By Brian I Park
Some side effects are associated with hormonal therapy using tamoxifen. Hot flashes are the most commonly reported side effect and occur in approximately 40 percent of women on the drug. In younger women, tamoxifen may be associated with irregular menstrual periods; however, pregnancy may still be possible, so young women need to use nonhormonal contraception to avoid pregnancy during the years they take tamoxifen. Some women notice mild nausea during the first few days on tamoxifen, but this generally disappears after a few days. Some women may find it helpful to take the medication with food or to experiment with taking it at different times of the day.
Less common side effects include abdominal bloating, leg cramps, headache, and ankle swelling. Weight gain is generally not associated with tamoxifen alone but is common in women who have received chemotherapy for breast cancer and is also seen in women after menopause. It is possible that the tendency to gain weight may also be affected by such additional factors as hormonal influence and age. Studies have shown that healthy women who took tamoxifen for five years for prevention did not show a significant difference in weight gain than seen in women who took a placebo.
Fortunately, serious side effects from tamoxifen are rare. They include a slight increased risk of developing blood clots, but this risk is less than 1 percent and is similar to the risk reported with estrogen therapy. If a woman has a history of prior blood clots or her doctor believes she is at particularly high risk for developing blood clots, then alternative hormonal agents such as Arimidex should be considered. Because of its estrogenlike effects on the uterus, tamoxifen can be associated with ovarian cysts and, very rarely, uterine cancer.
The risk of developing cancer of the uterus for a fifty-year-old woman is 1 in 1,000; the risk of developing endometrial (uterine) cancer for a fifty-year-old woman who takes tamoxifen is 2 in 1,000. So, although the risk is double, it remains an uncommon event. Generally, endometrial cancer makes itself known by irregular vaginal bleeding, or bleeding that you don't expect and that occurs outside of normal periods. Thus, women on tamoxifen who have not previously had hysterectomies need close gynecological follow-up, and doctors recommend routine yearly exams. If a woman has symptoms such as abnormal bleeding, prompt evaluation is needed. At that time, the gynecologist may choose to do an endometrial ultrasound or biopsy. However, studies have shown that women who are not having symptoms such as abnormal bleeding do not need these tests just because they are on tamoxifen. Finally, tamoxifen can be associated with a high risk of cataracts, so doctors recommend eye exams every one to two years.
Side effects of anastrozole include hot flashes and joint and muscle pain. There is a slightly higher risk of osteoporosis and bone fracture with anastrozole, in contrast with the slight protective effect of tamoxifen. In addition, anastrozole is associated with a lower risk of blood clots than tamoxifen and does not appear to increase the risk of uterine cancer.
Side effects of letrozole are similar to those associated with anastrozole and include hot flashes, joint and muscle pain, and increased risk of osteoporosis.
Side effects of adjuvant chemotherapy are generally temporary. Some women may experience vein irritation, prompting them to consider an indwelling catheter, which eases the administration of the chemotherapy drug. With Adriamycin, hair loss occurs by the second to fourth week of treatment; in some individuals this may include loss of body hair, eyebrows, and eyelashes.
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