The Big Question

I went to see an OB-GYN last saturday as per my oncologist's advise. I would need to see one every year as part of my yearly check up. Since we want to induce amennorhea with the treatments and medication, I thought it best to establish a baseline before taking Tamoxifen.

It was not really a pleasant visit to the doctor as I was quite shocked when my OB-GYN asked when am I having my hysterectomy! Waaaaiiiiiitttt a minute!!!! TIME OUT! TIME OUT! TIME OUT! What hysterectomy? Am I the right patient? I almost went into hysterics when I heard "hysterectomy". Can I give a new definition to the word? Hysterectomy means having a person going into hysterics. Ha! Ha! Ha! and Hah!

Back to business on hand. She said that it is best for breast cancer survivors who are under 40 y.o. who are going to take or taking Tamoxifen. Her explanation is that for pre-menopausal women, taking Tamoxifen to induce menopause will thicken one's uterine lining. And if there's no menstruation, the lining would not be shed/flushed out of the body. Thickening of the lining leads to a higher incidence of uterine cancer for pre-menopausal women. Since I'm also PR (progesterone receptor) positive, giving me progesterone to induce menstruation even for just 3 or 4 times a year is also out of the question as it might also trigger recurrence. So, for a supposedly worry free of Tamoxifen laden five years, it is "highly recommended" that I have that hysterectomy!

I would have stayed and argued with the doctor for the entire afternoon had I was able to keep my wits around me at the time. As it is, I ran out of steam after an hour and fifteen minutes. Since it will be me who will be having that hysterectomy, I think the doctor have a decidedly unfair advantage in the "great debate". So, I left her clinic, mind agog with all the information that was just fed to me.

Let's go to the other end of the spectrum. The way I understood the explanation given to me by my oncologist, taking Tamoxifen will reduce in half the remaining percentage of possible recurrence. This roughly translate to another 1% to 3% reduced probability of recurrence. I am also told that if after a month of taking Tamoxifen, and for some reason that it would not work for me (it will be reflected in the liver function test that I am to take after a month of Tamoxifen), I am to stop taking it. And that there are studies that with Stage 1 survivors, the survival rate of those who took Tamoxifen and who didn't is the same.

It seems that for the OB-GYNs, having your menstruation while on Tamoxifen is ok; but for the oncologists, menstruation is a no-no. My dilemma now is this: is the additional 1% to 3% chance of reduced recurrence worth the hysterectomy? Just the thought of another operation is enough to make me climb up the walls (oh, no! not another meltdown!). When I talked to Dad about it last night, he's dead set against hysterectomy. He said hysterectomy is so final. If I am to have that operation, there's no turning back.

I will be going back to my oncologist this Thursday to talk it out and weigh the pros and cons again. I am also considering consulting another OB-GYN. In the meantime, I will just go out WITH my mind! =) *LOL*

And I thought that the tough parts are over! Well, we do learn something new everyday.