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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@pattyayn59

Hello all! I’m 63 was diagnosed in august 21. Dcis stage zero grade2 and no lymph nodes. No history of breast cancer in family.
Tried anastrozole and couldn’t tolerate it ! After two months went off it! My mayo oncologist put me on tamoxifen 10 mg to start. Anyone - please share your experience with me on tamoxifen or other meds. It’s all so overwhelming. I did have some slight spotting and cramping in the fist few weeks so far on tamoxifen. But dr said after ultrasound that I was ok. God bless all of you - survivors!!!!!

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@pattyayn59 what was your Oncotype score?

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@windyshores

Also, grade is subjective, according to my doc. I had results that read grade 2 at two hospitals, and grade 3 at another two.

There are other factors that make things complicated. My cancer is mixed ductal and lobular: the ductal part is HER2+. The HER2+ result from the biopsy probably meant the biopsy mainly got DCIS and ductal cells, but the surgical pathology got mixed ductal and lobular, so it was equivocal overall for HER2, until more testing showed a negative result because more cells were tested.

Lobular always has a score of 3 for tubular in the calculation of grade, which presumably increases my grade, since my tumor was half lobular.

The highish ki67% could be from cells healing after the biopsy (proliferation), and one doc agreed. I also wonder if the LVI is from the biopsy, meaning it could appear some cancer cells ended up in the lymph vessels (they were not in blood vessels) though doc said no recently when I asked.

I mainly questioned these things because of the disparate results but also to explain my low Oncotype. It would be nice to trust every result as an absolute truth and I don't mean to upset anyone!

In the end, the treatment recommendations did not change after the first post-mastectomy pathology. The first HER2+ result was from the biopsy so that mistake would not have persisted. While the three post mastectomy lab results were a little different, my treatment remained "just" letrozole, based on the Oncotype which we also have to trust! Getting opinions and pursuing extra tests just let me feel more comfortable but didn't actually change anything.

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I think that getting opinions that don't change anything is a great outcome. That suggests that there was implicit unanimity, or near unanimity, among doctors you consulted with. That would give me a lot of confidence and lessen the chance of later regret or second-guessing.

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@ssalget

I would also like to see those studies. I was on letrezole for only 4 months after a bilateral mastectomy for invasive lobular carcinoma, er+, pr+, Her2- , grade II, stage 1A, before I developed very painful carpal tunnel symptoms with trigger thumbs on both hands and body aches everywhere, that kept me from sleeping. And brain fog with some depression thrown in. My oncologist suggested a break. I don't know for how long. I have been off the drug for two weeks and the body aches are better. Depression and brain fog is better, but the carpal tunnel and trigger thumbs have not resolved. I have tried physical therapy and ibuprophen. It's very difficult to think of going back on AI's. I am 69.

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I'll find the studies and send you the links by message if that's OK. As to what you're experiencing, hopefully this is temporary and will reverse itself. Can you get a second opinion and/or a referral to the right specialist to help? I have a golfer friend who had surgery to repair wrist tendinitis that was 100% successful so that might be an option if this doesn't self-resolve,

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@callalloo

I think that getting opinions that don't change anything is a great outcome. That suggests that there was implicit unanimity, or near unanimity, among doctors you consulted with. That would give me a lot of confidence and lessen the chance of later regret or second-guessing.

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"Implicit unanimity." Brilliant! And yes, avoiding regret and second guessing was one of my goals. Thanks for the great perspective!

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@windyshores

@pattyayn59 what was your Oncotype score?

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They told me oncotype doesn’t refer to me since no chemotherapy recommended.

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@pattyayn59

They told me oncotype doesn’t refer to me since no chemotherapy recommended.

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It would still tell you recurrence risk and how important hormonal treatment would be, as well as how effective. I would request one. The Oncotype is done for DCIS even though chemo isn't suggested.

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Did you have an Oncotype? It seems people with DCIS may not be having that test-?

Maybe you could try the medication and decide based on what you experience. Many people don't have horrible side effects. Bones can be dealt with with meds if need be but if you don't have osteoporosis, there may be less risk overall.

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@callalloo

I'll find the studies and send you the links by message if that's OK. As to what you're experiencing, hopefully this is temporary and will reverse itself. Can you get a second opinion and/or a referral to the right specialist to help? I have a golfer friend who had surgery to repair wrist tendinitis that was 100% successful so that might be an option if this doesn't self-resolve,

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Yes, if you find the studies please message me. Thank you. I'm pretty sure this is carpal tunnel. I've been searching physical therapy on the internet. The PT I've been doing to recover range of motion after bilateral mastectomy is working very well. I've asked for a referral for hand specialist. Just waiting to hear. Also having to deal with some sort of lung infection that doesn't present me with any worrisome symptoms, but was incidentally found on a CT scan. I just don't know where to put my attention. I feel like, after never seeing a traditional doctor most of my adult life, I'm suddenly caught up in an overwhelming system that I'm barely unprepared to manage!

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@ssalget

Yes, if you find the studies please message me. Thank you. I'm pretty sure this is carpal tunnel. I've been searching physical therapy on the internet. The PT I've been doing to recover range of motion after bilateral mastectomy is working very well. I've asked for a referral for hand specialist. Just waiting to hear. Also having to deal with some sort of lung infection that doesn't present me with any worrisome symptoms, but was incidentally found on a CT scan. I just don't know where to put my attention. I feel like, after never seeing a traditional doctor most of my adult life, I'm suddenly caught up in an overwhelming system that I'm barely unprepared to manage!

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Hi, Just wanted to agree wholeheartedly on your comment >>>> " I feel like, after never seeing a traditional doctor most of my adult life, I'm suddenly caught up in an overwhelming system that I'm barely unprepared to manage! "
I have had so much medical intervention in the 5 yrs of cancer/nocancer/MBC that it is MORE than all other 65 yrs combined . Also ,I chose to trust health foodies and diet based solutions , ie , add more fruit like grapes or oranges (or lessen the same if too much acid )at anytime in my diet . So, the idea of drugs drugs drugs and side effects galore has been more stress and confusion than the cancer really . Hang in there .

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@lcr2017

I made it through the aches and pains for 4.8 years and then got slammed. I don’t know why. I am your age and had a cortisone shot near my thumb/wrist since the hand doctor said it was tendinitis not carpal tunnel. It worked but now I have Achilles tendinitis (same side) and can barely walk. Not sure what I am going to do this time. I think the AI dried up everything! But I am glad I made it most of the way through. Yoga is helping a lot. I was lucky to try the hand doctor because my husband has been his patient or I never would have thought of that. Other people have tried different AI’s. My son’s mother in law switched to tamoxifen which is not without risk, so I would explore the options. Try not to give up.

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The article below citing New England Journal of Medicine article suggests that "aromatase-induced carpal tunnel syndrome" can reverse by going off the drug. As yours is. So maybe, if the Achillies tendon issue is related to the drug, it will ease up as well.

There's a family of antibiotics with a major side affect being damage to the Achilles tendon. If you've taken an antibiotic like Levaquin in the recent past, that could be the cause here. In any event, I hope your PCP can get you to the right specialist and onto treatment to ease this.

https://www.jwatch.org/na40241/2016/01/20/aromatase-inhibitors-and-carpal-tunnel-syndrome
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