Re: [MOL] NY Times re: Tamoxifen/Evista [01119] Medicine On Line


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



DEar Deb,

You may wish to take a bone density test first. If your bones are low in
density, 
Tamoxifen is another form of bone strengthening or may help you make
your decision. The test is quite simple its like a cat scan.

God Bless
marty auslander

deb grodin wrote:
> 
> 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.
> 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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