Aromatase Inhibitors: Did you decide to go on them or not?

Posted by nanato6 @nanato6, Oct 12, 2018

Nanaloves: I’m about to start arimidex and just feel that the contraindications , bone issues etc. are overwhelming. I’m 70 years old, dodged a bullet I feel with zero stage DCIS but the follow up is pretty much no different then if it was more aggressive. I’ve just done 33 treatments of radiation and now they advise arimidex as a preventative. I’m not sure with the beginnings of arthritis and lower back. sensitivity already that I should take it. Anyone not take it and not have a recurrence within the 5 years.

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@sequoia

If you take the AI, they know what the recurrence is, but without AI, they don't know hmmm Just sayin'

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I know, right? If they can argue that AIs reduce recurrence by 50% (rounded off) then just double the risk number by 2 to get the risk if AIs aren't taken. I had an oncology radiologist tell me that radiation could reduce a risk "from 10% to 2%, which is an 8% reduction." I pointed out that she was confusing percent with percentage point and that a reduction of 10 to 2 was actually 80%.

And I wondered how bad her arithmetic actually is and then double-checked the study she quoted and she was flat out incorrect. I worried about the women whom she might talk into radiation by fallaciously tossing out junk stats. And the radiologist was wrong about the study she was citing too.

So I had a discussion with her superior, citing the exact same study correctly, and noting that she needed to get this right as people have the right to hope their physicians are advising them based on defensible, verifiable facts. It's hard enough having breast cancer as it is. Sheez.

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@tygerrag2

would like feedback from others that have decided to not take AI"s or tamoifen.

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I took Tamoxifen for 9 months and the side effects were awful. I was supposed to take another drug but did not. Had a double mastectomy in 2002. So far cancer free thank the Lord.

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@nanny23

I took Tamoxifen for 9 months and the side effects were awful. I was supposed to take another drug but did not. Had a double mastectomy in 2002. So far cancer free thank the Lord.

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The other drug they offered was arimidex. I had cancer in both breasts. Two different types of aggressive cancer with lymph node involvement. Took tamoxifen for 9 months and I had enough. Refused arimudex and I’m cancer free still. This was back in 2002.

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@callalloo

I had DCIS invasive, 7mm including clean margins, stage 1A. Clean sentinel lymph node biopsy. Discovered September, 2021, excised October, 2021. Detected by diagnostic mammogram and ultrasound as I'd had a tiny underarm lump, which, oddly enough, went away before the tests and was undetected by them.

I missed a mammogram the previous year because of lockdown and wondered if this could have been caught earlier. Oncologist thinks it might have been...or not as it was small. But I'll never know.

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@callalloo DCIS is non-invasive/pre-invasive so did you also have invasive cancer? What do you mean by "I had DCIS invasive?"

I think it is reasonable to avoid meds with DCIS but that reluctance should not necessarily be relevant for those who actually have invasive cancer.

The Oncotype Dx is also used for those with 1-3 lymph nodes so not just stage 0 or 1.

Reduction from a risk of 8 to 4% is significant.

I took letrozole for 5 years with very few side effects, and none of my friends had side effects from AI's, other than bone loss of course, which can be addressed.

I just want to put a positive word in for these medications. I miss being on it because I felt protected. Forums tend to be negative and then everyone is too scared to take meds. Try them!

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@callalloo

I decided to not take aromatase inhibitors. I did have a low 'risk of locoregional recurrence within 9 years" according to the OncotypeDX test my oncologist suggested and we had done. [5% if I take the drug, 3% if I don't IF the OncotypeDX is valid and the oncologists I consulted think it is.]

I'm older and have osteopenia, which I hoping to reverse or keep in check, and the effect of estrogen depletion on the body, cardio system and bones is a concern that got my attention. I was about to write 'only time will tell if I was right' but would be intrue. I'd have a 3% risk IF I took the meds anyway so, if I suffer a recurrence, there's no way to prove it wouldn't have happened if I had taken them. It's a very personal judgment call though.

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Do I know how long following radiation do we have to decide to take an AI or not?

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@tygerrag2

Do I know how long following radiation do we have to decide to take an AI or not?

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Does anyone know how long do we have to decide on whether or not to tak an AI?

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@tygerrag2
As far as I know, one can start AIs at any time but usually, for obvious reasons, a few weeks after surgery. Your oncologist will advise you. But the thing is that some people start AIs and, maybe due to side effects or other health things going on, stop them for awhile. Then restart again.

Some people decide against AIs initially then change their mind and begin them later. There's not a deadline for the drugs, per se, but most oncologists who recommend them obviously prefer that a patient start them soon after surgery, or maybe after post-surgery radiation, and remain on them until further notice.

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@windyshores

@callalloo DCIS is non-invasive/pre-invasive so did you also have invasive cancer? What do you mean by "I had DCIS invasive?"

I think it is reasonable to avoid meds with DCIS but that reluctance should not necessarily be relevant for those who actually have invasive cancer.

The Oncotype Dx is also used for those with 1-3 lymph nodes so not just stage 0 or 1.

Reduction from a risk of 8 to 4% is significant.

I took letrozole for 5 years with very few side effects, and none of my friends had side effects from AI's, other than bone loss of course, which can be addressed.

I just want to put a positive word in for these medications. I miss being on it because I felt protected. Forums tend to be negative and then everyone is too scared to take meds. Try them!

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The only thing that matters is if a person's decision makes sense to that person, though. Mine does for me. I'll never know if it was 'right.' Even I get a recurrence of cancer, taking the AI would have still given me a 3% chance of recurrence so I wouldn't know if the AIs would have prevented it anyway. And I prefer to skip the joint pains, and limp, that anastrozole caused in two different attempts. Not to mention the risk of accelerated osteoporosis. But again I'd have 3% odds of recurrence even if I took the drugs. For me, it's worth an added 2% risk and avoiding AI side effects.

PS I was thinking that the OncotypeDX was for early-state cancers but, you're correct, a newly-caught tumor can be a higher stage. Apples and oranges
confusion on my part ;-).

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@callalloo

The only thing that matters is if a person's decision makes sense to that person, though. Mine does for me. I'll never know if it was 'right.' Even I get a recurrence of cancer, taking the AI would have still given me a 3% chance of recurrence so I wouldn't know if the AIs would have prevented it anyway. And I prefer to skip the joint pains, and limp, that anastrozole caused in two different attempts. Not to mention the risk of accelerated osteoporosis. But again I'd have 3% odds of recurrence even if I took the drugs. For me, it's worth an added 2% risk and avoiding AI side effects.

PS I was thinking that the OncotypeDX was for early-state cancers but, you're correct, a newly-caught tumor can be a higher stage. Apples and oranges
confusion on my part ;-).

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I haven’t written since April when I was one month into taking Anastrozole following 25 radiation treatments, preceded by a lumpectomy (5mm) and excision of 3 sentinel nodes for DCIS.
My radiation left me with a painful rash which led me to take a long weekend off before starting my drug.
A month into Anastrozole, I felt no different. Three months in, the side effects have started, mostly in my hands, which are so claw-like stiff in the morning, that I have to work them several minutes to ease the pain - they also get this way at night. Though I am experiencing some other mild joint pains, (stiff leg joints & lower back), the brunt of it is in my hands. OH, and did I mention the weight gain?! Ok, that’s a discussion for another time! 😳
My next followup is July 5th at which time I will discuss these issues as well as the possibility of taking an alternative drug - I have a few friends who switched to Letrozole w/o joint issues, so we’ll see. My surgeon asked to try to hang in there & discuss these options with my oncologist.
I wanted to briefly discuss the “invasive” word that I’ve seen discussed. My 5mm lump (found on routine mammogram- not felt/discovered by me or my GYN even a month before mammo); was labeled post-biopsy, “invasive ductal carcinoma in situ”. When I saw the word invasive, I almost fell over, but I was quickly schooled not to confuse “invasive” with “metatastic”. I was then told that in the breast cancer world, invasive means that cancer has invaded your otherwise healthy tissue. I was further told that “types” are determined post extensive biopsy - HER2 Neg, Estrogen/Progesterone Pos; and that “stages” are determined post surgery/Biopsy (for me, Stage1A -, except for Sentinel Nodes, which are examined initially during surgery (my 3 were Neg), then further examined post surgery - all 3 were clean, as were the outer margins of the tissue in my breast.
My point being, my cancer was confined to that 5mm area, even though initial biopsy reports after mammogram called it “invasive” DCIS. A scary word to the patient, but to those in the cancer field, not so much.
As always, this is my journey & I never try to speak to anyone else’s, other than to empathize and wish you all well with yours. ❤️

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@callallooo If you have DCIS, then your decision may be different from someone with an invasive cancer. I have read that DCIS is considered a pre-cancer.

@madeler22 interesting that you also had "invasive DCIS."

I am still not clear on the term "invasive DCIS" since I would have thought "invasive" would mean the cancer cells had spread beyond the ducts (or lobes). Any Google results say that DCIS is non-invasive so would love more clarification.

Most women I know did not have significant joint pains on AI's . Some do. I think it is worth it to try them and persist for awhile, since any side effects tend to change or even fade over time.

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