Breast cancer lesson 160: Welcome in the next decade with a glass of water and a Tamoxifen tablet

I find it mildly amusing that my first day back at work (after about four months away) should also be the day I am prescribed my hormone therapy tablet Tamoxifen. (It’s also the first day of Breast Cancer Awareness month, which is obviously an amazing thing with which I hope to be heavily involved for the rest of my life.)

For me, this October feels like my January, armed as I am with my freshly-organised work bags and clean notebook. I am more ready than ever to move forward, but I am now in possession of a packet of pills that, I hope very much, won’t pull me straight back. I guess I just hoped, for a few days at least, people might be more interested in what is going on inside my head – rather than growing out of it!

Of course, no office commute would be complete without that obligatory detour to the hospital. As some of you will remember, just over two weeks ago, I was sent on my merry way after radiotherapy with a list of potential side effects, advice to keep ‘creaming’ and a note of caution that, at some point in the very near future, I may hit some kind of cancer-related wall. I am delighted to report that the skin is happy, the tiredness is manageable and the wall is (currently) nowhere to be seen. It was, however, nice to speak to an oncologist today to get a little bit of reassurance that things are as good as can be and that, on the radiotherapy front at least, I did very well.

We did discuss the peripheral neuropathy and, as I feared, time is the only current healer on that score. Nerve damage can take years to disappear, and, given that I have only been chemo-free for two months, there is no current action to be taken. We also talked periods and menopausal symptoms. It seems that, because Zoladex interferes with the pituitary gland, it takes a while for the body to reactivate. If, at my follow-up appointment in three months, the ovaries are still asleep, they may do a simple blood test to assess my fertility levels. But, again, it seems time is the biggest factor here as well. Thank goodness I am trying to be more patient in this new post-cancer era.

Then, Tamoxifen had its moment. The oncologist explained that the hormone therapy (which blocks oestrogen to the breast tissue in pre-menopausal women) was another treatment designed to reduce the risk of the cancer coming back. We didn’t talk stats. He was straightforward in saying that, when it comes to breast cancer, it is the individual case that matters and they have no idea whether or not, in my particular case, the cancer will ever return. The only thing they know is that, because my cancer was oestrogen positive (basically fed by the stuff), Tamoxifen will help on the risk front. And, if it helps, I’m taking it!

Up until very recently, the standard course for hormone treatment was five years. Based on the results of a study (the findings for which are starting to filter through), however, the plan is to keep me on Tamoxifen for ten years. He did add though that, while beneficial to complete the term, we could have a debate after five years if my quality of life looks to be suffering as a result of the treatment. Let’s hope the next five years are kind so there is no need for a debate of any sort.

Whether or not Tamoxifen will bring with it any nasty side effects is yet to be seen (more menopausal symptoms, irregular periods, risk of blood clots, changes to the lining of the uterus are all on the list and there is even a risk of more cancer, but that risk is pretty low). There are, however, a few things I have learned that I think will be useful for others to hear too:

1) Because I shut my ovaries down using a Zoladex implant during chemo, my body currently doesn’t have normal levels of oestrogen in it. This means that, for a time, my body may not notice anything unusual with taking the drug. When my body starts to return to normal (and periods start), however, there is a chance the side effects may start (or get worse). That’s certainly something to look forward to.
2) In terms of the best time of day to take the pill, the official advice is simply ‘when you think you will remember it’. That means before bed for me.
3) Missing a day or two is not going to have a real impact on the overall effect of the drug.
4) There are certain foods and drugs that may affect enzymes in the liver (where Tamoxifen is metabolised), but as long as you aren’t doing anything extreme on a daily basis (such as consuming a litre of grapefruit juice a day) and are enjoying a healthy balanced diet, he didn’t seem to think there was any reason to cut things out completely. Always good to check, but I haven’t got a list of banned foods in my pocket and that is good enough for me.
5) On the subject of follow-ups, I will be seen again in three months to talk about the drug. All being well, I will then be put into a long-term follow-up clinic. No amount of medical software can predict the future, so it’s a case of watch, hope and live. Whether it will be mammogram or MRI scanning, is yet to be seen. He said, given my age, MRIs may be recommended, but only time (yes that magical thing again) will tell.

Breast Cancer Care has produced a really useful booklet on the subject, which is worth ordering if you’re keen to know more. It has a useful section, which talks about the different suppliers who make the drug and how the brands may affect you in terms of the side effects you experience.

Funnily enough, while I knew we’d talk about Tamoxifen today, I had no idea I would actually get a pack (in the case of clonidine, I had to go to the doctors to set up a repeat prescription first). I would be lying if I said I wasn’t a little nervous about taking it. The side effects can be brutal and, unlike all my other treatments, 10 years is a long while to feel uncomfortable. The only good thing? I feel like, by starting the course, I will be doing something every day to keep cancer at bay. That is certainly something worth smiling about.

So as you get into your PJs tonight, think of me with my brand new pill packet marking the start of my next decade.

Let’s hope it’s a good one!

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