Tamoxifen: miracle or menace?

By Emmalie Vance
It is difficult to leave the doctor’s office with the newfound knowledge that your body has turned on itself with the formation of a malignant tumor, otherwise known as cancer. For a woman, the diagnosis of breast cancer can be even more devastating.
Over the next several weeks, months, and possibly years, the patient is subjected to surgeries to attempt to remove the mass or masses, chemotherapy, radiation therapy, and finally medication and further treatments.
Patients become tired, physically sick, and emotionally drained after having gone through this overwhelming and lengthy process. Some keep their head high and try to live their life as best they can while trying not to think of cancer all the time. Others, however, sink into a hole of darkness and despair, sometimes becoming clinically depressed thinking not only of the cancer attacking their body but also the procedures, the medication, the bills, and some even begin to question their sexuality.
“Cancer has a very big stereotype behind it,” says Social Worker Stacey LaFave from CVPH. “When most people hear the words, they think death so they go there mentally. Chances are, most people have thought about that and have questioned their mortality a little bit with a diagnosis of cancer.”
Women who have been diagnosed with breast cancer have many additional psychological issues connected with their appearance after the diagnosis and especially after some of the treatments. A lumpectomy which removes a small mass from the breast could change the shape of the breast and a mastectomy which removes one or both of the breasts completely has an even larger impact on the woman. The loss of their hair, which is a very feminine trait, after chemotherapy, leaves its own scars on a woman’s spirit
“For some people, these things may have a bigger impact on them than others,” LaFave says. “As people age, it may not be as big of an impact for them, but say you’re 35, not married and you’re in the dating world. That’s a big deal.”
On top of all of these stressors that women may have in addition to the diagnosis of breast cancer, starting on the best treatment possible when they are finished with surgery, chemo and radiation to help prevent a reoccurrence can be another issue, when considering the choices they have and the possible side effects that they pose.
One such option for women who are pre-menopausal is a medication called Tamoxifen, which has been widely used in hospitals for several decades for the treatment of breast cancer in pre-menopausal women. The drug cuts off the flow of estrogen produced by the ovaries which is supplying the tumor, inducing artificial menopause and stopping the progression of the cancer. Post-menopausal women are obviously not a candidate for this medication because by that point, their bodies have ceased the production of estrogen so taking the drug would be pointless. Instead, they receive different medication called aromatase inhibitors, such as Arimadex, which block any further formations of estrogen to protect the women from a reoccurrence of the cancer.
“Tamoxifen is probably the most widely used drug for breast cancer - more than any chemotherapy or other drug,” said Elli Collins, Oncology Clinical Nurse Specialist at CVPH. Although she said, “Tamoxifen has probably been one of the best advances ever in breastcancer,” Collins added, “The search is on to find an ideal “treatment” that eliminates the unwanted, significant side effects.”
Some of the potential side effects taken from the laundry list of Tamoxifen are hot flashes, vaginal irritation, decreased libido, nausea, and musculoskeletal pain. These are all issues commonly connected with natural menopause. The more serious potential side effects such as thrombosis (blood clots), stroke, and a possibility of developing uterine cancers are what really weighs the patient’s decision.
“We are dealing with people who don’t want a relapse,” says CVPH Oncology Pharmacist, Catherine Mondon, “so people are going to be more inclined to accept the unwanted side effects and deal with them. It is also presented in a way that says ‘this side effect can happen and if it does, you need to let us know right away so that we can treat it.’”
Mondon, on the possibility of developing other cancers while on Tamoxifen, says, “It was like one percent of the patients taking it but even so, if you’re in that one percent, it doesn’t matter; you’re not going to be a happy camper.”
Despite these extreme, although still only potential, side effects, Tamoxifen continues to be used to treat pre-menopausal women who have breast cancer because there really isn’t another option until they reach menopause.
When a patient is prescribed Tamoxifen, they are informed of the possibility of developing a potentially fatal blood clot. They are also educated on the symptoms so that if they feel a sudden pain in the chest, notice a swollen leg, or shortness of breath while taking Tamoxifen, they are urged to go to the hospital right away. The possibility of developing uterine cancers is monitored by regular gynecological checkups and the patient is told to report any abnormal bleeding. Also, if the patient does develop such a cancer as a result of the Tamoxifen, they usually catch it relatively early because they’re watching for it so most people are treated and cured before it becomes a serious problem.
Mondon estimates that only one out of every 100 people do not choose to go on Tamoxifen because of its potential side effects, but for those who do, CVPH Oncologist, Dr. Jan Duus says that the drug cuts the odds for a reoccurrence of cancer by about a third.
“With most medicines there is no free lunch,” says Duus. “Some people will have a bad reaction to Tylenol but the reality is that for every person who gets hurt by it, there are a lot of people who get helped by it.”