Re: [MOL] NY Times re: Tamoxifen/Evista [01139] Medicine On Line


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



Your doctor will send you to a bone specialist for the bone density testing.
Just ask him.  Your friend, lillian


-----Original Message-----
From: deb grodin <debg@home.com>
To: mol-cancer@lists.meds.com <mol-cancer@lists.meds.com>
Date: Thursday, May 13, 1999 12:27 PM
Subject: Re: [MOL] NY Times re: Tamoxifen/Evista


>Too easy for me to see.Thank you that was brilliant. My next question
>what doctor would I go to for the bone density test?
>Thank you
>Debby G.
>
>Martin Auslander wrote:
>>
>> 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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