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Oophorectomy vs Goserelin shots/ Tamoxifen vs Letrozole
Hello lovely people,
I am wondering if anyone has insight on impact of oophorectomy procedure vs hormone shots for long period of time.
I am a 45 year old woman with triple positive breast cancer. I got diagnosed last November, had partial mastectomy, went through chemo (weekly Taxol) for 3 months, finished radiation in June, and started hormone treatment while i was getting radiation treatment.
Even though i was premenopausal before starting chemo, my oncologist suggested I go with AI (Letrozole) with monthly hormone shots (Goserelin) to induce menopause, because he believed Letrozole was slightly more effective than Tamoxifen. I had asked him before i started chemo whether he would think Oophorectomy would be beneficial for me since it would mean I wouldn’t have to take Goserelin every month, and he said it would be a good idea. I thought great! Relatively “simple procedure” and all i have left is daily Letrozole.
I had a consultation with gynecological surgeon last week and he told me he had concerns suggesting oophorectomy for younger women under age 65 because studies have shown it could create coronary artery disease, lung cancer and hip fracture from osteoporosis down the road. He wondered why my oncologist suggested Letrozole with hormone shots and suggested I weigh the risks and benefits of oophorectomy which can affect long term quality of life.
i have an appointment with my oncologist tomorrow (might be my last before he kicked me to the curve?) and I am wondering what I need to ask. I am curious whether Goserelin would have the same negative impact as taking ovaries out or whether I should take Tamoxifen instead. It seems oncologists only look at the immediate future and focus on preventing recurrence and gynaecologist specialists are concerned about long term effect.
At this point, i am having hard time deciding what to do. Hard to think with my foggy brain!
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@landofnorthernlights Unfortunately, there seems to be a lot of decisions to make in what seems like a short period of time. I was spared the decision of mastectomy vs. lumpectomy. The latter wasn't even an option. No one mentioned the possibility of having both breasts removed, so I didn't have to make that decision either.

Rightly or wrongly, there wasn't any discussion about Tamoxifen vs. Letrozole since my gynecologist wasn't sure I was truly in menopause so Tamoxifen was my only option. There was some discussion about Lupron to help ensure I was in menopause, but Lupron was not recommended for anyone with seizure disorders, and I have epilepsy.

I took Tamoxifen for 7 years because, based on bloodwork, it still didn't look like I was in menopause even though I hadn't had a period in years. Tamoxifen caused my uterine lining to thicken, which is one of the potential side effects. What no one ever told me was that with a thickened uterine lining, my chances of developing uterine cancer were higher. This is supposed to be a rare potential side effect of Tamoxifen.

Even after taking Tamoxifen for years, my bloodwork still didn't indicate that I was in menopause. Ultimately, I had my ovaries and tubes removed. My gynecologist did not want to do a hysterectomy. I wanted to have one because having a test done every six months to check my uterine lining is not quite as exciting as you might think. Eventually, when my gynecologist did a endometrial swab, pre-cancerous cells were found. That was it, I had a hysterectomy less than two years after my ovaries and tubes were removed. I had my last surgery just before the lock down in Ontario for COVID. At that time, I was 58 years old….a lot older than you.

Please keep in mind that I have been special from a health perspective. My brother told me that I should never donate my body to science because it would put any research done to date back 10 years. Just because a side effect happens to one person does not mean it will necessarily happen to you.

People can only share their stories. We cannot tell you what to do. I always wish that doctors would talk to each other to determine the best treatment. It's unfair to put a patient in the middle. It's like your oncologist asking you why your gynecologist would recommend a type of treatment. You can only interpret and remember what one doctor says and relay it to the other. Is there any way that you can get them to talk to each other?

As a compromise, you could have one doctor right down the pros and cons of each option so that you can take that information to the next doctor. In this way, you don't have to hope you are explaining things correctly and it gives you something to hang on to.

If you are willing to let me know how things go with your doctor(s), please type @ followed by cancer and cancertakesflight should pop up for selection. Once you select it, my name should show up in blue like yours did at the beginning of this post.

cancertakesflight

supersu
433 Posts

@landofnorthernlights

thanks for this post! what a great question. it illustrates perfectly that us mere mortals do not have a clue about some of the decisions we are expected to make, often on the fly, about things we know nothing of!

you really have to be a research expert to get enough information gathered to make an educated decision, don't you?

do you have a nurse navigator who could help you break down the information? I found in my story, the nurses were really the information keepers and sharers…..

another possibility is to contact a cancer specialist on the Canadian Cancer information line - 1-888-939-3333 - they may have some solid information/links to guide you.

let us know how you move along in this part of your story - your posts will no doubt help others who find themselves in a similar situation.

cheers
su

#breastcancer #decisionsontreatmentoptions

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