Kicking Cancer

Prevention Through Healthy Living

To Take, Or Not To Take? That is the Question

When I arrived home from Radiation in Marin, relieved to put all of this behind me (the bulk of it anyway), I received an email from a friendly friend entitled…I Know You Like Research.  I do, I do!  Especially when the research has to do with a pill that I need to put in my body for five years (ten years of hormone therapy, but five will be tamoxifen, the later five an aromitase inhibitor).  I will provide you with the link to the article Tamoxifen:  A Major Medical Mistake? (click here in fact), but if you are on tamoxifen, or are going to be on tamoxifen, please proceed with caution.  It is a wonderful, informative  article which prompted me to drop the regimen for four days before my doctor (also wonderful and informative) urged me to forge ahead, embracing the drug.

The article opens with the story of DES, a “medical blunder/shameful chapter” of medical history.  Tamoxifen and DES are similar in structure and both produce hormone-like effects.  I will try to explain in a nutshell for those not interested in reading the whole article…..Tamoxifen acts like an estrogen blocker.  As I mentioned in my previous post, my cancer cells were estrogen receptor positive (ER+).  So, they have these “key holes” that are waiting for the estrogen key to click in place and “drive” the cell.  So tamoxifen acts as a weak estrogen–the structure is similar to estrogen and for every tamoxifen molecule that plugs into an estrogen receptor on the cancer cells,  the estrogen is effectively blocked.

The problem is that while Tamoxifen acts as an anti-estrogen in breast cancer cells (because it inhibits activity of regular estrogen) it also acts as an estrogen in other areas of one’s body such as the uterus (also but to a lesser extent, bone, liver, blood) and is known to cause uterine and other cancers.

So…..treating cancer only to cause another cancer.  A dilemma.

The article goes on to explain that the lucrative Tamoxifen is the most widely prescribed cancer medication in the world, generating hundreds of millions of dollars for the pharmaceutical company that produces it.  Same old story.


I suppose my point is that none of these decisions are easy.  If you have been following my story since the beginning you know that I am a big supporter of “Take One Step At A Time”.  It has been motto in a way and I did not take a new step until I was completely in harmony with it. I was actually excited for my mastectomy “can I have it yesterday?”, the same thing for chemo, and radiation.  I was ready for each of those things.  I know all of these things are horrible (maiming and toxic), but I do not feel like I have the luxury of deciding anything different given the extent of my disease.  When it came time I was not super excited about taking Tamoxifen, but now that I have read this article, quit taking it for a few days, and was presented with another article and in-depth discussions with my doctor I am in harmony with it and will do my best to embrace it.

I felt honored that Dr. Gullion read the article I sent and discussed it at length with me.  Of course you may say!  It seems like that should just be a part of a doctor’s job, but these days doctors are so busy and overwhelmed that things like that may often fall through the cracks.  So, he read it, we talked by phone about a multitude of studies and is continuing research. Here is the article he sent me.  It is more  balanced about the benefits and side effects.

The hardest part for me with taking something like tamoxifen is the thought that I am playing into fear.  I am healthy!  I did chemotherapy and radiation, have an impeccable diet, get plenty of exercise and rest and am in an awesome emotional space.  How could my cancer metastasize?  It should be gone.  I did all the work!  One thought Dr. Gullion shared with me about the chemotherapy, however, is that my cancer cells weren’t rapidly dividing (it is important to know your cancer characteristics!  They are all so different) and chemotherapy targets rapidly dividing cells (hence hair loss).  So, my cancer cells may not have been touched by the chemo drugs.  Who knows?  We will never know!  They could have been in a resting phase.

The idea is to come at it from every possible angle.

So, the debate continues.  The different camps get in their corners, and in the meantime I will continue to scrutinize, educate myself, do qi gong, take herbs, and for now……take my tamoxifen.

If you have additional information about tamoxifen, please let me know.

I am heading home and ready for the cozy holidays.  The Scoop is closing for a month, and I am ready to hunker down and play with my family!  Happy Holidays.

Getting' some hair in time for winter!

Growing some hair in time for winter!

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4 thoughts on “To Take, Or Not To Take? That is the Question

  1. I am a firm believer in knowing the information and then making the choice that works for you, not anyone else. I also think if you say a prayer or state an intention each time, as you have been doing with your blog and also just perhaps with your altar or privately, that makes a difference. There is no Jewish blessing for taking medicine, which is a very interesting thing. Everything has a blessing, but not a drug. One of the reasons for this has to do with the major teaching that trumps all the prohibitions: CHOOSE LIFE. You can break the Sabbath to save a life, you can eat pig fat or crab cakes to save your life, you can roll around in shrimp guts if that will heal something on your skin (this is a made-up sample of something very un kosher being okay). So, no blessing for a medicine is related to the idea that it is an “of course” you have to do it kind of thing. That’s how I interpret it. I still think you can say a blessing or make one up, because that is NEVER wrong. I just wrote a piece for next week’s Eye about my favorite prayer, which would work before you take any medicine or course of action. I will send it to you privately as a sneak peak and once it has been published I’ll put it in my FB notes.
    Big Love to you as you spend sweet family time!

  2. Melissa Kraemer on said:

    Thanks for sharing Nicole. You look awesome by the way. I say follow your instinct . You are very wise to always question and research, but it sounds like your oncologist is excellent, attentive, and trustworthy so I think you are in good hands under his care and treatment regime. I asked my medically oriented cancer survivor mom if she had any insight on this and she suggested asking your doctor if your cancer has been analzyed pharmacogenomicly, which has something to do with personalizing therapy based on individual genetics.
    Have a wonderful holiday and time off with your family!
    (PS – I plan on swinging by sometime soon to pick up a glass baking dish. I’ve come by before but no one was home and didn’t see it on the porch)

  3. Hanna Greene on said:

    I view Tamoxifen no differently from mastectomy, chemo and radiation. It’s all part of the arsenal of weapons available in the toolbox to stave off a recurrance. Will any or all of them cure a specific cancer in the long run in any particular patient is anyone’s guess.

    Some women forego everything beyond mastectomy and have been successful in that approach decades later. Others use the entire pharmaceutical package and still face metastasis.

    Ultimately, it takes thinking about recurrance for a few minutes, no matter how disturbing. It takes asking yourself an honest question. IF I were to pass on the Tamoxifen (or mastectomy, chemo, radiation), IF I were to pass on any of the strong recommendations from my Oncology team and IF I were to develop metastasis a year from now, would I beat myself up over that prior decision? Would I live with a deep regret that I hadn’t used everything available to me and that now I will pay for that mistake with my life?

    It’s one thing to use everything in the arsenal of weapons and STILL face metastasis – but there may come a peace of mind in having done all you could fathomably do. But to decidedly decline one of the medications your medical team deems important in your longer term health could cause enormous distress (and self recrimation) should your health not remain stellar.

    If you believe you’re doing everything in the best manner possible and, come what may, you have done your best and you have no risk of future regrets….then, by all means, do as you wish.

    Whatever you choose, I’m wishing you the very best health and a long life.

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