If you have been diagnosed with hormone receptor positive breast cancer, meaning that the cancer cells were shown to be fueled by estrogen, and sometimes progesterone, no doubt as part of your post-surgery treatment plan, your doctor recommended that you take hormone inhibiting drugs. You would have been recommended to take either Tamoxifen, which blocks the action of estrogen and is normally offered to premenopausal women, or an aromatase inhibitor like Femara, Arimidex, Aromasin or Evista, which block the production of estrogen, and are normally offered to postmenopausal women.
You probably then went to the Internet, had a look at the side effects of these drugs, and got worried. It seems that taking them for five years was hard enough – so what are the merits or pitfalls of taking them for ten years?
For Tamoxifen, a study released In 2012  found that extending treatment with Tamoxifen from five years to ten years reduced both recurrence of and death from breast cancer. Because of this study, many women have been recommended to continue on with Tamoxifen for ten years rather than five.
For those taking aromatase inhibitors, however, many wondered if the findings about Tamoxifen could be extrapolated to aromatase inhibitors. A study published in 2016  in the New England Journal of Medicine investigated whether or not extending the taking of the aromatase inhibitor letrozole (Femara) from five to ten years for women with hormone receptor positive breast cancer would be beneficial.
1,918 postmenopausal women were enrolled in the trial and half of them were assigned to either take letrozole for five additional years (after already taking it for five years), the other half were given a placebo. 959 women were treated with letrozole for ten years and compared with 959 women who took letrozole for five years and a placebo for five years. On average, the participants were followed for just over six years so that researchers could examine their recurrence rates in the same breast, or a new breast cancer diagnosis in the opposite breast. They also looked at overall survival and quality of life.
Researchers found that although there was a “statistically significant” improvement in disease-free survival (women experiencing neither a recurrence in the same breast nor a new diagnosis in the other breast), for women taking the letrozole there was no difference in actual survival at the five year mark. So in effect this means that 91% of women who did not take the letrozole for the additional five years were disease-free five years later and 94% of women who did take letrozole for an additional five years were disease-free five years later. That’s a difference of 3% between the two groups, with no difference in overall survival. The study was partly funded by Novartis, the maker of letrozole.
Those Pesky Side Effects
The problem is that there are significant side effects from hormone blocking medications. The side effects and toxicity of Tamoxifen and the aromatase inhibitors are rather different, but each definitely has a significant impact on health and quality of life for a large percentage of the women who take these drugs.
In my experience as a health coach, a small percentage of women tolerate these treatments fairly well, but for most, these drugs come with fairly severe side effects. Many women stop the medication before completing the recommended course due to life-altering side effects. What are some of the most common side effects? Here’s a partial list:
• joint pain and stiffness, feelings of being far older than you actually are • muscle pain and weakness, leg cramps • bone pain, bone fractures, higher risk for osteoporosis • hot flashes and night sweats • headaches • dizziness • vaginal dryness and loss of libido • uterine lining abnormalities, and a higher risk for needing hysterectomy • tiredness, fatigue, lethargy • anxiety, depression (sometimes severe) • vision changes, dry eyes, damage to cornea and retina • insomnia • weight gain • loss of mental acuity and brain fog • hair thinning • blood clots and pulmonary embolisms • fatty liver
I believe that any treatment which fails to significantly improve overall survival while at the same time exposing women to that many serious side effects should be considered very carefully. It’s also important to know that the World Health Organization considers Tamoxifen to be a human carcinogen.
I believe we need our estrogen, keeping it in balance is the key. Many women are not even checked to see what their estrogen levels are after surgery, chemotherapy and radiation have taken their toll – they are just told that blocking the action of estrogen is imperative and they “need” to take these drugs to improve their chance of survival.
The Many Functions of Estrogen
Besides its functions in reproductive health, which can be found in any book on the subject, here’s what our body’s own estrogen also does for us :
• helps maintain body temperature • involved in energy production in the body including muscles • enhances the effects of certain neurotransmitters, the brain’s “feel-good” chemicals, so intimately involved in mood regulation • improves the thickness and quality of skin, as well as collagen content • alters disposition of fat cells around abdomen • helps to preserve bone strength • prevents bone loss • promotes pancreatic health and regulates insulin secretion • regulates cholesterol production in the liver, so has cardioprotective properties • maintains vaginal health • affects vascular tone and blood flow in organs and tissues, including the eyes • protective to brain and nervous system
The Role of Xenoestrogens in Hormone Receptor Positive Breast Cancer
I believe that xenoestrogens (environmental estrogens, known hormone disrupters) are much more dangerous to our health than our body’s own estrogen, and I’m not alone. In the book “Molecules of Emotion“, author and scientist Candace Pert stated “… accumulated environmental pollutants within our bodies are mimicking and disrupting the action of our sex hormones — estrogen, progesterone, and testosterone — which run the male and female reproductive systems.” She continues with this line of thought, stating “A recent report on receptor binding in Science, for example, has shown that environmental toxins have estrogenlike effects and bind to estrogen receptors, where they can stimulate breast cancer tumor growth. Similarly, various toxins can act like testosterone in the male body and stimulate prostate cancer, which is embryologically similar to breast cancer. Although this has been suspected for a long time, only recently have we gotten the hard proof that accumulation of these toxins in our bodies chronically stimulates our estrogen and testosterone receptors, putting them into a state of overdrive and leading to cancer.”
Dr Pert is not alone in these thoughts. Countless others have seen the problems associated with xenoestrogens on hormonal health. It is my belief that we need to start there – by detoxifying our food, our body products, our household cleaning supplies, etc. See my article for more information.
Bottom Line: Please evaluate the potential benefits and harms of hormone blocking medications, and talk to your health care provider about your concerns. Please be aware that estrogen is not the only factor involved in breast cancer. For a tumor to begin growing, and to be allowed to continue to grow, a good many things have to go wrong first. A good overall anti-cancer strategy would be to eat a healthy diet full of fresh organic fruits and vegetables, include particular super foods, take supplements that have research backing them (see my page discussing that), detox your household from toxic skin care, hair care and household cleaning products, get plenty of exercise every day, and keep your stress levels down. If you’d like my help putting together a personalized program, I’d be happy to assist you. You might like to consider my coaching services.
 Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial – https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61963-1/fulltext
 Extending Aromatase-Inhibitor Adjuvant Therapy to 10 Years – https://www.nejm.org/doi/full/10.1056/NEJMoa1604700
 The Role of Estrogens in Control of Energy Balance and Glucose Homeostasis – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660717/
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As a breast cancer coach, one of the most asked questions is how to cope with Tamoxifen side effects, so today I’m offering assistance!
Tamoxifen is a drug recommended for people whose breast cancer cells exhibited estrogen receptors, termed ER+ breast cancer.
The Action of Tamoxifen
Tamoxifen is in a class of drugs called “SERMs” – selective estrogen-receptor modifiers. Tamoxifen’s action is to occupy an estrogen receptor on a cell, thus paralyzing the receptor and preventing it from triggering the events that result in cell division. It does not kill cancer cells, rather it disables them or puts them to sleep. Tamoxifen targets not only the estrogen receptors in breast tissue, but also all of the other cells in the body that have estrogen receptors.
Tamoxifen Side Effects
Tamoxifen is currently the “gold standard” treatment recommended for all women with hormone driven breast cancer, regardless of the stage. The recommendation of most oncologists for women with ER+ breast cancer is that taking this medication for 5 years after a breast cancer diagnosis can supposedly reduce the risk of recurrence by up to 50%, which is a very persuasive figure. They are now recommending Tamoxifen use for up to 10 years.
Part of my problem with Tamoxifen is the wide range of side effects which include headaches, dizziness, nausea, hot flashes, night sweats, vaginal dryness, leg cramps, hair thinning, brain fog, pins and needles in hands and feet, joint pain, moodiness, depression and anxiety.
Tamoxifen may also put a patient at a higher risk for blood clots in the legs (deep vein thrombosis) and the lungs (pulmonary embolism), endometrial cancer and overgrowth of the lining of the uterus.
Since women are recommended to be on this drug for 5-10 years, their concerns about the side effects and loss of enjoyment of life are very real.
It Doesn’t Work For Everyone
What we are finding out here in the trenches is that this drug works for some but definitely not all. I cannot tell you how many times I’ve been told by a woman that she took the Tamoxifen for the prescribed amount of time and is still battling her second or even third round of breast cancer. So it is clear that the drug doesn’t work for everyone.
Are There Alternatives To Tamoxifen?
At this time, there do not appear to be any good research studies that directly compare specific diets or nutritional strategies with the use Tamoxifen to prevent breast cancer recurrence. Having said that, we do know that a healthy diet and plenty of exercise are truly important, they do make a big difference, and this has been proven by research studies.
The Women’s Healthy Eating and Living (WHEL) study followed 1,500 women with early stage breast cancer who were treated between 1991 and 2000, and found that women who both ate plenty of vegetables and fruit every day as well as got regular physical activity were nearly 50% less likely to die during the study follow up. In this study both women taking Tamoxifen and not taking Tamoxifen were included, so it is clear that diet and exercise are incredibly important for staying well.
For those who choose to take Tamoxifen, some of the side effects can be quite troublesome and these people really need some help.
Here Are My Best Recommendations For Coping With Tamoxifen Side Effects:
Headaches – Having a regular deep tissue massage and/or acupuncture from qualified practitioners can make a huge difference with headaches. Also, as simple as it may seem, drinking plenty of filtered water can assist your body to clear the drug from your system a little better. So make sure to drink plenty of water (and not tap water!).
Dizziness – As odd as it may seem, meditation can be very helpful with the dizziness associated with Tamoxifen use. If the dizziness becomes severe, however, seek the advice of your doctor. You may need to go off the Tamoxifen or reduce your dosage. As with headaches, drinking more water can often help to ease dizziness.
Nausea – Drink ginger tea. You make it with organic ginger root (not the dried spice), slice off a small chunk of it and put it in hot (just off boiling) water and let it steep for several minutes. Sip as needed.
Hot Flashes & Night Sweats – These are more difficult to solve – these symptoms show that the Tamoxifen is doing its work. You may find that certain herbal remedies like Remifemin assist with the frequency, intensity and duration of hot flashes and night sweats. Traditional Chinese Medicine has a number of herbs that are helpful, so seek the help of a qualified Chinese medicine doctor. For a list of other helpful hints, see my article Tips Tricks and Support For Hot Flashes.
Vaginal Dryness – This is one of the most distressing of the side effects and not often discussed. There is one very safe product I can recommend, a natural lubricant called Sylk. Highly recommended. Also organic coconut oil is very useful.
Leg Cramps – Take 500 mg of magnesium citrate twice daily. Magnesium is also found in plenty of green leafy vegetables, so eat your salad!
Brain Fog – Essential oils are extremely helpful here because they help to clear off the neuron receptor sites of any accumulated gunk (which can result in brain fog). Deep breathing of oils like basil, peppermint, and frankincense helps to clear your mind, improves memory and brain function. Meditation is also very helpful.
Pins & Needles in Extremities – Again, I recommend the use of massage therapy and/or acupuncture, drinking plenty of water, and it would also be helpful to do a bowel cleanse and a liver cleanse because Tamoxifen is a toxic drug, and cleansing will help you clear chemical residues which may be building up in the tissues of your body.
Joint Pain – This is one of the more widely experienced side effects of Tamoxifen. Yoga is helpful, as is massage therapy, and I also recommend a good quality glucosamine sulfate supplement for joint health, together with plenty of omega-3 fatty acids in the diet.
Moodiness, Anxiety, Depression – Sometimes associated with Tamoxifen use, but often these problems arise just from the fact that you are going through cancer. It’s better not to ignore them and I recommend getting some counseling. Meditation is extremely helpful for anxiety and moodiness. For depression related to Tamoxifen, check with your doctor to see if you can reduce your dosage of Tamoxifen. Some women are taking it every other day, rather than daily, and still getting good results. Dietary assistance for these problems includes eating lots of fresh organic veggies and fruit, omega 3 fatty acids, and vitamin B complex – all of these are surprisingly beneficial. One last word about depression – it can come on slowly over a period of several months, and some women will not realize that they are depressed. Pay close attention to this please and get some help if you need it. You may want to discontinue the use of Tamoxifen if the symptoms are severe (discuss this with your doctor). I would not recommend the use of anti-depressants because they may make Tamoxifen less effective.
If you are having problems with any of these side effects (or anything not mentioned above) associated with Tamoxifen and would like more information from me, please feel free to contact me. I have plenty of information about all of the things I have recommended and would be happy to share it with you. I also have a more holistic protocol for staying well without the use of hormone blockers, so please contact me if you would like information about that.
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Every single day I am contacted by women who are either going through breast cancer treatments or have finished their treatments and have been prescribed estrogen blocking drugs like tamoxifen (Nolvadex), anastrozole (Arimidex), exemestane (Aromasin), letrozole (Femara), raloxifene (Evista).
Many of these drugs are also known as aromatase inhibitors because they deactive a key enzyme (aromatase) that is responsible for a key step in the biosynthesis of estrogen.
Why Women Are Prescribed Hormone Blockers
A breast tumor is called “estrogen receptor positive” or “ER+” if it has receptors for estrogen – this suggests that the cancer cells, like normal breast cells, may receive signals from the hormone estrogen that could promote their growth. The cancer is termed “progesterone receptor positive” or “PR+” if it has progesterone receptors. Again, this means that the cancer cells may receive signals from progesterone that could promote their growth. According to BreastCancer.org, roughly two out of every three breast cancers test positive for hormone receptors.
The women who are contacting me are very concerned about the side effects of such medications, they are researching and wanting to know more and they are wondering if there are any natural products that will do the same job without the side effects.
My Personal History
I went through breast cancer in 2004. If you’d like to read my whole story, check out my Breast Cancer Diary page. Briefly, however, I had a 2.5 cm tumor, about the size of an olive, and it was a rapidly growing tumor known as infiltrating ductal carcinoma. I had a large lumpectomy and a latissimus-dorsi flap reconstruction. I was recommended to have chemotherapy right away, but being a natural therapist I needed to be convinced of the necessity of that, so I went home to heal up and work on my immune system. Eventually both my oncologist and my natural therapists convinced me that it would be beneficial for me to undergo chemotherapy and I did 6 months worth. I chose not to have radiation for various reasons, and although both my oncologist and my regular doctor tried hard to get me to say yes to the hormone blocking drugs, I just could not be convinced that this was a good route for me to follow. For one thing, I was progesterone receptor positive only, which is somewhat unusual. I couldn’t see how tamoxifen, which is used as an estrogen-blocker, was going to help me since I was PR+. My doctors argued it would “still have some therapeutic benefit.” I wasn’t convinced, and especially when I read about the side effects of these drugs. Instead I went home and went into deep research mode. Here’s what I found.
1. Some research indicated that tamoxifen was more useful in elderly and frail women and it removed the need for surgery in a high proportion of those women. (Akhtar SS, et al. A 10-year experience of tamoxifen as primary treatment of breast cancer in 100 elderly and frail patients. Eur J Surg Oncol. 1991; 17:30-5.)
2. The Institute of Cancer Epidemiology in Copenhagen studied 3,500 post-menopausal women who received surgery for breast cancer. About half of these patients were considered to be low risk and received no further treatment. The high risk patients received either radiotherapy or radiotherapy plus tamoxifen. After about 8 years, the scientists looked at the incidence of cancer in these women. All 3 groups had more cancer than the general population and for those who had received radiotherapy there was a higher incidence of leukemia. There was no difference in cancer incidence in the high risk group that received tamoxifen plus radiotherapy compared to those who just received radiotherapy, indicating that tamoxifen did not confer any special protective effects. In fact, there was a tendency to an elevated risk of endometrial cancer. (Andersson M, et al. Incidence of new primary cancers after adjuvant tamoxifen therapy and radiotherapy for early breast cancer: J Natl Cancer Inst. 1991; 83:1013-7.)
3. The McArdle Laboratory for Cancer Research of the University of Wisconsin studied rats given tamoxifen. At first, all appeared okay, but when the rats were also given a small dose of chemicals and then fed tamoxifen, the livers of these animals showed an increase in the size and number of altered liver lesions compared with the animals that had been fed the chemicals but not the tamoxifen. The researchers felt that tamoxifen acts as a tumor promoter in the rat liver, that it was four times the strength of phenobarbital (a drug commonly used as a representative promoting agent in experimental carcinogenesis). (Dragan YP, et al. Tumor promotion as a target for estrogen/anti-estrogen effects in rat hepatocarcinogenesis. Prev Med. 1991; 20:15-26).
4. There were too many disturbing reports of eye damage from the use of tamixofen. In one article that appeared in the Annals of Ophthalmology, I read about toxicity to the cornea, retina and optic nerve. And though it seemed that the damage did not progress once the drug was stopped, it could not be repaired. (Gerner EW. Ocular toxicity of tamoxifen. Annals of Ophthalmology 1989; 21:420-3). I had enough problems with my vision, I certainly didn’t need any more.
I could go on and on here, citing all of the research that I did – and yes this research is a little older, I went through breast cancer in 2004, as I mentioned.
Possible Side Effects of Hormone Blocking Drugs
The list of possible side effects of these drugs is lengthy: hot flashes, vaginal dryness, headaches, muscle, joint and body aches, dry mouth, nausea and vomiting, changes in bowel habits, muscle weakness, fatigue, increased risk of liver cancer, precancerous changes in the uterus, blood clots which could travel to the lungs and cause pulmonary embolism or a stroke, cataracts and other vision changes.
I just wasn’t willing to submit my body to any of that.
It’s Time To Wake Up
What I am seeing as a breast cancer coach is a large quantity of women (more than I ever thought possible) who have taken the hormone blockers for the prescribed length of time (usually 5 years) and are coming to me with a new breast cancer.
We need to wake up people! These drugs are not working. They are toxic to our bodies and there are better ways of regaining our health. The thing is, you can’t just say no and do nothing else. You really need to be very pro-active with your health. If you don’t know what to do, feel free to sign up for my e-books and newsletters, I provide them as a free service to people going through breast cancer and I share all of my best tips and information in them (see the sign-up form on the right side of this page).
It’s Not All About Estrogen!
I have said this so many times lately, it’s starting to become my slogan. Estrogen is a hormone we want and need in our bodies. The doctors are so focused on the fact that there are estrogen receptors on our breast cancer cells but part of the problem is that there are synthetic estrogens in our body products, our drinking water, our cosmetics, our environment, and these are part of the problem with our health (see my article Protect Yourself From Xenoestrogens and Estrogen Dominance).
In her book “Molecules of Emotion“, author and scientist Candace Pert shares with us “… accumulated environmental pollutants within our bodies are mimicking and disrupting the action of our sex hormones — estrogen, progesterone, and testosterone — which run the male and female reproductive systems.” She goes on to state that “A recent report on receptor binding in Science, for example, has shown that environmental toxins have estrogenlike effects and bind to estrogen receptors, where they can stimulate breast cancer tumor growth. Similarly, various toxins can act like testosterone in the male body and stimulate prostate cancer, which is embryologically similar to breast cancer. Although this has been suspected for a long time, only recently have we gotten the hard proof that accumulation of these toxins in our bodies chronically stimulates our estrogen and testosterone receptors, putting them into a state of overdrive and leading to cancer.”
There are many other factors which put us at a higher risk for breast cancer, and right up there at the top of the list is STRESS. You can do little to avoid it but you certainly can change the way that you react to it. Try meditation to relieve that stress. Get yourself into a meditation group, or if you live in a remote area download my meditation course.
I also believe that it’s vitally important to build up your immune system to be as strong and healthy as it can be, since our immune system is our first line of defense against cancer cells. Why don’t the doctors tell you that? Any natural therapist certainly will. Have a look at my page 8 Ways To Build A Super Strong Immune System. How important are these 8 items? I believe they’re absolutely crucial. Give proper attention to each of the 8 items on the list and you will be much happier and healthier than if you are taking toxic drug therapies.
Cancer Therapy, The Independent Consumer’s Guide To Non-Toxic Treatment and Prevention by Ralph W Moss, PhD.
Molecules of Emotion by Candace B Pert, PhD.
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters and e-book on the right, and/or “like” me on Facebook (MarnieClark.com). It is my honor and my goal to help you through this so that you emerge from breast cancer feeling better than before, thriving!
PLEASE BE AWARE THAT THIS BLOG POST IS INFORMATION I HAVE DISCOVERED FOR MYSELF. IT FEELS TRUE FOR ME. THE INFORMATION PRESENTED HERE IS NOT MEANT TO DIVERT YOU ON YOUR HEALING PATH, IT IS ONLY INTENDED TO RAISE AWARENESS OF OTHER WAYS OF THINKING. YOU MUST DO WHAT IS RIGHT FOR YOU.
Curcumin Very Helpful For Those With Resistance To Chemotherapy, Tamoxifen
According to breastcancerresearch.com, approximately 70% of breast cancers are estrogen receptor positive (ER+) at diagnosis. These patients are often recommended to have endocrine therapies that target estrogen receptors, such as the drug Tamoxifen.
Tamoxifen works by binding to tissues that use estrogen. This binding blocks the action of estrogen in the breast but mimics the action of estrogen in the bones and uterus. Tamoxifen is used to treat ER+ breast cancer in men and women and to prevent breast cancer in those at high risk.
Some People Are Resistant
Some people, however, are resistant to anti-estrogenic drugs like Tamoxifen, and also to certain chemotherapy drugs. See my article about chemoresistance, Chemo-Resistant Breast Cancers In The News. This has proven to be a huge problem for some patients.
According to breastcancerresearch.com development of resistance is a process that “appears to result from upregulation of growth factor and protein kinase signaling pathways that provide an alternate mechanism in support of tumor cell proliferation and survival.” So researchers are keen to identify or target the factors that come into play with endocrine resistance.
The good news is that a new Chinese study, published in January 2013 in Molecules, indicates that curcumin, the active ingredient in turmeric, has been shown to be effective in helping to restore Tamoxifen sensitivity and also sensitizes cancer cells to chemotherapy, thus making the chemotherapy more effective. The researchers “discovered that curcumin treatment displayed anti-proliferative and pro-apoptotic activities” and that the “findings suggested that curcumin alone and combinations of curcumin with endocrine therapy may be of therapeutic benefit for endocrine-resistant breast cancer. Click this link to read the Chinese study.
You can get curcumin in capsules in health food stores, you can also use turmeric in your cooking. Allrecipes.com has a big list of recipes that utilize turmeric. It’s a gorgeous spice and adds depth and flavor to your curries, as well as other dishes. I recommend turmeric in my page Diet and Cancer (scroll all the way to the bottom).
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). It is my honor and my goal to help you through this.
Dr Schor is a gifted naturopath in Denver, and is also President of the Oncology Association of Naturopathic Physicians. Fair warning – the article is not an easy one to read – I suggest you print it out and go put your feet up in a quiet place to digest the information. It will probably require several readings to fully appreciate what Dr Schor is telling us about estrogen metabolite ratios.
I found the information fairly depressing, because I (and many like me) had been relying on DIM to keep circulating estrogen levels at a safe range without having to resort to the toxicity of Tamoxifen. Having said that, I really appreciated Dr Schor’s review of the research, and his courage to publish an article that goes against the current thinking. We need more fine minds like his in this fight.
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