Prophylactic Use of Tamoxifin

[murray]

My wife is 37 years old, and has a history of breast cancer in her family.  Her mother (75) and mother's sister (60) each had a lumpectomy, and are now doing fine.  Her paternal grandmother died of breast cancer in her 60's.

My wife has been diagnosed as polycystic, and has had fluid removed from a clogged duct (pardon the lack of precision with which I use medical terms, but the doctors also spoke of calcifications).  To date, all reports have been negative (i.e., good for us).

In a recent exam, doctors has advised my wife to consider the use of tamoxifin as a guard against the development of breast cancer. We are reluctant to do so because of its effects (impact on menopuase and menstruation -- pregnancy is less a concern because we have two children already).  We are pursuing second opinions from other specialists and onconologists, but I wanted to know whether this type of prophylactic use of tamoxifin is common, increasingly suggested, uncommon etc.

Thanks for the insights.

[Baskie]

How do I post a question?  Mine was just rejected.

[Baskie]

I have been taking Tamoxifin for about 6 months.  The side effects have been very difficult.  Terrible night sweats, hot flashes all day and, now, terrible pain in my elbows.  I arbitrarily took myself off of Tamoxifin a week ago.  The pain in my right elbow has subsided but the left is still very painful and weak.  The night sweats are a little better.  The hot flashes are no different.

Has anyone else had this experience?  What does it mean?  How can I help myself heal--my elbows and night sweats?

Will appreciate any help anyone can offer.

Thanks!

[CCF-RN,MSN-JS]

Dear Murray, There has been an increasing amount of literature and studies about the use of tamoxifen in the prevention of breast cancer.  The question that continues to be studied is; which people would potentially benefit the most from its use as a chemoprevention agent?  In an attempt to provide patients and health care professionals some standards to go by in terms of risk potential, scales have been developed. Two such scales that are currently used are the Gail model, or the Clause model.  Specific information, such as age, number of first degree relatives (mother or sisters) that have had cancer, a personal past history of an abnormal breast biopsy, are keyed in to the scale and a computer generated score is obtained.  This score gives a relative risk potential that can be used when discussing the risks and benefits of using tamoxifen as a prevention agent.  The scores obtained from either scale are not perfect predictors, they are meant to be used as a guide.   What you are doing in terms of discussing the risks and potential benefits of tamoxifen with an oncologist and other specialists makes sense, as the absolute answer for your particular situation is not going to be clear cut.  The decision of whether or not to take tamoxifen will ultimately be up to you once you have been informed of the possible risks and benefits.