoccurrence.