Re: [MOL] NY Times re: Tamoxifen/Evista [01063] Medicine On Line

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Re: [MOL] NY Times re: Tamoxifen/Evista

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 - Tonight at 7:00 she will
be on line -  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.
Debby G.
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
>               tamoxifen.
>               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
>               disease.
>               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
> are
>               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
> stopped.
>               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
>               flaxseed.
>               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
> cancer.
>               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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