When someone has estrogen driven cancer and can't take the meds

Risks
I would have her talk with the best breast cancer oncologist she can get to for his or her opinion about the best course of action. I don't have many problems with either tamoxifen that I took for three years or with exemestane that I have taken now that I am post-menapausal, but some women find the side effects very problematic. Length of life is important. But so is quality of life. Tamoxifen caused a few hot flashes, but it did not cause the joint pain that I got at first on the exemestane. When my vitamin D level was checked (it was low) and got corrected with prescription D3, that problem went away and my quality of life returned to normal. Tamoxifen was very easy next to the aromatase inhibitors. It is not a bad option to try. It was the gold standard that was used, even in post-menapausal women, before the advent of aromatase inhibitors. The aromatase inhibitors work about 50% better than the tamoxifen and the tamoxifen was about 50% better than nothing. But understanding those statistics is a bit mind bending. Here's the cancer math lesson: If she has about a 90% chance of surviving 5 years without a reoccurance, tamoxifen cuts that in half. That means that on tamoxifen she has a 95% chance of making it 5 years without a reoccurance. On exemestane (one of those three aromatase inhibitors), her chances improve another 50%, which means on that her chance of no reoccurance for 5 years goes up to 97.5%. You never get a zero chance of reoccurance. (I wish!) Anyhow, if she was lucky enough to get a non-aggressive breast cancer with a 90% chance of reoccurance in 5 years, she might decide to play the odds and enjoy the time without the side effects of the drugs. If her cancer is more aggressive, she might get a bigger benefit from trying the tamoxifen. See, if her odds are more like only a 50% chance of no reoccurance with no meds, tamoxifen might better her odds to 75% chance of no reoccurance. That's a much bigger difference, and maybe one that is worth a few hot flashes. The oncologist can help her read her pathology report and determine what her particular odds of reoccurance are and how much tamoxifen or another drug might help. Good luck!

C. Abbott

PS The reoccurance that occurs in the same breast is usually treated with more surgery and usually won't kill you unless you neglect it for years. The reoccurance that we need to be worried about is when cancer starts setting up camp outside the breast in our bones, liver, lungs and brain. The drugs taken to prevent reoccurance work body-wide. A mastectomy will only prevent occurance of a second incidence of breast cancer in the breast.