Date: Fri, 24 Apr 1998 17:25:31 -0500
Reply-To: bulletin-reply@PATHFINDER.COM
Sender: DRWEIL <DRWEIL@LISTSERV.PATHFINDER.COM>
From: "Ask Dr. Weil" <bulletin@PATHFINDER.COM>
Subject: Ask Dr. Weil Bulletin - 27 April 1998
To: DRWEIL@LISTSERV.PATHFINDER.COM
The Week of April 27, 1998
______________________________________
The Ask Dr. Weil Bulletin
http://www.drweil.com
Dear Friends:
Because of the importance of the breast cancer news this week -- and
some
editing errors in the original published version of Dr. Weil's answer --
we
are reprinting the Q&A in its entirety here.
News About Breast Cancer Prevention?
Q: I'm more worried than ever about getting breast cancer. News of
false mammograms, tamoxifen controversy and now the death of Linda
McCartney! Can tamoxifen really help? If it's too risky, what else can I
do
to protect myself from getting breast cancer?
-- Anonymous
I know that for a lot of you the passing of Linda McCartney hits home.
For
those of us who grew up through the '60s and '70s, she mirrored our
generation's growth, from the heady days of the Beatles to the
discovery of healthier living through vegetarian diets. Her death from
breast cancer at age 56 is yet another experience many -- too many --
can
relate to.
High levels of female sex hormones (estrogens) in your blood favor the
development of cancers of the breast and reproductive system, because
estrogens stimulate cells of these tissues to divide and proliferate.
You
can lower your estrogen levels by getting more exercise, reducing or
eliminating consumption of alcohol, eating hormone-free meat and poultry
(if you eat those foods) and having a first baby earlier in life rather
than later. You can also protect yourself by eating soybeans and soy
foods
frequently, eating plenty of fresh fruits and vegetables, and including
fish or
flaxseed in your diet to get omega-3 fatty acids.
Women at high risk for breast cancer should avoid oral contraceptives
and
hormone replacement at menopause -- treatments that are safe for others.
Pharmacological help may be on the way for women at especially high
risk,
such as those with strong family histories of breast cancer. Tamoxifen
(trade name Nolvadex) is a drug, taken in pill form, that blocks effects
of
estrogen. Recent results of a six-year research project called the
Breast
Cancer Prevention Trial (BCPT) showed a 45 percent reduction in
breast cancer among the 13,388 healthy but high-risk women participants.
That's the good news. The downside is that tamoxifen increases risk of
three rare, life-threatening health problems: endometrial cancer (cancer
of the lining of the uterus), pulmonary embolism (blood clot in
the lung), and deep vein thrombosis (blood clots in major veins). It may
also cause menopause-like symptoms such as hot flashes, nausea, swollen
ankles, irregular vaginal bleeding, mood swings and weight gain.
For years, I've recommended tamoxifen to women with estrogen receptor
positive breast cancer as a relatively safe and effective treatment.
When
the drug is used along with other therapy for early stage breast cancer,
it
helps prevent recurrence of the original cancer and development of new
cancers in the opposite breast. Also, while acting against the effects
of
estrogen in breast tissue, it acts like estrogen in other parts of the
body, providing such benefits as lowering of blood cholesterol and
slowing
bone loss.
The National Cancer Institute emphasizes that the benefits of tamoxifen
as
a treatment for breast cancer are firmly established and far outweigh
the
potential risks. The question is, can tamoxifen prevent breast cancer in
women who have an increased risk of developing it?
Tamoxifen is a serious drug. Women who are at high risk should work with
a
doctor and do a careful risk/benefit analysis of tamoxifen based on age,
personal history and family history. This should include mammography.
They
should also follow news about a related drug, Evista (raloxifene), just
approved by the FDA for the prevention of osteoporosis in postmenopausal
women and now being tested for efficacy in preventing breast cancer
without
increasing risk of uterine cancer. I am cautiously optimistic about this
drug and other selective estrogen receptor modifiers now under
development.
_________________________________________
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