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Is Tamoxifen A Better Medicine For Prophylaxis Of Breast Cancer?

Posted on Thu, 29 May 2014

Question:
I am almost 59 yrs old and dx with breast ca at age 50 (premenopausal but menopause from chemo), er pr positive with 3 small nodes. Had partial mastectomy, chemo, and radiation. Tamoxifen for 4 years, Arimidex for 2 years. Have been w/o hormonal rx for 2-3 years.

Now with the new info about tamoxifen, should I consider starting a few more years of tamoxifen or would Raloxifene be OK (I have osteoporosis). My oncologist was unsure but said Tamoxifen is OK if I want to and she prefers over Raloxifene. I prefer Raloxifene since it would address both problems.

I am otherwise healthy except for skin cancers. My mother was the first in our family know to have breast ca and died from metastatic about 10 yrs after dx and similar rx to me and dx at later age.

She took DES when preg with me.

I know the recent studies are on Tamoxifen but would not Raloxifene perform similarly?

I am not concerned about minor side effects; I don't want to get recurrent cancer!

Thank you.

XXXX

Answered by Dr. Manisha Jain (45 minutes later)

Brief Answer:
tamoxifen is better. add bisphosphonates

Detailed Answer:
Hello,

Thanks for trusting health care magic.

Tamoxifen is the best drug for prophylaxis of breast cancer especially when you had hormone receptor positive cancer.

Raloxifine though has almost similar effect but definitely less efficacious than tamoxifen plus you have family history so you have another indication for taking tamoxifen.

As far as osteoporosis problem is concerned I would suggest you to visit your orthopedic surgeon and get a prescription for bisphosphonates after physical examination which help in increasing bone density.

Take care. In case you have other questions you can contact me on health care magic and I will be happy to help.

Dr Manisha XXXXXXX

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Manisha Jain (10 hours later)

What about using Aromatase inhibitors?
Wouldn't that make more sense in post menopausal for prophalaxis?
Also, I have already been on 6 years of anti estrogen therapy.
So what is the recommendation about restarting?

Answered by Dr. Manisha Jain (8 hours later)

Brief Answer:
no need of therapy, anastrazole better choice

Detailed Answer:
Hello mam, in my opinion firstly you don't need further anti estrogen therapy and I consider you free from breast cancer risk and recurrence.
But as you are very much bothered and want to restart then aromatase inhibitor is a better choice because of
- better tolerance
- Lesser side effects
- No effect on endometrium (tamoxifen is carcinogenic for endometrium)
So if you want to start anastrazole is a better choice for you.
I wish you the best of health and cancer free life ahead.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Manisha Jain (3 hours later)

So if I don't need any hormone treatment, why not use Raloxifine for my osteoporosis to get benefit of anti estrogen?

Answered by Dr. Manisha Jain (44 minutes later)

Brief Answer:
bisphosphonates for bone health, tamoxifen best

Detailed Answer:
Hello mam, in my practice and gynecologists worldwide pyt patients on bisphosphonates along with adequate calcium and vitamin D intake to patients with poor of falling bone health alone.
I would have prescribed you the anti estrogen in case
- you had other significant menopausal symptoms too or
- if you had some breast tissue left in situ.
If at all you want to have extra surity then best is aromatase inhibitors but as you are well versed with tamoxifen customised treatment in my opinion is TAMOXIFEN.
But keep visiting your gynecologist on yearly basis.
I wish you the best of health.

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Above answer was peer-reviewed by : Dr. Yogesh D