Re: [MOL] NY Times re: Tamoxifen/Evista [01194] Medicine On Line


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



Dear Deb,

Your Doc or any Doc can prescribe bone density test. Its an easy scan
test and takes about 1/2 hour at most.

God Bless
marty auslander

deb grodin wrote:
> 
> 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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