The Tamoxifen Blues

Washington, D.C.–July 22, 2009–It has been a difficult year but I’m still standing. I am happy for that little comfort. I may not be the same girl that I was before I was diagnosed with breast cancer July 2008 but I made it through. And I’m still here. That is a huge blessing, just to be here. There were many days when I wondered if I would make it.

I started taking tamoxifen a few months ago. This is the next step in my complex breast cancer treatment plan. I am to take this drug for 5 years. It is supposed to reduce my chances for recurrence of cancer. But, between you and me, I don’t know if I’m doing the right thing.

In the beginning of my breast cancer treatment, I had several women tell me to refuse to take tamoxifen if my oncologist recommended it. They told me, in strong language, that the risks of this medicine outweighed the advantages. At the time of their admonitions, I had no idea what tamoxifen was or whether I would need it. I just wasn’t at the point in my treatment where their language made sense. I was drowning in a sea of despair and sadness and did not have the strength to research what the drug was and learn for myself whether I felt confident about taking it. It was the dark ages for me… the early days of my fight for my life.

In the past year, I have been through quite a bit. I have finished the hardest part of chemotherapy (the AC and Taxol). I have lost my breast and a few lymph nodes with a radical modified mastectomy. I have gone through nearly 8 weeks of radiation treatment and am more than half-way through my herceptin treatment. I am looking forward to my reconstruction surgery in a few months and am feeling somewhat whole again. I can see the end… and it encourages me.

I pushed the tamoxifen conversations to the back of my mind and pressed on through my treatment. When I was mid-way through the radiation treatment that followed my surgery my oncologist mentioned that I would begin tamoxifen at the end of the treatment. It was then that I recalled that tamoxifen was something fearful. But I didn’t know why.

Now, I have the energy and stamina to figure out whether tamoxifen is something I should be taking. The problem is that I started taking it over 3 months ago. Naturally, it would have been better had I researched the drug before I started but we do what we can, when we can. One thing is certain…my research is making me wonder… what am I doing?

Tamoxifen is highly recommended to women with breast cancer fueled by estrogen and it is suggested to be taken for 5 years. For those of us who are pre-menopausal when breast cancer strikes, it is said to reduce our chances of cancer recurrence between 30% – 50%. It reduces our chances of having cancer show up in the opposite breast by up to 50% as well. That is a very good thing.
I don’t know how it works specifically, but I do know that it reduces the estrogen in your body. I’m suffering from menopausal side effects – hot flashes and all. It’s a challenge to bear these side effects and keep my positive attitude. But I manage.

My fears lie in the possibilities that tamoxifen can lead me to have uterine cancer. Yes, you read that correctly. This treatment for breast cancer is linked to causing a different kind of cancer. The numbers are small… I think that the percentage of women who may end up with uterine cancer is about 1%. So, for the doctors, the good that the medication does outweighs the potential risks.
And for me, it seemed like a logical choice too. Until I talked to someone who fell in that small percentage. Well, her son. His plaintive comments to me about being aware of the risks of tamoxifen brought me back to a place of fear and concern for my own chances. According to the numbers, it is most likely that nothing will happen to me and I will get through the five years with little problem. Well, with the exception of being able to handle the menopausal-like side effects. But being able to put a face to that 1% makes it all too real that there is no easy answer to figuring out how to treat your breast cancer.

I am grateful for an oncologist who is easy to talk to. I plan on discussing my concerns about tamoxifen and uterine cancer at my next appointment. I don’t know how much it will change my perspective or make me more comfortable with my choice to take the tamoxifen. But… as with every other step of this journey, I have to find a way to make peace with all of the uncomfortable and scary parts. I made it through everything else. I can hope that I will make it through this too.

Nic McLean
Contribuing Writer for Fight Pink

Nic McLean is an African-American woman who is a Breast Cancer Survivor. Please read her Survivorship story here on the Fight Pink Site! Nic lives in the Washington D.C. Metro area, and is a contributing writer to Fight Pink. Nic will be writing about Breast Cancer and the African American Population. Fight Pink is very honored to have Nic contributing to our organization. Please visit Nic’s Blog to read more about Nic McLean.

For more information on SERM’s please view Fight Pink’s copy of the National Cancer Institutes’s “Understanding Cancer and Related Topics” Understanding Estrogen Receptors Tamoxifen, and Raloxifene. PowerPoint Presentation. Please make sure to view the notes at the bottom of the page to correspond with the power point.

Please visit the National Cancer Institute’s Fact Sheet Tamoxifen Questions & Answers.