Here they are: the pills I’ll be taking for the next five to 10 years.
…or maybe not.
At my most recent appointment with my oncologist, we discussed a couple options for my endocrine/hormone therapy. I’ll be getting my monthly ovarian suppression shots (#buttshots) for sure, but there was a little uncertainty over which pill to pair them with: tamoxifen or an aromatase inhibitor. Tamoxifen is typically used in pre-menopausal folks and prevents estrogen from binding to estrogen receptors in breast (or breast cancer!) cells, whereas an AI prevents the adrenal glands from producing estrogen in the first place. AIs are typically used in post-menopausal folks, but because my Lupron shots put me into chemical menopause, an AI would work for me.
Anyway, my oncologist was leaning toward an AI because it has fewer scary side effects—tamoxifen slightly increases one’s risk of uterine cancer, cataracts, and blood clots; an AI doesn’t. However, AIs cause bone density loss, whereas tamoxifen strengthens one’s bones. Confusing! So my doctor decided to order a bone density test: If I had strong bones, we’d go with an AI; if I showed any bone density issues, we’d go with tamoxifen.
I had my DEXA bone density scan last week (super easy; you lie there and get low-dose X-rays of your spine and pelvis) and heard back from my oncologist earlier this week. Unfortunately, two spots on my pelvis came up as juuuust on the verge of osteopenia, the precursor to osteoporosis. (Like, literally on the border between “fine” and “osteopenia.”) Curses! My doctor says it’s probably because of chemo, which can mess with bone density. (On the plus side, my spine is above average density!)
The plan right now is to go with tamoxifen to take advantage of its bone-strengthening effects. We’ll reevaluate my bone density in a couple of years and potentially switch to an AI at that point. The Lupron-plus-AI combo is slightly more effective at preventing breast cancer recurrence than the Lupron-plus-tamoxifen combo, but my oncologist doesn’t want to send me into full-blown osteopenia or osteoporosis by starting me on an AI now.
I’m kind of bummed about it. I’ve been low-key dreading starting tamoxifen because I’m terrified of blood clots, so when I learned that an aromatase inhibitor might be an option for me, I was relieved… only to then have that option taken away because of the bone density issues. When I filled the prescription, I felt such a strong mix of emotions. Pride that I’ve gotten this far in my ~cAnCeR jOuRnEy~ (starting hormone therapy seemed like such a distant point when I first discussed my treatment plan with my surgeon), plus a bit of sadness that these pills and their side effects will be part of my life for such a long time, plus anxiety about said side effects.
But I’ve been thinking about it quite a lot, and I’ve realized… it’s my body. If I find that my anxiety about tamoxifen’s side effects is too strong, I can ask to go on an AI instead. I have every right to ask, at the very least.
In the meantime, I’m getting back into lifting weights to help strengthen the ol’ bones. I’d been really enjoying CrossFit-style workouts last year, but after my diagnosis I just… stopped doing them. I didn’t have the motivation when I was just trying to make it through every day; instead, I started a daily yoga practice that was just what I needed at that time. But now I’m incorporating more weights into my workout routine, which has also expanded to include jumping rope and playing (really bad) tennis. There’s some compelling evidence that regular exercise reduces one’s risk of recurrence for breast cancer, which is reason enough to stay active—not to mention that the endorphins help combat the survivorship blues (more on those in the future, I’m sure).
So here I am, two pills into the 1,676 I’ll take over the next five years. Take that, cancer cells! If there are any of you left hiding out in my body, I hope you starve!