Of interest, before my oncology appt. Tamoxifen

Found this while looking into Tamoxifen, the drug that seems pretty likely in my future: (I added the bold type since it applies to me.)

Tamoxifen is the oldest of all the SERMs (Selective Estrogen Receptor Modulators). Tamoxifen is prescribed for women with hormone-receptor-positive breast cancer before and after menopause. While tamoxifen is the hormonal treatment of choice for pre-menopausal women, research suggests that tamoxifen is not quite as effective as the aromatase inhibitors for post-menopausal women.

Tamoxifen is used to reduce the risk of breast cancer for women who:

are at high risk of breast cancer but have no personal history of the disease, or
have non-invasive, hormone-receptor-positive breast cancer, or DCIS (ductal carcinoma in situ), or
have hormone-receptor-positive invasive breast cancer at any stage.
Tamoxifen is taken for up to five years. But women with advanced (metastatic) disease can continue taking tamoxifen as long as it is working well.

Tamoxifen has very weak estrogen activity. When you take tamoxifen, it passes into your bloodstream, joining all kinds of hormones, nutrients, oxygen, and other molecules as it circulates through the tissues of your body. If breast cancer cells are present, tamoxifen flows around them as well. If these cancer cells have estrogen receptors (about two-thirds do), tamoxifen slips into the receptor "locks," filling up a space that would normally be taken by the body's natural estrogen.

Cell with estrogen receptors blocked by tamoxifen and helper proteins.
Larger VersionBecause tamoxifen is such a weak estrogen, its estrogen signals don't stimulate very much cell growth. And because it has stolen the place away from more powerful estrogen, it blocks estrogen-stimulated cancer cell growth. In this way, tamoxifen acts like an "anti-estrogen."

Tamoxifen may also take the place of natural estrogen in the receptors of healthy breast cells. In that way it holds down growth activity, and possibly stops abnormal growth and the development of a totally new breast cancer. By blocking natural estrogen from getting to the receptors, tamoxifen is helpful in reducing the risk of breast cancer in women at high risk who have never had breast cancer. It also can help women who have already had breast cancer in one breast by lowering the risk of a new breast cancer forming in the other breast.

For pre-menopausal women, tamoxifen is the best hormonal therapy. But tamoxifen is no longer the first choice for post-menopausal women. If you've been on tamoxifen for two to three years and now you're in menopause, your doctor may recommend that you switch to an aromatase inhibitor to finish your five years of hormonal therapy. However, you can still get a lot of benefit if you take tamoxifen for up to five years and then switch to an aromatase inhibitor.

Over the years, it's important for you to be checked regularly so that you and your doctor can re-evaluate how the drug's potential benefits and side effects.

Tamoxifen plus other treatments
Hormonal therapy doesn't replace other forms of treatment. The value of each treatment adds up to give you a better overall benefit. Hormonal therapy may be recommended on its own or in addition to chemotherapy or radiation therapy (but not at the same time as chemotherapy).

One study found that radiation plus tamoxifen was much better than tamoxifen alone at reducing the risk of breast cancer coming back after a lumpectomy in women with hormone-receptor-positive breast cancer. This was true even for women with very small cancers (less than one centimeter). Another study showed similar results for women with very small cancers with no lymph node involvement. This means it's important to have radiation treatment after a lumpectomy, even if you have a very small cancer and are taking tamoxifen or other hormonal therapy.

How the benefits of tamoxifen and chemotherapy add up depends on your individual situation. In general, for women with hormone-receptor-positive breast cancer, hormonal therapy is more powerful than chemotherapy. But chemotherapy can also be very helpful if you have a high risk of the cancer coming back. For example, if you have lymph node involvement, you may want to take both forms of treatment to get your risk as low as possible.

One study found that tamoxifen AND chemotherapy improved survival rates by about 40–50% compared to taking one treatment or the other. (Again, tamoxifen and chemotherapy are not given at the same time.)

However, another study found that chemotherapy plus hormonal therapy was no better than hormonal therapy alone for women with hormone-receptor-positive cancers that had not spread to their lymph nodes. This was especially true for women age 40 or older. The benefits of two hormonal therapies, tamoxifen and Zoladex (chemical name: goserelin), together are the same as the benefit as CMF (cytoxan, methotrexate, 5-FU) chemotherapy in pre-menopausal women. (Zoladex shuts down the ovaries so that estrogen production stops.)

Should you consider chemotherapy if the breast cancer has not spread to your lymph nodes? If you've been diagnosed with lymph node–negative invasive breast cancer that is hormone-receptor-positive, chemotherapy may not add much benefit above and beyond hormonal therapy. Plus, side effects of chemotherapy tend to be more difficult to handle than those of hormonal therapy.

To help figure out whether chemotherapy might or might not add benefit, you could consider having a test, called Oncotype DX. The test is available for women who have hormone-receptor-positive, node-negative breast cancer. Ask your doctor if this test might be helpful in your situation, and if she or he can help get the cost (about $3,200) covered by your health insurance.

ANY further reduction of risk may seem worthwhile to you. Many women feel that they want to do anything and everything to keep lowering their risk.

Back to me--as I mentioned, I am having the Onco-Type test...I'm going to be sure to take this info with me to the appt.