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Aromasin Makes Post-Treatment Trouble For Breast Cancer Survivors

By February 13, 2012

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Aromasin pills
Aromasin Pills
Photo © Karl Stephan

Aromasin (exemestane) is an important drug for estrogen-positive breast cancer patients.But, like many cancer drugs, it comes loaded with trade-offs. It helps many patients prevent a recurrence of estrogen-sensitive breast cancer by blocking your body's estrogen production. But taking Aromasin produces menopausal symptoms: the classic hot flashes, fatigue, joint pain, and even bone thinning. A recent study was published in The Lancet by a group of oncology scientists in Canada and America, looking at the effects of Aromasin on bone health. They concluded that, "Exemestane worsens age-related decreases in bone mineral density by about three times, even in the setting of adequate calcium and vitamin D intake."

Chemotherapy as well as hormonal follow-up therapies can cause bone density loss (osteopenia) and sometimes when a women takes an aromatase inhibitor after her primary treatments, her bones may continue to thin out until she has osteoporosis. This loss of bone density and strength can take place even if she is taking sufficient calcium and Vitamin D to guard her bone health. The study, led by Dr. Angela Cheung, followed 242 women over 2 years on Aromasin (exemestane). All of the women had a baseline bone density scan and none of them were taking medicine for osteoporosis. These women were divided into 2 groups - one took Aromasin and the others took a placebo. While all the women showed some bone thinning at the end of two years, the group on Aromasin fared worse in their bone density.

Most women lose some bone density as they age, even if they never have cancer treatments. Estrogen levels drop during menopause, when your ovaries stop making the female hormones. Taking calcium and Vitamin D can help delay bone thinning, as well as weight-bearing exercise. If you can't tolerate calcium carbonate very well, try calcium citrate instead (it is easier to digest). Your doctor may recommend preventive drugs such as Fosamax or Actonel, to help treat bone loss. You may also need to have annual bone density scans as part of your well woman checkups, to monitor your bone health.

I was diagnosed with breast cancer almost 10 years ago, and took Tamoxifen for 2 years, then Aromasin for 3 years. Many women complain of the side effects of both these drugs - I know I did! - but we keep taking them because we want to avoid the return of cancer. I haven't taken hormonal therapies for 5 years now, but my bone density loss continues to progress. Who knows how long the effects of Aromasin will be with me? My latest mammogram showed no signs of cancer (Hooray!) but my bones are weakening like a much older lady. The good news is - I hope to live longer after breast cancer than I would have 20 or 30 years ago, but I must be more vigilant over my brittle skeleton. That's a tradeoff I'm willing to take, hot flashes and all.

Has Aromasin given you any trouble? Let me know by leaving a comment here.

Source: Bone density and structure in healthy postmenopausal women treated with exemestane for the primary prevention of breast cancer: a nested substudy of the MAP.3 randomised controlled trial.  Dr Angela M Cheung MD,Lianne Tile MD,Savannah Cardew MD,Sandhya Pruthi MD, et al. The Lancet Oncology - 7 February 2012.

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Comments
February 14, 2012 at 9:13 am
(1) Concerns says:

Thank you for the informative article and for sharing your personal story. You’re right, I think, about the trade-offs: you might rightfully complain about side effects, but if the drug helps you live a longer life you’ll take those side effects.

I only had once concern with the reference to Fosamax. People should be aware of the current studies (and fosamax lawsuits) regarding long-term use of bisphosphonates like Fosamax. Ask your doctor if you’ve taken it for more than a few years. I’ve heard from women whose prescribing physician (sometimes an OB/GYN) was unaware or only slightly aware of the issue, while orthopedic physicians who treat the fractured femurs seem to know more. Always talk these issues over with a doctor, of course, before stopping medication.

Thanks again!

February 14, 2012 at 3:03 pm
(2) Darlene Varaleau says:

Although the study claims that the women were taking adequate calcium and vitamin D…I would like to know if they received vitamin D blood tests during the study. The recommended daily intake (RDI) vastly underestimates how much supplementation is required during the winter in northern regions. I was taking 2,000IU daily and fell below the acceptable range by January. I now take 5,000IU in the winter because adequate vitamin D can improve calcium absorption dramatically and is essential for the prevention of osteoporosis. Did this study assume that the women were getting enough vitamin D or did it include blood tests?

February 15, 2012 at 9:03 am
(3) Sally says:

I don’t know if it was due to Aromasin or having been treated with chemo twice for breast cancer, (Once 15 years ago and once 5 years ago). but just now at age 60 I developed an aggressive type of leukemia and have just been diagnosed and started treatment for it.
For me, the Aromasin caused the least of the creaky, painful joints. My bone densities were always the best they could be. I couldn’t take the other preparations as I could hardly walk when I took them. Finally I was put on Aromasin and could tolerate the little bit of creaky I had.

February 15, 2012 at 9:47 am
(4) Pat Phelan says:

I’m taking arimidex and am having some symptoms like achy joints etc but I’m also takin vit d3, 1000 units/day. My MD measured my vit d level and found it low, so increased the dose to 2000 u/day. I haven’t had a bone density test since two years ago and it was normal then. should I have another done now since I’ve been on the arimidex for two years?

February 15, 2012 at 10:28 am
(5) Victoria says:

I have been taking Arimidex for over 5 years now, following surgery, chemotherapy and radiation for statge IIIB breast cancer. I started out with osteopenia, then moved to osteoporosis which has worsened in the last couple of years. I did have a Vitamin D screening, was low, and increased my dosage, plus do daily calcium. I was on Boniva for a while, but am also concerned about the side effects of these drugs marketed to improve bone density.I don’t know whether it’s better to go back on Boniva and take my chances with possible future fractures, or to take my chances for potential bone issues without it. I want to continue the Arimidex as long as possible to lessen chances of recurrence, but what’s a girl to do?

February 15, 2012 at 10:33 am
(6) Verite Reily Collins says:

Re Osteoporosis – I developed this after being on Aromasin. Researched what European cancer care does to help – and discovered that special weight-bearing exercises are the key to possible reversal – or to stop developing.
Many women in Austria are put on an exercise regime the moment they are given Aromasin. This was too late for me after I had developed this, but I went to Austria, found out about exercises – see http://healthspanews.com/exercise-is-fun-in-austrian-alps/
and doing these for a year, my specialist says I have increased bone density by 21%. Just a thought but hope it helps.

February 15, 2012 at 10:35 am
(7) Verite says:

Here’s more on using exercise to help with osteoporosis :
http://after-cancer.com/?s=Osteoporosis

February 15, 2012 at 10:39 am
(8) Victoria says:

Thanks for the info and link, Verite! I’ll check it out. Maybe I need to tell my hubby I need to go to the Austrian Alps (for medicinal purposes only, of course)! Thanks again and great to hear of your success.

February 15, 2012 at 10:55 am
(9) Cheryl says:

I’ve only been on letrozole daily,an AI since dx.
I also get a monthly infusion of Zometa for bone strengthening since I am Stage IV with bone mets.
This plus calcium and Vit D3 will hopefully prevent osteoporosis.

February 15, 2012 at 11:05 am
(10) jess says:

Yes Aromasin is causing me to lose bone density. Osteoporosis runs in my family also. However, my research has indicated that exercises esp weight bearing, isometrics and yoga can improve bone density. Also, magnesium, vitamin D3, Vit K(meniquine), boron and strontium citrate all help with this. I cannot take any of the meds due to GI disorders. Finally, a Pyrill Links urine test will show how much bone you are losing.

February 15, 2012 at 5:59 pm
(11) Celeste says:

I have been on arimidex for 3 1/2 years and have bone density done every year. I had taken fossomax before the cancer of some bone thining, but when standards were revised I was taken off the fossomax. My oncologist and obgyn have kept careful watch on my vit D levels, calcium, and bone density and so far there has been no change in my bone density since I began the arimidex. I am very thankful.

March 4, 2012 at 6:14 pm
(12) n.novicevic says:

I have taken Aromasin for a year. I am so afraid for my bones as I have osteopenia and trouble with bones. I also take every four weeks drug for bones, named zolendronic acid (five treatments). I have hot flushes. Please, let me know if it is good for my bones as they weaken from day to day.
Thanking in advance, yours sincerely,
N. Novicevic

March 7, 2012 at 12:43 am
(13) kristina says:

Just stopped Aromasin 3 weeks ago. I had 10 more months left to take it but it was a quality of life issue for me. I’ve had major fatigue on it, some joint pain and other lesser SEs, but for me, the fatigue was the hardest one to deal with. So I chose to stop it, with my oncologist’s blessing. Since going off it, the fatigue has gotten worse (go figure) and hot flashes have come back big-time! I’m hoping this will soon pass as it washes out of my system.

March 7, 2012 at 12:50 am
(14) Kristina says:

I forgot to mention the bone loss. Major bone loss. My onc wanted me to go on Reclast but I refused. Took Boniva for 3 years prior to diagnosis. I do yoga (tree pose 3 x day has shown to build bone). I walk several miles a day and take calcium, vit D and eat a very healthy diet. My bone loss stabilized after going off Boniva. It should be much better now that I’m off the Aromasin.

July 9, 2012 at 1:22 pm
(15) Denise says:

I was on tamoxifen for a year and was switched to Aromasin back in February. I have been having severe burning in my arms and legs and almost daily headaches, along with fatigue and hot flashes and joint and muscle pain. I do have rhematoid arthritis but it was under control with medication. I stopped the Aromasin 4 days ago and was wondering how long it will take to get out of my system because I am still having the side effects. Going to ask the doc to put me back on the tamoxifen because the only side effect I seemed to get from that are the hot flashes.

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October 6, 2012 at 10:02 pm
(20) susan says:

Just switched from 3 years of Tamoxifin to Aromasin. Ouch! I feel 100 years old – I am achy – dread waking up in the a.m. – I can barely move. Getting out of bed, my feet hurt – my legs, my knees, my arms, my hands – my very being actually. As much as I disliked my side effects from Tamoxifen this almost seems cruel. The discomfort is so great, my once Very active lifestyle and exercise regime are almost impossible. I hiked to day, hoping it would relieve the achey-ness, but it has enhanced it. My high-risk for osteoporosis only adds to my concern about “sucking it up” and continuing this course of treatment. If ANYone has recommendations – proactive ways to reduce the aches and pains of this medication – I would greatly appreciate it. I am fearful of a bone density scan at this point hearing what everyone has to say about the results…Feedback would really be appreciated.

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December 25, 2012 at 1:14 pm
(24) Marian says:

After taking Aromasen 12 months, I now have bone mets ? Tomorrow I have my consult with radiation Oncology. I had Breast Cancer 12 years ago and took Tamoxifen for 4 years. Last year the Breast Cancer showed up in Soft tissue.. No signs of bone mets were evident even 4 months ago… After Bone Density scans, CT scans every 6 months, MRI’s Ultra sound’s not to say that many of these don’t detect Bone mets… I complained of the constant bone pain just after starting to take Aromasen. But not until after a rib fracture found hip and arm mets on an Xray and CT Scan. just a few months after previous scans. Did not show up before. Can Aromasen cause this sand should I get off of it ?

December 25, 2012 at 1:26 pm
(25) Marian says:

Aromasin !

Agree my work outs stopped because after work my bones were too weak… Now since the discover of bone mets I have to worry about pathologically fracturing a bone. My Bone Scan did not reveal osteoporosis, but osteopenia. The thing is… my muscles are good and I want to do rings I am used to doing….. but now have to fear fracturing a bone … I fractured my rib leaning over with a big belt that was cutting into my rib…it hurt not a big deal — strapping a pair of shoes…I didn’t realize the pain I felt with no concern was me fracturing my rib.

January 1, 2013 at 2:11 pm
(26) Janet Solie says:

I have been on Aromasin 6 months. I too have experienced joint pain in feet, ankles, knees, hips, shoulders, hands. My oncologist recommended SAMe 400 mg three times a day. It has helped big time, but still difficult. I took Fosamax three weeks and joint pain much worse, so I stopped Fosamax. I continue to exercise and take calcium and vitamin D daily. I do pilates, walking, biking and exercises to strengthen and stretch large joints. I am concerned about bone thinning and am looking for strategies to help prevent.

March 14, 2013 at 8:45 pm
(27) Kay says:

I have taken aromasin for 5 years and thought I was done. Now my oncologist said that studies show I should be on it for another 5 years! Has anyone else been told this?

April 3, 2013 at 4:59 am
(28) Sylvia says:

Hi, I’m a novice at this but here goes. Diagnosed with bilateral bc 15yrs ago. After bilateral mastectomy, chemo and Tamoxifen for 5 yrs remained cancer-free until Nov 2008 when diagnosed with Mets after pleural effusion of r lung. Had pleurodesis after which put on Femara. Definitely noticed arthritis worsened (having had osteoarthritis prior to bc). Switched to Tamoxifen 7 wks ago as Femara ceased its effectiveness over past year as indicated by consistent increase
in tumor marker. Although osteoarthritis
has had debilitating effects on my daily activities ie running, cycling, gardening and even singing (result of pleurodesis) I have managed discomfort with Mobic and Panadol Osteo. Today’s onc visit showed great drop in tumor marker. I’m on a mission of survival and I respond to cancer with all the stubborness I can muster. A half marathon is in my sights this August (though a lot of walking!!) May you all find ways to keep on fighting.

hasknob

April 9, 2013 at 7:57 pm
(29) slatt says:

I can add my two cents. I worked 50 hours a week before the $#@t hit the fan. I drove myself to every chemo and radiation appt I had. I was so ready to go back to work after radiation. 180 turn, I have been on HT for 2 years now. My side effects are so bad until I had to start collecting SSDI. I am only 50 but feel like I am 90. Three more years, maybe longer of this, Wow

April 14, 2013 at 7:59 pm
(30) chris says:

Kay – I am in the same situation as you – thought I only had a year to go on Aromasin when my oncologist suggested I stay on it for 10! Given all the side effects and lack of information on the long term effects of Aromasin I think I am going to go off it and take my chances. Although my cancer was aggressive, my lymph nodes were clear. Am very interested to hear other thoughts on this.
Chris

April 29, 2013 at 10:10 pm
(31) debra says:

I was on Aromasin for 7 months. The first 3 months I had no side effects. Then the 4th month they started to kick in. Fatigue, severe insomnia, weight gain, joint pain, muscle pain….and finally heart palpitations. (Stroke and heart failure are listed as side effects) I was immediately taken off of them. The next 2 weeks the side effects got worse. Its been 3 months, and Im just starting to feel like myself again. For me quality of life was far more important. There is no study that says these drugs guarantee that you will not get a recurrence. Many many people have had recurrences while taking these drugs. So its not a huge leap for me to think I have just as good a shot NOT taking them as I do taking them. I have changed my diet, taken up yoga, hike regularly and see a naturopath for my heath care.

May 10, 2013 at 6:00 pm
(32) Eliza says:

I was on Tamoxifen for 5 yrs then put on Femara. After hating the side effects of Femara but pressed on knowing it wasn’t forever, my doctor took me off after 4 1/2 yrs since I was doing so good. Well 6 months later my bc was back. I had a bi-lateral in 2010 and am presently on exemestate with an unknown end time. Bone loss has been an issue and now have osteoporosis. Just wanted to share my results. We all are different so what works for one may not work for the next. I’ll just keep moving forward with a smile as usually, glad I’m here to smile!

May 12, 2013 at 4:59 pm
(33) dorothy schwab says:

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June 4, 2013 at 4:29 am
(34) shahadot1 says:

Your website is better and available all time The content are realy uniqe the comments are very useful
The comments are interested me. I hope the this type of comment we get next day

June 4, 2013 at 4:31 am
(35) shagor says:

Your website is better and available all time The content are realy uniqe the comments are very useful
The comments are interested me. I hope the this type of comment we get next dayI was on Aromasin for 7 months. The first 3 months I had no side effects. Then the 4th month they started to kick i

June 7, 2013 at 6:29 pm
(36) Lisa says:

Following breast cancer/mastectomy/chemotherapy/radiotherapy/he reception I was on tamoxifen for 2 years & exemestane for 3. My worst problems are so much pain in my feet I can’t walk for more than about 30 min & have swollen ankles & have put on weight. I have now been told I can stop taking exemestane but should I continue? I hear what everyone says about quality of life & I don’t like feeling like an old lady but also, I don’t want the cancer back.
Also, if I stop, now long before I feel like m old self if ever?

June 23, 2013 at 5:10 am
(37) Lynne says:

It’s a case ladies that your damed if you do and damed if you don’t take the meds
I was Told on my 32nd birthday I had aggressive bc and the prognoses was not good
I took tomxifen for for about 11- 12 years but then was told I could not stay on it any Longer so I had to undergo a full hysterectomy at 45just so I could go on post menapose medication my first tablet made my life hell for 2yrs the joint pain was unbearable but you keep fighting so if s not working ask to try something else I have now been on exemestane for the last 2 year and yes I still feel the side effects but nothing like the ones from the first tablet I will be 50 this year and life with the pain is better than no life at all girls so keep going and good luck to you all

July 10, 2013 at 2:09 am
(38) lunavu says:

For ER+ tumors we can’t ignore the benefit of taking aromatase inhibitor meds– i’m trying to boost the benefit of the meds by making myself even more inhospitable to tumor cells via diet modification… read Crazy, Sexy, Diet, read also The China Study for beneficial effects of eliminating animal protein from your diet… this includes milk protein (casein)– sorry no cheese, yogurt, etc. Or at least keep it under 10% of total protein consumed. OK to eat fish 2-3 times a week…. you need the omega 3′s. White button mushrooms are natural aromatase inhibitors; mushrooms boost your immune system generally– eat lots of them! I avoid soy products because soy is a phyto (plant-based) estrogen… no soy milk, miso, soy sauce, tofu, tempe. Research shows health benefits for Asian women who consume soy products, but it is not clear if western women gain similar beneficial effects. Also looking to Chinese medicine to increase odds of killing rogue tumor cells by supplementing with artemisinin (wormwood)– see: Crespo-Ortiz MP, Wei MQ. ‘Antitumor Activity of Artemisinin and its Derivatives: From a Well-Known Antimalarial Agent to a Potent Anticancer Drug’, Journal of Biomedicine and Biotechnology, 2011. I’m taking 200mg/day for just 10 days each month… there have been no human trials testing artemisinin– so the dose and duration are not documented. Why does breast cancer return after so many years? Researchers are theorizing a cancer stem cell (CSC) that is not a typical tumor cell and that goes dormant or becomes resistant to the prescribed meds.

July 10, 2013 at 2:14 am
(39) lunavu says:

(Cont of previous post:) They are examining constituents in certain foods that disrupt the replication pathways used by these cells: for example sulphoraphane found in broccoli (we need to consume 3 grams/day of it according to one study), and curcumim, an ingredient in tumeric. Curcumin is not easily absorbed– most is excreted, so find it in a ‘bio-available’ formulation– probably online. For joint pain I take 500-1000mg/day of MSM, and sometimes a baby aspirin. Osteoporosis is extremely worrying– so far I have avoided bisphosphonates (fosamax); D3 is important to slow bone loss and increase immunity generally, it has anti-cancer effects– your blood levels need to be 40-45 whatever-the-units… ‘normal’ range is 30, so take more. I take a calcium supplement derived from algae that includes vitamine K, boron, strontium, D3 to improve absorption. What promotes bone loss?– for example carbonated drinks contain phosphate– your bones release calcium to neutralize it. Salty food may have a similar effect. Weight-bearing exercise is essential– walking a mile 5 days a week is a good start– jogging if you can tolerate it.

July 10, 2013 at 2:18 am
(40) lunavu says:

(Cont from previous post): They are examining constituents in certain foods that disrupt the replication pathways used by these cells: for example sulphoraphane found in broccoli (we need to consume 3 grams/day of it according to one study), and curcumim, an ingredient in tumeric. Curcumin is not easily absorbed– most is excreted, so find it in a ‘bio-available’ formulation– probably online. For joint pain I take 500-1000mg/day of MSM, and sometimes a baby aspirin. Osteoporosis is extremely worrying– so far I have avoided bisphosphonates (fosamax); D3 is important to slow bone loss and increase immunity generally, it has anti-cancer effects– your blood levels need to be 40-45 whatever-the-units… ‘normal’ range is 30, so take more. I take a calcium supplement derived from algae that includes vitamine K, boron, strontium, D3 to improve absorption. What promotes bone loss?– for example carbonated drinks contain phosphate– your bones release calcium to neutralize it. Salty food may have a similar effect. Weight-bearing exercise is essential– walking a mile 5 days a week is a good start– jogging if you can tolerate it.

July 31, 2013 at 1:57 am
(41) Mandy says:

Had L mastectomy 6 months chemo and radiotherapy. Just had two years of tamoxifen. Now on exemestane. I’m exhausted!!! I ache all over. I can hardly walk when I get up in the morning. I don’t sleep because of the violent hot flushes! When will it all end?? I’m terrified to stop taking them but can’t stand the impact it’s having on my life. Not sure i can take much more. What is the other option…

August 1, 2013 at 12:14 pm
(42) Lesley says:

Was put on Tamoxifen for 2 years have now just about to finish 3 years on exemestane like everyone else my body aches Hot flushes really bad kept on it to scared not to.

August 4, 2013 at 8:53 am
(43) Lucia de Mexico says:

IEn el me de Enero del año 2011, me detectaron cáncer lobulillar hormono dependiente en seno izquierdo y me lo extirparon. A partir de entonces estoy con tratamiento de Aromasin por cinco año pero mi preocupación es la pérdida de peso que he tenido en dos años. Pesaba 67 kilos cuando fui diagnosticada y ahora peso 53 kilos, mido 1.65 m. de altura , he bajado 14 kilos y realmente me veo delgada. Sin embargo me siento bien, no tengo dolores en mis articulaciones y soy muy activa, aunque no con la misma agilidad de antes. Me doy cuenta que en los comentarios que he leído de personas que tienen el mismo tratamiento nadie hace mención de pérdida de peso. Estoy comiendo menos que antes porque he perdido el apetito pero trato de alimentarme balanceadamente. Mi pregunta es la siguiente: ¿No es común la pérdida de peso con el tratamiento de “Aromasin” ?

August 28, 2013 at 12:11 am
(44) Doreen Carter says:

Thanks for posting this… I did not have any stage of BC and yet my oncologist who is now wanted for many bad things has fled to his home land to avoid procecussion. I ended up with Neuropenia and Lemphena … another words I was admitted into the hospital missing most of my CD3, CD4 and CD8 surpressors. I ended up with pancreatic IPMN after almost 4 yrs on it. I am a double Mastecomy Radical again NO CA just high risk at age 42. I have bone, and RA , OA the pain in my hands over the chart. My fingers get lumps on the joints when in full pain and they split.
I did not drink, or do drugs ever.
I am frustrated do to pain, and I know, when it occurred.

October 3, 2013 at 5:55 am
(45) Linda says:

After reading the posts from the women here on the effects of Aromasin, I am more convinced than ever that I am not suffering in pain alone. My cancer was found in stage 1a with note spreading to the lymph nodes. After having a lumpectomy & 35 radiation treatments I was put on Arimedex. Joint pain was bad so I was switched to Aromasin……which is 10x worse. OTC pain Meds, pain patches, rub in creams have become a way of life. Icing used to help my knees, but in the last few days that has no effect. We lost a son to pancreatic cancer, both of my parents to cancer & my Mom had ovarian cancer & osteoporosis.

November 21, 2013 at 2:30 am
(46) Anne says:

Diagnosed 7 yrs ago at age 43 aggressive her2+ already had bone mets and positive nodes. Chemo, herceptptin tamoxifen, letrozale then lung tumours appeared went into study taking capcidibine and tykerb, terrible side effects nausea, diaherra, problems with skin on hands and feet but between chemo and specialized radiation liver problems solved, got on the other side of the study with TDM1 virtually no side effects lung spots changed slightly so because it was still a study I was taken off, put on exemestane, joint pain is intense and at times almost unbearable high amount of pain meds not working, they want to give me radiation on my hip. Because I have mets there but I feel the pain is because of the meds. Frustrated but I love my doctor and as I am considered terminal I don’t want to run through all of my options.

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