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48 years old with stage 1 ILC - Tamoxifen Advice
Breast Cancer | Last Active: Oct 1, 2023 | Replies (16)Comment receiving replies
I agree that it is all fascinating and there is much research being done everywhere on how to predict who will become metastatic and when. I read both of those, thank you for sending them, I was pretty shocked by the kind of blanket statement that 9 to 12 months was enough. Especially since I took 15 years of endocrine therapy. After reading them both I realized that it probably was your specific type of cancer that was essentially 9 to 12 months if the hypothesis is correct.
I think even knowing all they know now, I still would probably have had to do most of that. Lol 😂
I was really happy to read all of this because it means that newer patients go through less treatment, and less harsh treatments like chemo too. I have also been reading on how they are starting to pull back on radiation. Just mind boggling. 🤪
Are you still thinking 20% dose for starters, what does your doctor think?
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Hey! Well--I was writing quickly so may have been vague. I meant 9-12 mos might be all I could handle and it would be an improvement. But I also concluded from these studies that two doubling cycles for the tumor(s) in question was "enough," to eradicate dormant tumor cells. (Again, this is one study--and they qualify their work too as all good scientists do.) What they meant was depending on your tumor grade, were that tumor to remain it'd "double" in volume over a given period of time--something like from 6 to 18 mos depending on fast or slow growing. Their results support taking HT for at least two doubling times of the tumor you had to kind of clear out dormant cells.
Now, does this protect from a new primary? That's one of their key questions--and they seem to think that patients may have been overtreated by the claim to prevent "new primaries." But if you've had bilateral mastectomy, and it's ruining your quality of life . . .
I still don't think they're claiming that every single itty bitty dormant circulating tumor cell can be gotten out of your body, but that doing hormone therapy for two volume doubling times (which is anywhere from a year to 3 1/2?) is what's most demonstrably helpful.
OTOH, some dormant tumor cells may have already changed by the time the tumor is discovered--and I think there's some concern (please correct me if I've got this wrong) that HT might 'incentivize" dormant cells to evolve in a different way to evade it, a way that might put the patient at risk in another way.
These are all scary things to contemplate--the fact that there may be unintentional iatrogenic harm in prior BC tx protocols, but the best research is willing to challenge old shibboleths. It may just be that certain chemos paradoxically trigger tumor cell evolution--I've even read in a 2023 article that the angiogenesis of major surgery can itself be tumorigenic, which made me really crazy. I mean, what? Why have a mastectomy then? It's all the more reason to make sure your patient doesn't have silent metastasis before you rush to surgery for supposed Stage 1, right?
I'm a trained social scientist myself so I'm comfortable w/ these conflicting interpretations, but when it's applied to a life and death matter, maintaining an equinanimous attitude toward scientific uncertainty is a little more challenging. 🙂