OUR resident specialist and NHS GP, Dr Zoe Williams, shares her expert advice.
Today, Dr Zoe helps a reader who is suffering horrendous hot flushes since their breast cancer diagnosis.
Q: A YEAR ago, I was diagnosed with breast cancer. I have since had a single mastectomy, chemo and radiotherapy. I also have to take letrozole for the next ten years.
My problem is, I’m getting terrible hot flushes, and day and night sweats. Is it worth trying tamoxifen instead? Or is there no difference? I’m also taking clonidine, but it’s not helping.
A: I’m really sorry you’re going through these hormone-treatment side effects, on top of what you’ve been through.
Letrozole is an aromatase inhibitor (AI), usually prescribed after menopause (or if the ovaries have been suppressed), and is generally more effective than tamoxifen at reducing recurrence risk in many breast-cancer subtypes.
Tamoxifen works differently (blocks oestrogen receptors rather than reducing oestrogen production).
It’s often used in premenopausal women, but can be used after menopause too.
Whether it’s safe or reasonable to switch depends on your cancer’s characteristics and your tolerance of side effects.
Sometimes oncologists do switch patients from letrozole to tamoxifen if side effects are unmanageable and it is safe to do so. But unfortunately, both drugs can cause hot flushes and sweats.
So, even if you do switch there’s no guarantee there’ll be improvement – but some people do notice a difference.
Please don’t stop or change letrozole on your own. Any switch to tamoxifen (or a break in therapy) needs to be discussed with your oncologist, weighing recurrence risk against quality of life. Many oncologists are open to trying an alternative.