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Tamoxifen: Are Jacksonville docs moving from 5 to 10-year doses?

2:03 PM, May 17, 2013   |    comments
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JACKSONVILLE, Fla. -- Some women don't have a bit of trouble taking Tamoxifen, the well-known cancer drug for estrogen positive receptor breast cancer. Others, though, hate Tamoxifen.

At least they hate the side effects. Who can blame them? Nobody wants to be sitting at a meeting and go from freezing cold to dripping sweat in two minutes.

But Jacksonville doctors are moving some of the patients now to 10 years of the drug from the typical five years.

To be clear, the decision is made on a case-by-case basis. It's not appropriate for everyone.

The move comes from findings announced in the Atlas study in December. Since then, doctors have had time to absorb the findings and decide which patients they'd like to change to a 10-year-plan.

Oncologist Dr. Maria Valente at Baptist wrote a summary for us of the study and what it means (By the way, Dr. Valente's own sister is a breast cancer survivor. She's urging her to take Tamoxifen five more years, even though she said her sister cried when she found out about it.  Nevertheless, Dr. Valenti thinks the hassle is worth it because Tamoxifen can extend her sister's life.):

TAMOXIFEN five years or longer?

Most premenopausal women diagnosed with hormone (ER/PR) receptor positive breast cancer being treated to prevent recurrence take Tamoxifen for five years.

Tamoxifen blocks the effects of female hormones, estrogen and progesterone, on breast tissue thereby reducing the changes of recurrence by nearly 50 percent as well as reducing the risk of dying from breast cancer for 10 years following diagnosis.

The findings from the recent ATLAS trial which was presented at the San Antonio Breast Cancer Symposium and published in The Lancet on December 5, 2012 have lead to a change in the five-year Tamoxifen recommendation for many women.

The ATLAS trial studied 7,000 women with early stage, hormone receptor positive breast cancer between 1996 and 2005. After taking Tamoxifen for five years, some women discontinued and some took it for five more years for a total of 10 years.  

There was no significant difference in outcomes among all women between years 5-9 after starting Tamoxifen. The women who took Tamoxifen for a total of 10 years, however, seemed to have better outcomes during years 10-14. There was an ongoing reduction in risk of recurrence and about a 30 percent decline in the risk of dying from breast cancer among the women who took Tamoxifen for a total of 10 years.

Nothing is without risk. The main toxicities/risks of taking Tamoxifen are hot flashes/weight gain, blood clots and endometrial cancer. The risk of clots and endometrial cancer dose increase slightly with extended dosing however in many instances those small risks are outweighed by the benefits derived from reducing the risk of breast cancer recurrence.

At this time, these recommendations are still being made on a case by case basis. Women taking Tamoxifen should definitely discuss the option of extended duration of treatment with their oncologist.  Note this recommendation does not apply to women taking Tamoxifen for precancer (DCIS).

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