The right to refuse Tamoxifen

I just wanted to share my experiences, in case this helps anyone. Jan 2020 – aged 42 I was diagnosed with grade 1 breast cancer, one small lump, had a lumpectomy and LICAP flap reconstruction, and radiotherapy. I refused to take the hormone blocker Tamoxifen as both the hospital and Oncology did not take my concerns about the side effects seriously. I was bullied and shouted at by a trainee Oncologist on a phone call about it. Then I saw a woman from Oncology who said no-one takes it, or people try it and have serious side effects and then stop taking it.

June 2023 (aged 46) – I found another lump. I have had a left side mastectomy with implant reconstruction, full lymph node removal and my full nipple removed (3 small grade 1s and a minor stage 2 on size). 1 out of 6 lymph nodes had cancer in them. No evidence of spread beyond this so only a local recurrence.

I have had another very bad experience with the NHS this time. I am not having any further treatment. Chemo came out as 1.6% benefit on the Predict tool and hormone blockers as 1% benefit. I did not approve having chemo as it is not a guarantee and seemed excessive given that the surgery is 90% benefit. I tried one of the 20mg Tamoxifen and was very very ill for a week – I have bad eczema and my skin was burning like acid had been poured over me. I told Oncology about this and they were happy for me not to take it and support my decision not to have further treatment.

I still felt very bullied on more than one occasion by the hospital about the hormone blockers again this time so I wanted to let people know what their rights are. You have the right to refuse any treatment you do not consider acceptable – see https://www.nhs.uk/common-health-questions/nhs-services-and-treatments/do-i-have-the-right-to-refuse-treatment/ I do not consider that the NHS get adequate consent for the hormone blockers given that they clearly cause serious side effects which ruin lives. Research into better treatments needs to be carried out. The only proper prevention is a mastectomy.

No proper research has been done into the side effects of the hormone blockers and whether they really are worth taking as a result. Remember people have lives and careers, bills to pay etc. I do not regret taking it at all even after having a recurrence because hormone blockers are not a guarantee, and I will not be bullied into a course of action. I am looking forward to returning to my career in the new year.

  • Hi Lara. I am trying to find out where the original studies are, whether they are accessible for free online (not behind a paywall) and whether they are suitable for a 'layperson' to read / whether they are full of medical jargon.

    I will report back if I have any success.

    A couple of articles I have found interesting are:

    A previous study where people with a family history of breast cancer did not consider taking Tamoxifen for preventative purposes as they did not consider the side effects to be acceptable:

    www.independent.co.uk/.../women-breast-cancer-drugs-nhs-side-effects-tamoxifen-prevention-pill-a8318461.html

    And a study about why hormone blockers don't work for everyone (I don't recall any of the doctors mentioning this):

    www.independent.co.uk/.../women-breast-cancer-drugs-nhs-side-effects-tamoxifen-prevention-pill-a8318461.html

    I would also like to find out more about the studies which have shown Tamoxifen increases the risk of endometrial cancer.

    As I say I will report back when / if I find out more. I just think all the information and studies need to be more readily accessible.

  • And with the correct link for the second article:

    https://www.imperial.ac.uk/news/177133/breast-cancer-drugs-stop-working-when/

    A study about why hormone blockers don't work for everyone (I don't recall any of the doctors mentioning this).

  • Hi ProfBaw Thank you very much for sharing your experiences. There are always limits to any of us communicating our experiences as each type of breast cancer is very different and specific so thank you for sharing.

  • Hello Angry Lady 

    You do have the right to refuse meds. However maybe my situation can help? I had breast cancer 5 years ago. They put me on Tamoxifen which was 5 years of not getting repeat breast cancer but the medication did not suit me. I still persevered and kept going though I was nauseous almost every single day for 5 years I just could not get used to it. I did not get recurrence of breast cancer but one factor was omitted when I was taking it. I was 50 and it caused the menopause almost within a week or so of starting it and I never had a period since. No one advised me of the increased risks of endometrial thickening. I am Diabetic, never been pregnant and tick a lot of the boxes for potential endometrial hyperplasia. I started getting period like cramping a year ago which got more persistent so had a referral to gynae-oncology. My endometrial lining was thickened and underwent hysteroscopy and curretage under Gen Anaesthetic in May. They told me it was benign and that I was being discharged from their dept. Its Dec and since last month the cramps and exact same symptoms have flared up again. Now I am being referred again on 2 week referral to gynae oncology. 

    Was it worth taking Tamoxifen? yes it has kept me from a highly aggressive and high risk of recurring breast carcinoma but it does have complications that now need more tests and biopsy again on my endometrium. Make sure you ask questions, ask about risks because I was certainly not told of this risk. Then make a decision. Some people settle with Tamoxifen after a few months so maybe worth giving it a go? I am still sure it stopped recurrence of breast cancer but now life is back on the merry go round of tests, scans and biopsies I on some days feel like was it worth it? I was never offered any scans or checks of my endometrium make sure you ask about this. 

    Otherwise maybe just maybe you try it for a few months and see how you get on with it? The weird thing is cancer is horrid but the treatment for it seems worse especially as its given after a a really stressful time. 

    I hope I have not ranted too much.... Sending you hugs and healing 

  • Yeah, my wife has had those issues too with her womb. But her thickening happened within the first year. Luckily, like yourself, everything turned out to be benign.

    Caught between a rock and a hard place with certain treatments. She is the same age as yourself, and her periods also stopped when she began taking that. But the cells they removed showed she was still pre menopause, but the doctors all said she probably isn't. It's all rather confusing if truth be told. She's at that awkward age where she could be considered pre or post menopause. Before her cancer diagnosis, she was still having periods.

  • I know how stressful it all becomes I thought I had the menopause when I started Tamoxifen but 5 years later and having stopped it I am now going through yet another menopause it seems. 

    Got my next biopsy for the endometrium booked in ow...fingers crossed 

  • Angry lady 

    thank you so much for sending these across much appreciated keep in touch xx love Lara xx 

  • Offline in reply to laraj

    Hello angry lady . I see your point entirely and of course it’s your right to refuse treatment if you wish , however I would like to put my side across . I had Bc 18 years ago , grade one , no lymph node involvement so had a lumpectomy & radio . At the time it wasn’t deemed necessary for me to go on Tamoxifen as it was only a grade one . I was so relieved at the time as I didn’t want the side effects , weight gain etc . Fast forward 18 years and then had a local recurrence , resulting in mastectomy and DIEP . Current practice would be to have offered me Tamoxifen first time round ….. maybe it would have prevented recurrence ?? Who knows for sure? So as much as I hate taking Letrozole , I will carry on taking it . I wish you all the best . 

  • Thank you  very much for telling us about your experiences. I am so sorry to hear about this. My heart goes out to you and to the other people who have suffered similar issues.

    I was never given any proper indication of the side effects by any of my treatment team so I really value real people talking about their real life experiences.

    I know people think eczema is a joke but it has nearly killed me before (an infection across the whole of my skin), and the effect the tablet had on my skin was alarming.I can't live in pain like that. I don't have the luxury of not being able to work either - I do need to be able to work and pay my mortgage.

    I don't think other conditions as you say are fully considered with treatment recommendations.

    I really agree that 'The weird thing is cancer is horrid but the treatment for it seems worse especially as its given after a a really stressful time.'

    Please do feel free to rant as much as you like - it's really helpful for me.

    I am only sharing my experiences and in no way intending to tell people what to do. That's the point really - to facilitate people making their own informed choice. Again I am speaking from the 'luxury' of having had a low grade / stage recurrence and I can appreciate it is not that simple.

    It helps me a lot to hear from other people that have been through similar issues.

    I hope your referral to gynae oncology goes as well as it can do. Thinking of you. Feel free to return and rant any time. Take care.

  • Fingers crossed for you. Do keep us updated on here if you feel happy to.