I was diagnosed almost three years ago, at age 32, with Stage 2 breast cancer with estrogen receptors positive. I was treated and am surviving. I have been put on tamoxifen for 13 months. Should I be concerned that my menstrual cycle has not ended? It even continued during my chemotherapy. I have contemplated asking the doctor to perform a hysterectomy, as I desire to have no more children. Would you consider this too radical of a decision?

G.P.

Premenopausal women may continue to ovulate and cycle normally after treatment for breast cancer -- and may even become pregnant. Tamoxifen does increase the risk of cancer of the uterine lining, so any periods that are unusually heavy, prolonged or frequent (meaning less than 21 days from beginning of one to beginning of the next) should be reported to your doctor.

As for having a hysterectomy, women with breast cancer are at increased risk for other cancers, including ovarian and uterine. It is not considered appropriate care to just go ahead and do a hysterectomy in every breast cancer victim, but certainly if you are having problems such as pain or heavy bleeding, that would be a consideration. This is a decision that should not be made lightly. You should discuss your feelings and concerns with both your gynecologist and oncologist in order to make the best informed decision.