Taking a Lower Dose of Tamoxifen?

Posted by vivi1 @vivi1, Oct 6, 2021

Given the risk of endometrial cancer from tamoxifen, which apparently increases with dosage, length of use, and the age of the patient, is anyone taking a lower dose in order to extend adherence and soften side effects?

Interested in more discussions like this? Go to the Breast Cancer group.

I did find an article about endometrial hyperplasia, and even polyps, but I didn’t find any studies that found an increase in endometrial carcinoma. All are a problem but if you have a link to any information. I would love to read it.
Pubchem lists two dosages, 10 mg, and 20 mg. As to which you would typically be prescribed, I have no idea, but at least there are choices.
That being said if you are troubled by the possibility of endometrial changes or ( reproductive issues) have you discussed this with your doctor? Maybe considering a different drug?

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I am certainly no doctor, but it could be a difference between pre and post menopausal women. "Tamoxifen use may be extended to 10 years based on new data demonstrating additional benefit. Women taking tamoxifen should be informed about the risks of endometrial proliferation, endometrial hyperplasia, endometrial cancer, and uterine sarcomas, and any abnormal vaginal bleeding, bloody vaginal discharge, staining, or spotting should be investigated. Postmenopausal women taking tamoxifen should be closely monitored for symptoms of endometrial hyperplasia or cancer." (ACOG Number 601 (Replaces Committee Opinion Number 336, June 2006. Reaffirmed 2020) unable to enter link)
I am not thrilled with AI's because of their effect on bones and heart. I have osteopenia and high cholesterol and do not want to take other meds to counter side effects. There has to be a better way…eventually.

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@vivi1

I am certainly no doctor, but it could be a difference between pre and post menopausal women. "Tamoxifen use may be extended to 10 years based on new data demonstrating additional benefit. Women taking tamoxifen should be informed about the risks of endometrial proliferation, endometrial hyperplasia, endometrial cancer, and uterine sarcomas, and any abnormal vaginal bleeding, bloody vaginal discharge, staining, or spotting should be investigated. Postmenopausal women taking tamoxifen should be closely monitored for symptoms of endometrial hyperplasia or cancer." (ACOG Number 601 (Replaces Committee Opinion Number 336, June 2006. Reaffirmed 2020) unable to enter link)
I am not thrilled with AI's because of their effect on bones and heart. I have osteopenia and high cholesterol and do not want to take other meds to counter side effects. There has to be a better way…eventually.

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Hi Vivi, I noticed that you wished to post a URL to a resource with your post. You will be able to add URLs to your posts in a few days. There is a brief period where new members can't post links. We do this to deter spammers and keep the community safe. Clearly the link you wanted to post is not spam. Please allow me to post it for you.

– Tamoxifen and Uterine Cancer https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/06/tamoxifen-and-uterine-cancer

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@colleenyoung

Hi Vivi, I noticed that you wished to post a URL to a resource with your post. You will be able to add URLs to your posts in a few days. There is a brief period where new members can't post links. We do this to deter spammers and keep the community safe. Clearly the link you wanted to post is not spam. Please allow me to post it for you.

– Tamoxifen and Uterine Cancer https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/06/tamoxifen-and-uterine-cancer

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about the link you provide has no different from others about tamoxifen.
But what is questioned me that it says reduced the risk of cancer return
and says as common side effect can increas the tumor.
Very confusing.. Any comments from the members??

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I didn't want to take tamoxofin for my breast cancer because of the side effects. I am 80. i don't want hot flashes and hair loss. He now has me on raloxifine HCL. It actually strengthens bones. I read it can also cause hair loss. I am trying 1/2 tab a day instead of a whole one. I don't know if a little is better than none.

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@monigue

about the link you provide has no different from others about tamoxifen.
But what is questioned me that it says reduced the risk of cancer return
and says as common side effect can increas the tumor.
Very confusing.. Any comments from the members??

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Thank you @vivi1 for bring this to our conversation, and @colleenyoung for providing the link. This is the best way I can explain what I know with what I think I just read. Like all of our cancer treatments there are risks to tamoxifen. The risk being discussed is primarily but not exclusively endometrial changes. Tamoxifen is given because it can dramatically reduce the risk of your breast cancer returning. It might be given for metastatic breast cancer as well. Along with the common side effects of hair loss and hot flashes it carries a risk of endometrial and cervical cancer. I did take it for years, as is it often the choice for young women with breast cancer. It is a cost vs. benefit decision for every person. Let’s talk about what all of you place into that decision making equation.

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A respected oncologist said in an online YouTube, breast cancer prevention drugs should be "incredibly easy, very nontoxic, shouldn't interfere with your life, shouldn't make you worry about long-term toxicity, and be cheap." So before I start anti-estrogen therapy I am looking for an option that decreases the recurrences with the above qualities. The low-dose trials for tamoxifen (5mg for 3 years) sound promising because the toxicity and SE's are significantly lowered, but the recent trials have not included early stage no lymph node involved IDC. It is always a question of benefit vs risk, as well as adherence. I will discuss this with my oncologist.

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Wow! Unfortunately, I haven’t seen one of those that also include “effective”. That would be awesome, sadly most of us won’t have the time to wait for one before we decide. That will be one happy day indeed.

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@vivi1

A respected oncologist said in an online YouTube, breast cancer prevention drugs should be "incredibly easy, very nontoxic, shouldn't interfere with your life, shouldn't make you worry about long-term toxicity, and be cheap." So before I start anti-estrogen therapy I am looking for an option that decreases the recurrences with the above qualities. The low-dose trials for tamoxifen (5mg for 3 years) sound promising because the toxicity and SE's are significantly lowered, but the recent trials have not included early stage no lymph node involved IDC. It is always a question of benefit vs risk, as well as adherence. I will discuss this with my oncologist.

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ViVI1 Agree with your comments!. In a long run the benefit of not returned cancer might not overweight the quality of life , and serious side effects coming for all the years of using hormonal therapy.-tamoxifen, etc.
.Plus always worries ,what next is coming on the line parallel with cancer treatment.
The oncologists going by protocol,. even if they know something permissible, but not approvable..
By the way, have anybody use the integrated therapy offered by CTOAM company and/or integrated holistic treatment support, helping co-op with conventual chimo, radiation or hormonal therapy side effects treatment

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@raebaby

I didn't want to take tamoxofin for my breast cancer because of the side effects. I am 80. i don't want hot flashes and hair loss. He now has me on raloxifine HCL. It actually strengthens bones. I read it can also cause hair loss. I am trying 1/2 tab a day instead of a whole one. I don't know if a little is better than none.

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Hello Raebaby I am in the same shoes as you are. What is your stage or kind of cancer. Started tamoxifen 1/2 tablets even without consulting with dr. Stringing the bones is okay, but what about heart, blood clocks, etc. something else
Please let me know how you feel. Thank you

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I just started Raloxifine 1/2 the dosage,(on my own like you did) 3 days ago. Once the doctor told me that it wouldn't do any good take tamoxifen every other day. I figure at my age I'd rather have fewer years alive, but have quality instead of feeling sick. The oncologist did agree that the anti -hormone drugs only add about 2 percent more chance of having the cancer not come back. I am stage 2, less than 2 cm tumor and I had it in three lymph nodes. I had a lumpectomy, chemo and 6 weeks of radiation. I am HER2 positive so i get Herceptin in what is left of my chemo. Strangely enough, what bothers me the most is if my hair thins again on the Raloxifene. I was so happy to get a nice head of hair back. I'm not really worried about my heart or blood clots. My feet stopped swelling and i no longer need support socks. My feet got numb due to the chemo. They are improving and my biggest goal in life is to drive again. Formerly I was an RN, so I like to think i know something about my treatment and understanding of it. But, who knows really….

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Raebaby, I have read that Raloxifine is a SERM good for the bones and less toxic to the endometrial and uterine linings than tamoxifen, although less effective with recurrences. I am with you about fewer years but more QOL. It would seem logical that lower dose is better than no dose. The recent low-dose tamoxifen trial [https://ascopubs.org/doi/full/10.1200/JCO.18.01779] showed that 5mg was as effective as the 20mg with no apparent side effects for certain conditions. I will bring up Raloxifine with my MO.

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