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How Effective Is Tamoxifen Pill In Treatment Of Papillary Carcinoma?

Posted on Wed, 15 Jun 2016

Question: I am 76 year old woman who was recently diagnosed with breast papillary carcinoma, stage 1. I had full mastectomy on my left breast about 2 months ago and not nodes were affected. The biopsy showed that the cancer is HER2 positive. I was put on Tamoxifen pills and after taking it for 1 month, my liver enzymes got really elevated, some of them 3-4 times the normal value. My question is what is the effectiveness of Tamoxifen and this age? In my case, is it worth to risk damaging the liver and continue taking Tamoxifen? My dilemma is which one is more probable statistically? If I continue taking it, the probability of damaging the liver is much higher and more severe compared to the probability of reoccurrence of the breast cancer.

Please advise.

Thank you

Answered by Dr. Indranil Ghosh (1 hour later)

Brief Answer:
need a few more details

Detailed Answer:
Hi
Thanks for your query.

I understand your concerns. However, the info provided is incomplete. You have mentioned that nodes were negative and her2 was positive.

But I need to know the size of tumor, grade, lymphovascular invasion and the estrogen and progesterone receptor status.

If I assume it is a small tumor with no lymphovascular invasion, grade 1 and estrogen receptor positive, then the absolute effect of tamoxifen on survival is around 3%. That is, 3 more persons out of 100 will survive due to tamoxifen.

And if you cannot tolerate tamoxifen, you can always try aromatase inhibitors.

Hope this helps.
Regards

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Indranil Ghosh (43 hours later)

Hi,

Thank yo for your response. Here is more information: stage 1A, pTNM=pT1b, pN0, Pmx, G2, about 2-7 mm size, progesterone and estrogen positive, no lymphovascular invasion. I am very scared since I went to the ultrasound for my liver today and the doctor said that he noticed some changes in the liver. I did ultrasound on my liver in February ( about 2.5 months ago) and the specialist listed normal findings and size of the liver. This is in addition to the elevated liver enzymes that I am experiencing.
If the absolute effect of Tamoxifen on survival is 3%, I am thinking to stop it.

Thank you,

Answered by Dr. Indranil Ghosh (3 hours later)

Brief Answer:
for you it may be even lower

Detailed Answer:
After reviewing all the details, I think in your case, absolute benefit of tamoxifen may be 1-2%.

You can try aromatase inhibitors, probably that will not irritate the liver. But it can cause joint pains and worsen bone density in long run.

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar