Tamoxifen (Nolvadex) has been used for over 40 years to treat hormone-receptor positive early, locally advanced and metastatic breast cancers.
Learn about tamoxifen and other hormone therapies for metastatic breast cancer.
How does tamoxifen work?
Figure 5.9 below shows how tamoxifen works.
Hormone receptor-positive breast cancers need estrogen and/or progesterone (female hormones produced in the body) to grow.
Tamoxifen attaches to the hormone receptor in the cancer cell, blocking estrogen from attaching to the receptor.
This slows or stops the growth of the tumor by preventing the cancer cells from getting the hormones they need to grow.
Figure 5.9
Image source: British Broadcasting Corporation
Tamoxifen as breast cancer treatment
Treatment with tamoxifen lowers the risk of [67]:
- Breast cancer recurrence
- Breast cancer in the opposite breast
- Death from breast cancer
Tamoxifen is a pill taken every day for 5-10 years. For premenopausal women, tamoxifen may be combined with ovarian suppression.
The benefits from tamoxifen last long after you stop taking it.
Findings from a large randomized clinical trial showed taking tamoxifen for 10 years reduced the risk of breast cancer recurrence and death more than taking tamoxifen 5 years [73].
These findings have led to increased use of tamoxifen for more than 5 years, especially among premenopausal women who can't take aromatase inhibitors.
Taking tamoxifen for a longer time means a continued risk of health effects, such as endometrial cancer [73]. For premenopausal women, tamoxifen may also impact fertility.
Discuss the benefits and risks of taking tamoxifen for more than 5 years with your health care provider.
Learn about the importance of completing treatment with tamoxifen.
Learn more about tamoxifen and fertility.
Find a list of questions on hormone therapy for your health care provider.
Tamoxifen and anti-depressant use
Some types of anti-depressants called selective serotonin reuptake inhibitors (SSRIs) can interfere with the metabolism of tamoxifen (how tamoxifen works in the body) [66].
Whether these SSRIs may impact the effectiveness of tamoxifen is under study.
Some SSRIs (such as fluoxetine (Prozac), buproprion (Wellbutrin), paroxetine (Paxil) and sertraline (Zoloft)) may interfere with tamoxifen. However, it’s not known whether this might affect tamoxifen treatment for breast cancer.
If you are taking an SSRI to treat depression or menopausal symptoms, talk with your health care provider about possible drug interactions and other treatment options.
Learn about SSRI anti-depressants for the treatment of menopausal symptoms.
The side effects of tamoxifen include menopausal symptoms, such as hot flashes and vaginal dryness.
Learn more about the side effects of tamoxifen.
In addition to treating breast cancer and lowering risk, tamoxifen may have other health benefits. It may:
- Improve blood cholesterol profile by lowering LDL levels (the "bad" cholesterol). A better cholesterol profile may lower the risk of heart disease.
- Help maintain bone density and thus, lower the risk of osteoporosis and bone fractures (in postmenopausal women).
Learn more about tamoxifen on the National Institutes of Health's Medline Plus website.
SUSAN G. KOMEN® SUPPORT RESOURCES |
- Our Breast Care Helpline 1-877 GO KOMEN (1-877-465-6636) provides free, professional support services to anyone with breast cancer questions or concerns, including people diagnosed with breast cancer and their families. Calls are answered by a trained and caring staff member Monday through Friday from 9:00 a.m. to 10:00 p.m. ET and from 6:00 a.m. to 7:00 p.m. PT. You can also email the helpline at helpline@komen.org.
- Komen Affiliates offer breast health education as well as fund breast cancer programs through local community organizations. Your local Affiliate may also help you find breast cancer resources in your area. Find your local Affiliate.
- Our fact sheets, booklets and other education materials offer additional information.
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Importance of following your breast cancer treatment plan
Breast cancer treatment is most effective when all parts of the treatment plan are followed as prescribed.
It's important to follow the treatment plan (for medications and other therapies) prescribed by your health care provider in terms of:
Completing tamoxifen therapy
Tamoxifen for breast cancer treatment is prescribed for 5-10 years. The length of treatment coupled with side effects, such as menopausal symptoms, can make it tough to complete tamoxifen therapy.
Dealing with menopausal symptoms related to hormone therapy can be hard. Talk with your health care provider about ways to ease these and other side effects.
To get the most benefit from hormone therapy, you need to take the full course of treatment. People who complete the full course have better survival than those who do not [70-72].
If you have trouble remembering to take your medicine, a pillbox or setting an alarm on your watch or phone (you may be able to download an app) may help [1].
However, you don't need to panic if you miss a day or 2.
Learn more about the importance of following your breast cancer treatment plan.
Prescription drug assistance
Tamoxifen has a generic form. Generics cost less than name brand drugs, but are just as effective.
Medicare and many insurance providers offer prescription drug plans. One may already be included in your policy or you may be able to buy an extra plan for prescriptions.
You may also qualify for programs that help with drug costs or offer low-cost or free prescriptions.
Learn more about insurance plans and prescription drug assistance programs.
Susan G. Komen®’s position on fairness in oral cancer drug coverage |
Medications taken by mouth (oral) are usually covered under a health insurance plan’s prescription drug benefit rather than the plan’s medical benefit. As a result, people often find themselves facing high out-of-pocket costs when filling their prescriptions for oral cancer drugs (sometimes costing thousands of dollars per month). High prescription drug costs are a barrier to care. They can prevent people from getting the medications prescribed by their health care provider. Komen supports state and federal efforts to require insurers to provide the same or better coverage for oral breast cancer medications as they do for medications given by vein (through an IV). This would help ensure patients have access to affordable, appropriate treatment. |