Letrozole or Tamoxifin?

Background: 52, large tumour, minor lymph involvement, single then double mastectomy. Letrozole was advised as more effective for my high risk tumour (big & aggressive) - I have normal bone density but even so bone strengthening is recommended as a preventative for bone loss and because the combination is seen to work better than Letrozole alone for my subtype (ER/PR+ HER2- high risk).  I've also not yet started bone strengthening as my teeth are not yet stable/am sure I wouldn't need an extraction. If you find yourself choosing Letrozole, do make sure to let your oncologist know about your pain levels and try to walk daily if you aren't able to exercise (I play squash 3x a week + walk). I suffered for several months and worried myself with fear of a recurrence due to the intense pain I had initially in my legs. I suggest you arm yourself with a script for Codeine from your GP at the start - after 2 months, I now take Panadol Osteo 24*7 to control bone pain as my feet hurt to walk on otherwise (in their words, it's the lesser of 2 evils). I do suffer from extreme bone pain events about twice a month where it's uncontrolled, usually preceded by me lying in bed for a while or sitting for a long time esp driving.  My oncologist has given me Palexia to manage it as codeine takes 20-25mins and I am unable to do anything when those events happen. Having said all that, beyond sudden intense tiredness a few times per month, standard medical menopause side effects and the occasional pain event, it has improved over the last 6 months and is mostly manageable. Good luck with your decision and be sure to get plenty of advice from your oncologist, surgeon, breast cancer nurse, here and your GP - and always remember asking about the possibility of reducing a dose/duration, taking a medication holiday or trying another option.

I agree with Afraser​ this is about giving your body the best chance to be rid of it all.  I did a combination of Tamoxifen, Letrozole and back to Tamoxifen for a total of 10 years.  My time flies, although early days I thought I was on it for 5 years only but things evolve, plans change, but now it is behind me.

I had bone density testing at the start and all good. 

Like some of us I had twinges, aches and pains as my body adjusted to the medication regime.  Emotionally at times it was hard yards as fatigue is also a factor early days.  Once through those hurdles I am out the other side with some aches and pains but I am still here and NED!

Best wishes with your decision, there's no right or wrong it is what you and your Oncologist decide suits best and is tweaked as you go along, as you can see from my brief explanation above.

Take care

Think positive - may not seem much of a choice, but much better than cancer! I took the letrozole road, but .... I was almost a decade older than you when I started, had excellent bone density and I did a full ten years on letrozole. My bone density now is not great, but then again it's pretty par for my age group. The impact was not so developed after five years but my oncologist felt that, in my case, research warranted a further five years. I didn't go the bone strengthening route (prolia or similar). I was anxious about teeth - being older, and with some dental work looming, but many have. You can of course have dental treatment but it needs to be between courses of the drug. Which may not always be the best option. Also the drug is more or less ongoing, if you stop taking it, your bone density drops. None of this may present problems in your case. 

Another side effect of letrozole can be joint pain - I never had a twinge, but many others have stopped taking letrozole because of severe joint pain. I'd ask your oncologist if you can switch from letrozole to tamoxifen if you experience really bad side effects. To my limited knowledge (I have never taken tamoxifen), it's usually not the preference for post-menopausal women. But your oncologist is doing all the right things by providing lots of material and giving you time to decide. And what happens to one person, even in what seems very similar circumstances, isn't what happens to another. The major thing to remember is that the treatment is to keep cancer at bay - 14 years post diagnosis and I am NED (no evidence of disease). Good luck whatever you decide.