Hormone Therapy
- Tamoxifen
Tamoxifen, also called Nolvadex, acts against oestrogen. The drug has been shown to prolong life and to reduce the risk of cancer recurring in the same breast. It also reduces the possibility of developing cancer in the other breast. Tamoxifen is particularly effective if the cancer contains special proteins, called oestrogen receptors (ERs, for short). All women with oestrogen receptor-positive breast cancer are, therefore, advised to take tamoxifen for 5 years.
Other benefits of taking tamoxifen are a decrease in the risk of getting bone fractures due to osteoporosis (brittle bone disease).
What are the Side-effects of Tamoxifen?
One in three patients taking tamoxifen experiences minor side-effects. These include hot flushes, weight gain, dizziness, change in bowel habits, suppression of periods (in young women) and visual disturbances.
Tamoxifen affects the lining of the womb, where it can cause the growth of polyps. It also causes a slight increase in the risk of developing cancer of the womb, of about 1 per 1000 per year. This means that if 1000 women take tamoxifen for one year, one of them will develop womb cancer. Any women taking tamoxifen should consult her doctor if she notices any abnormal vaginal bleeding or discharge.
Tamoxifen also increases the risk of thrombosis (blood clot) and stroke. This risk is very small (of the order of 1 per 1000 per year), but postmenopausal women with a personal or family history of thrombosis or womb cancer should be considered for one of the new drugs: Femara, Arimidex or Aromasin. Early results have demonstrated that these drugs are superior to tamoxifen and are much less likely to cause vein thrombosis or womb cancer.
Other Uses of Tamoxifen
Tamoxifen is also used in patients with metastatic breast cancer. It relieves symptoms such as bone pains and helps to shrink any tumours that have spread elsewhere in the body. Patients with inoperable breast cancer may be treated with tamoxifen prior to further treatment with radiation or surgery. Frail patients with breast cancer can be treated with tamoxifen alone, and may experience substantial reduction in the tumour size – in some cases the tumour can even disappear.