I was diagnosed with ductual carcinoma in situ Nov/96. I was 36. I had a
lumpectomy and radiation. I am currently on Taxoxifen. The Dr recommended
it because the lump was receptor positive, meaning it feeds on estrogen.
These two drugs are estrogen blockers. I am including an article which was
posted last week about these drugs. I have had no side effects but some
people do! What has your Dr recommended?
Christine
At 11:59 AM 21/05/98 EDT, you wrote:
>I was diagnosed with Stage I breast cancer last June, had a lumpectomy and
>just finished chemo and radiation. Now another decision! Need I follow up
>with tamoxifen or raloxifen or whatever? What are your experiences? Oh, I'm
>47 years old. These decisions are so stressful.Thanks for any help. Andrea
>(AGDouglas@aol.com)
>-Thursday May 14 5:42 PM EDT
Tamoxifen could save many more lives
NEW YORK (Reuters) -- Tamoxifen is even more effective at treating
hormone-sensitive breast cancer than previously
thought, and could save an additional 20,000 lives every year worldwide
if prescribed for more women, according to a new
analysis of data from over 37,000 women.
But many breast cancer patients are not getting the drug, a panel of
experts announced Thursday at a press conference that
took place here and simultaneously in the UK via a satellite link.
Tamoxifen is effective in both younger and older women, in early and
advanced cancer, and in combination with other
treatments, such as chemotherapy and radiation, said Richard Peto of the
University of Oxford, UK, and colleagues, who
combined data from 37,000 patients enrolled in 55 different clinical
trials from around the world.
The Early Breast Cancer Trialists' Collaborative Group study, to be
published Saturday in the medical journal The Lancet,
was independent and not funded by any pharmaceutical company, Peto
emphasized.
Despite the availability of this very effective treatment, not all women
who could benefit are receiving it. A survey of more than
800 breast cancer specialists in Europe, Asia, and South America found
that doctors tend to offer the drug only to patients
over age 50 with cancer that is more advanced at diagnosis, the Oxford
researchers reported. Less than half of these
physicians prescribe tamoxifen for women under 50 who have a tumor that
was diagnosed at an early stage, according to
Christina Davies, the coordinator of the Clinical Trial Service Unit
Breast Cancer Trials, Oxford University.
Anecdotal reports suggest that physicians in the US are using the drug
in a similar manner, the panelists said.
"There is plenty of evidence all over the place that a lot of women who
would benefit are not getting it," said Peto.
The benefits of the treatment for women with breast cancer clearly
outweigh any increase in risk of endometrial cancer, which
is often curable if caught early, said the researchers. "Close
surveillance and if it happens, the discovery of early stage
endometrial cancer is manageable and in fact can be cured, so patients
and physicians need to be extremely alert but in a
management mode," said Amy Langer, breast cancer survivor and executive
director of the National Alliance of Breast
Cancer Organizations.
Tamoxifen does not increase the risk of any other type of cancer, and
only carries a small risk of pulmonary embolism, a
potentially life-threatening formation of blood clots in the lungs,
according to the researchers from the University of Oxford.
Over 10 years, the drug prevents 80 deaths due to breast cancer per
1,000 women taking tamoxifen for 5 years, but may
cause 2 deaths per 1,000 women due to endometrial cancer and 1 death per
1,000 due to blood clots in the lungs.
What is not clear is if the benefits of tamoxifen treatment outweigh the
risks for women who are at high risk for the cancer, but
who have not yet developed the disease. A National Cancer Institute
study released last month found tamoxifen could reduce
the risk of breast cancer by 45% in women at high risk for cancer.
"In the last month or two, there's been an enormous amount of press
coverage of tamoxifen for use in the prevention of breast
cancer in women who don't yet have the disease, but these results relate
to the use of tamoxifen in women who've already got
breast cancer," Peto said. "What we are talking about is the use of
tamoxifen in women who've already got breast cancer and
the effects are bigger than we generally suppose," he said.
The drug cuts the risk of cancer recurrence in half -- 74% of women who
take tamoxifen will not have a recurrence compared
with 54% of those who don't take the drug.
Peto also noted that the drug appears to work only in women whose cancer
cells are hormone sensitive, that is, the cells carry
the estrogen receptor. About 65% to 70% of all breast cancers are
hormone sensitive.
The findings emphasize the importance of testing all breast tumors for
the estrogen receptor, said Langer.
"If you are estrogen receptor positive, the course of your care and its
benefits will be very different, but even here in the US
there are women who call us whose physicians do not have their tissue
tested for estrogen status," Langer said. "Women now
need to know how important that is and be advocates for themselves and
ask that that test be performed."
Two drugs may prevent breast cancer
By Mark Egan
LOS ANGELES (Reuters) - Women who have a high risk of breast cancer may
have two drugs to choose from to prevent
the disease -- one a cancer drug and one a drug originally designed for
osteoporosis, researchers said Monday.
They said both tamoxifen and raloxifene work to prevent breast cancer in
certain woman.
The news about raloxifene leaked out ahead of the annual meeting of the
American Society of Clinical Oncology, but this was
the first presentation of the details.
Researchers said they were planning another trial that will pit the two
drugs against each other to determine which of the two
is more effective in preventing breast cancer.
Dr. Steven Cummings of the University of California San Francisco said
the osteoporosis drug raloxifene reduced the risk of
developing breast cancer by 68 percent in post-menopausal women with
osteoporosis.
The trial of raloxifene, sold under the name Evista for treating
osteoporosis by Eli Lilly & Co., began with the aim of
determining the rate of fractures among women with osteoporosis and
produced the breast cancer data as a bonus benefit.
The study of almost 8,000 women found that raloxifene reduced the
incidence of breast cancer in post-menopausal women
by as much as 70 percent. Results indicated the drug did not increase
the incidence of endometrial, or uterine, cancer. "These
results for 33 months are very good news for women who are concerned
about breast cancer and osteoporosis," Cummings
told reporters. "Our trial is continuing so we can learn how well Evista
prevents breast cancer over the longer term."
Dr. Donald Wickerham of the National Surgical Adjuvant Breast and Bowel
Project at Four Allegheny Center in Pittsburgh
and colleagues did a separate study on tamoxifen.
They found tamoxifen reduced the risk of breast cancer in 45 percent of
women at high risk of the disease.
"(This data) represents the first step in making the hope of breast
cancer prevention a reality," Wickerham said.
Wickerham said the comparison trial of the two drugs would begin this
fall in post-menopausal women at high risk of breast
cancer.
Breast cancer is the most prevalent form of cancer in women, with about
180,000 cases diagnosed each year in the United
States. It is expected that 43,500 women will die from the disease this
year in the United States.
Tamoxifen is marketed as a cancer drug under the name Nolvadex by Zeneca
Group Plc.
The two trials were not easily comparable given their different
patients, hence the need for a comparison study.
The tamoxifen trial followed 13,388 healthy women whose risk of
contracting cancer was about five times greater than the
average woman.
High risk was determined by family history, age, pregnancy history, age
at time of menstruation and other factors.
The study found a small risk of some major complications. Patients
taking tamoxifen increased their risk of developing
endometrial cancer, cancer of the lining of the uterus.
Of those who took tamoxifen in the trial, 33 developed endometrial
cancer as compared to 14 in the placebo group. The risk
of blood clots was also higher. Women under 50 had no excess risk of
side effects, the report said.
It was not a great surprise to doctors that raloxifene can work an an
anti-cancer drug.
Both tamoxifen and raloxifene are drugs called selective estrogen
receptor modulators, which block the negative actions of
estrogen in some tissues such as the breast and mimic estrogen's
benefits in other tissues such as bones.
In other cancer news, researchers said too many women with early stage
breast cancer have their breasts removed even
though many could be treated without having a mastectomy.
A study of almost 18,000 women found that fewer than half, 44 percent,
were treated in a way that would save their breasts
-- despite guidelines from the National Cancer Institute stating that 75
percent of women with early stage breast cancer do not
need mastectomies.
Results of the study, which tracked the treatment of breast cancer
patients in more than 800 U.S. hospitals in 1994, were
presented by Dr. Monica Morrow of Northwestern University Medical School
in Chicago.
"If a woman is told she needs removal she should ask why," Morrow told
reporters. "By seeking a second opinion ... we will
see more decreases (in the number of mastectomies performed) over time."
The study, sponsored by the American College of Surgeons and the
American College of Radiology, found that women over
60 were less likely to receive breastbone therapy despite the fact that
age is not supposed to be a factor in deciding whether
to perform a mastectomy.
The likelihood of a woman undergoing a mastectomy increased by 11
percent for each decade older she was, the study
found.
Breastbone therapy involves the removal of the tumor in the breast,
called a lumpectomy, followed by radiation therapy. The
NCI guidelines state that age, prognosis and tumor type should not be
used to choose mastectomy over breast conserving
therapy in early stage breast cancer.
Breast cancer is deemed early stage in the period before the cancer
becomes metastatic -- when it spreads to other sites in
the body.
The only factors that should be used in choosing mastectomy are large
tumor size, small breast size, small breast size in
comparison to tumor size, early pregnancy and multiple tumors in various
sites of the breast, the NCI guidelines state.
Morrow said patients without private medical insurance were more likely
to have a breast removed that those with private
insurance.
Patients in the eastern and western sections of the United States were
more likely to receive breast conservation therapy than
those elsewhere in the country. In the East 58 percent of women were
given breast conserving therapy, compared to 48
percent on the West Coast and just 33 percent in the South.
The study also found that almost one quarter of women who underwent
breast conservation therapy did not receive the
needed radiation therapy -- because doctors failed to tell them about it
and refer them for it.
Morrow said the low rates of breast conservation therapy were a result
of a poor understanding among doctors of the
National Cancer Institute guidelines.
Breast cancer is the most common form of cancer in women, with about
180,000 cases diagnosed each year in the United
States and 43,500 deaths from it expected this year.
About half of all cancer patients do not survive. Around 1.2 million
cases of cancer are diagnosed annually in the United
States and about 565,000 Americans are expected to die of the various
forms of the disease in 1998.
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