Tamoxifen is PBS listed as a primary prevention in breast cancer.

The 2005 paper entitled Acceptance of adjuvant therapy and quality of life issues by Lesley Fallowfield of the Cancer Research UK Psychosocial Oncology Group, Brighton & Sussex Medical School, University of Sussex summarises a number of studies. Key outtakes of the paper are as follows:

• “Studies show that 40% women do not adhere to tamoxifen because of side effects affecting Quality of Life (QoL).”
• “Most novel therapies appear, initially at least, to have much better profiles than the standard treatment that has been in use for much longer.”
• “In one such study, 72 pre-menopausal women who had taken part in a clinical trial of adjuvant goserelin and/or tamoxifen… Symptoms such as weight gain, hot flushes, fatigue and night sweats were commonly reported.”
• “Another study compared the symptoms reported on QoL questionnaires by 581 women who had been taking 2–3 years of tamoxifen… Hot flushes, weight gain, night sweats, loss of libido and sleeping difficulties were frequently reported by the women as severe…”
• “In the pre-menopausal women, the effects of a premature menopause and fertility loss following adjuvant chemotherapy exerts a profoundly deleterious impact on QoL.”
• “Adjuvant endocrine therapy Until recently, tamoxifen was the gold standard in adjuvant endocrine treatment, but despite the efficacy of the drug, the serious side effects such as thromboembolic problems, stroke and endometrial cancer limit its use.”
• “Tamoxifen also has many nonlife-threatening side effects, which also affect QoL.”
• “Although the drugs appear to be reasonably well-tolerated in the trial settings in which they have been tested, there are significant, non-life threatening problems that women must endure.”
• “The worst symptoms of endocrine therapy are the vasomotor problems with hot flushes, night sweats and cold sweats being apparent…”
• “Joint pains with particularly troubling arthralgia are something to watch and if in the future the fracture rate increases then this will have a detrimental effect upon QoL.”
  Paper