Good Medicine
The latest chapter in my ongoing Tamoxifen decision
One thing I don't talk about very often is how lucky I've been with my oncology team.
I've had three oncologists at Scripps since my breast cancer diagnosis in 2021. Not because anything was wrong with the first two—quite the opposite. They were phenomenal. Both left for other opportunities, and each transition left me wondering whether I'd be starting over with someone new who didn't know my history or understand the context behind the decisions we'd already made.
Instead, I somehow hit the jackpot three times: Dr. Lin, Dr. Maslov, and now Dr. Nasraty.
I am so happy with my new oncologist. She's thoughtful, collaborative, and takes the time to connect with me as a person, not just a patient. Lately, we've been trying to answer a question that many hormone-positive breast cancer survivors eventually face: How long should I stay on Tamoxifen?
While I'm grateful for the protection it provides, Tamoxifen isn't exactly a medication you forget you're taking. Fatigue, joint pain, and brain fog have all been part of the experience. Last year, my Breast Cancer Index (BCI) test suggested I would likely benefit from extended endocrine therapy, meaning ten years of Tamoxifen rather than five.
At a recent appointment, I told Dr. Nasraty that I would feel more comfortable eventually weaning off Tamoxifen if I had some additional way to monitor for recurrence. Without hesitation, she suggested a Signatera test.
Signatera is a tumor-informed blood test designed to detect molecular residual disease (MRD) and monitor for recurrence. It uses the unique genetic fingerprint of a patient's original tumor to look for tiny traces of cancer DNA circulating in the bloodstream. The science behind it is fascinating, and while no test can predict the future, I appreciate having another piece of information to help guide these decisions.
The next day, I received a call from Signatera to discuss the process. What surprised me most was learning that they could send a mobile phlebotomist directly to my home to collect the blood sample. After years of appointments, waiting rooms, scans, procedures, and blood draws, there's something almost surreal about having cancer monitoring show up at your front door.
For now, I'm continuing Tamoxifen while we gather more information, and I have a blood draw scheduled soon.
Whether I ultimately stay on Tamoxifen for five years, ten years, or somewhere in between, I'm grateful to have an oncologist who sees me as more than a protocol or a statistic. After everything that's happened over the last few years, that kind of partnership feels like its own form of good medicine.