And I wonder why I can't decide to take tamoxifen or not.
Finally finished 28 regular radiation treatments!!! Begin first of 5
boosts tomorrow and then I am done!!!!!! Wanted to celebrate today and
did - fell asleep outside under a tree. Do I know how to party or
what!!! Next week for a real celebration my husband is going with me and
then it's lunch in Princeton.
As for the channel 7 special report on Stacey Sagers breast cancer, part
two is on tonight. I did not watch it yet, however if you wish to view
it just go to the web site - www.7online.com. Tonight at 7:00 she will
be on line - www.7online.com to answer questions as to how she made
her decisions, and to answer questions. I think it runs for one hour.
I need to revisit my tree, I am so tired.
Becker, Joyce wrote:
> Round 3 in Cancer Battle: A 5-Year Drug Regimen
> [05/11/99; New York Times (Free Registration Required)]
> Having completed the first two phases of treatment for an
> early breast cancer -- a
> lumpectomy and six weeks of radiation therapy -- I have
> now begun the third and, in
> a way, the most exciting phase: five years of daily
> treatment with the drug
> Unlike traditional cancer chemotherapy, tamoxifen does not kill
> cells and does not cause
> nausea and hair loss. Tamoxifen is more like a growth
> regulator. It is an estrogen-like
> compound that acts in the breast as an antiestrogen, preventing
> the natural hormone from
> stimulating the growth of breast cancer cells.
> Tamoxifen has been around for about 20 years. It was first used
> to treat advanced breast
> cancer, then to prevent recurrence of less advanced disease.
> Now it is being used to prevent
> breast cancer from occurring in the first place in women at
> high risk of developing the
> Factors that contribute to a woman's risk of developing breast
> cancer include being over 60,
> having a family history of breast cancer, having had a
> noninvasive breast cancer or
> precancerous breast abnormalities, having begun to menstruate
> before the age of 12 and
> having had no children or a first child after age 30.
> The First Cancer Preventive
> I admit to being confused and disappointed when my surgeon
> announced gleefully that my
> cancer was highly sensitive to hormone stimulation, as
> indicated by a test for estrogen and
> progesterone receptors on the cancer cells. To me that meant I
> would probably never again be
> able to take postmenopausal hormones, which could protect my
> heart, bones and brain from
> premature deterioration and which prevented hot flashes and
> vaginal dryness.
> The surgeon was pleased because being
> estrogen-receptor-positive meant that my tumor was
> slower growing, and that I could reap the maximum protection
> from tamoxifen, which has
> been shown to cut in half the risk of recurrence of the
> original breast cancer as well as the
> development of a second cancer in the opposite breast.
> Estrogen receptors are found in about 65 percent to 80 percent
> of breast cancers in
> postmenopausal women and 45 percent to 60 percent of cancers in
> premenopausal women.
> The higher the level of estrogen receptors in a woman's tumor,
> the greater the survival
> benefit associated with taking the drug. Women whose cancers
> estrogen-receptor-negative reap some benefit from tamoxifen as
> well, suggesting that the
> drug has other as-yet undiscovered actions.
> Studies have indicated that five years of daily tamoxifen is
> more protective than one or two
> years and as good or better than taking the drug for 10 years.
> Its protective effects have been
> shown to persist for at least five years after the drug is
> Most exciting, last year tamoxifen was shown in a study of more
> than 13,000 women to
> reduce by 50 percent the development of a first cancer in women
> considered at high risk for
> the disease. This made tamoxifen the first drug found to
> prevent cancer, although it is still
> not known for sure whether the protection is permanent. But
> tamoxifen may not be helpful in
> women who carry cancer-promoting mutations of the genes BrCa1
> and BrCa2.
> Dr. D. Lawrence Wickerham, an oncologist at Allegheny
> University in Pittsburgh and a
> co-leader of national tamoxifen studies, said, "The cancers
> that developed in
> tamoxifen-treated women tended to be smaller and were found at
> an earlier stage," meaning
> they were more readily cured. Describing other benefits found
> in the studies, Dr. Wickerham
> said: "Women taking tamoxifen suffered fewer bone fractures of
> the wrist, hip and spine and
> their cholesterol level dropped by 12 to 20 percent.
> Furthermore, there is no evidence that
> tamoxifen is associated with weight gain, depression, nausea or
> cancers of the ovary, liver
> and gastrointestinal tract."
> The effects of tamoxifen on the brain are unknown, though there
> is no evidence of any ill
> effect, like memory impairment.
> Unwanted Effects, Too
> But for all the good tamoxifen does, it has certain major and
> minor disadvantages. Like
> estrogen, it raises the risk of developing a relatively
> uncommon cancer of the uterus,
> endometrial cancer, a disease that can be detected early
> through routine monitoring and cured
> by surgery and, if needed, radiation therapy. Its other serious
> side effect -- one that is shared
> by estrogen as well -- is an increased risk of blood clots,
> which are occasionally fatal.
> Nonetheless, Dr. V. Craig Jordan of Northwestern University's
> cancer center, who did
> pioneering research on tamoxifen, said the survival benefit
> from the drug for a woman like
> me who has had breast cancer outweighs the risk of death from
> its effects on the uterus and
> blood by about 30 times.
> Stimulation of the growth of the endometrium, or uterine
> lining, which could increase the
> risk of cancer, occurs in a small percentage of women who take
> tamoxifen. Nonetheless,
> women may be advised to have a baseline uterine examination
> before starting tamoxifen,
> followed by annual checkups to see if the drug is stimulating
> growth of the endometrium.
> This examination can be done in a doctor's office as an
> endometrial biopsy or painlessly by
> transvaginal ultrasound. A woman who experiences an unusual
> vaginal discharge or bleeding
> while on tamoxifen should report that to her gynecologist
> without delay.
> On a less serious note, tamoxifen also causes hot flashes in a
> quarter to a third of users and
> an annoying vaginal discharge in about 5 percent to 10 percent
> of women. The hot flashes
> may seriously disrupt a woman's life. But they usually diminish
> with time, and their
> intensity may be diminished by daily consumption of soy
> products like tofu and ground
> A New Class of Drugs
> Tamoxifen, sold as Nolvadex, is the first of a new class of
> drugs called SERM's, for
> selective estrogen receptor modulators. These compounds compete
> with natural estrogen for
> a docking site on cells throughout the body. When these sites,
> called receptors, are occupied
> by tamoxifen, estrogen cannot hook on properly and exert its
> usual effects.
> A more recent addition to this class is raloxifene, sold as
> Evista, which seems to share most
> of the characteristics, good and bad, of tamoxifen, and several
> other such drugs are in
> various stages of development. The ultimate goal is to find a
> compound that does all the good
> that estrogen does, including reducing the risk of heart
> disease and osteoporosis, stimulating
> brain cells and preventing menopausal symptoms, but that has
> none of estrogen's bad
> effects, especially raising the risk of cancers of the breast
> and uterus and causing blood clots.
> Raloxifene, which is approved for the prevention of bone loss,
> also appears to protect the
> breast and heart but without stimulating cell growth and cancer
> in the uterus. But like
> tamoxifen, it can increase clotting and induce hot flashes, and
> it is not yet known whether it
> is as good as or better than tamoxifen in preventing breast
> A study to determine this, called STAR (for Study of Tamoxifen
> and Raloxifene), is just
> getting under way. The study, sponsored by the National Cancer
> Institute, will involve
> 22,000 women and is expected to last 5 to 10 years.
> "At the moment, it's too early to use raloxifene to prevent
> breast cancer outside of a clinical
> trial," Dr. Wickerham said during a teleconference sponsored by
> Cancer Care Inc.
> "We don't yet know raloxifene's long-term benefits or risks."
> He suggested that women interested in possibly participating in
> the STAR trial call the
> National Cancer Institute's hot line, (800) 4-CANCER, or sign
> on to the Web site of the
> National Surgical Adjuvant Breast and Bowel Project.
> More information on tamoxifen can be found in a new paperback
> book, "Tamoxifen," by Dr.
> John F. Kessler and Greg A. Annussek (Avon, $5.99).
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