Is hormone therapy safe at 48 with DVT and liver issues?

Question

Hello doctor,

I am a 48-year-old woman recently diagnosed with hormone receptor-positive (HR+) breast cancer, with a 2.8 cm tumor in my left breast. My biopsy showed that the cancer is estrogen receptor-positive (ER+), progesterone receptor-positive (PR+), and HER2-negative. My oncologist recommended starting on Tamoxifen, but I am concerned because I have a history of blood clots and currently take Warfarin for a deep vein thrombosis (DVT) I had two years ago.

Additionally, I have a family history of breast cancer. My mother passed away from it at age 54, and I have been experiencing menopausal symptoms like hot flashes and night sweats. My most recent blood tests showed slightly elevated liver enzymes (ALT: 58, AST: 54), and I am worried about the potential side effects of hormonal therapy, especially the risk of clots and liver complications.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Hormone receptor-positive breast cancer, which is both estrogen receptor-positive (ER) and progesterone receptor-positive (PR), is treated with hormonal therapy.

In your case, Tamoxifen is commonly prescribed as it blocks estrogen receptors on breast cancer cells, reducing the tumor's ability to grow and spread. Tamoxifen has been associated with an increased risk of blood clots. Given your clotting history, Tamoxifen may not be the safest option for you. It increases the risk of clot formation.

For postmenopausal women with HR breast cancer, aromatase inhibitors may be considered, which work by reducing the amount of estrogen produced in your body. Aromatase inhibitors do not have the same increased risk of blood clots. They are preferred in women with a history of thrombotic events, such as yourself. These inhibitors have side effects such as joint pain, bone thinning (osteoporosis), and menopausal symptoms like hot flashes.

Given your history of slightly elevated liver enzymes, it is important that any medication you take is monitored closely. Regular monitoring will be necessary with your oncologist. Discuss the possibility of genetic testing for mutations like BRCA1/2. Menopausal symptoms are worsened by hormonal therapies, hot flashes, night sweats, and mood changes.

Lifestyle modifications, keeping cool at night, using fans, or wearing light layers, and stress reduction may also help. Regular monitoring of your liver function and physical examination by a doctor in a hospital is a must.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.