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Medical Forum / Diseases and Disorders / Breast Cancer / January 2004Newsletter Comment on Tamoxifen
A friend sent me a copy Healthline by Phil Rainer and tonight the following was in it: >If you're a woman at high risk for breast > cancer, the drug Tamoxifen could save your > life. But a new study suggests many doctors > aren't prescribing it. Ochsner cancer > specialist Jay Brooks says despite research > supporting Tamoxifen's wide spread use, it > simply hasn't become universally accepted > yet. Does anyone have any information on the "new study" the newsletter is referring to? I don't understand what it means that it "hasn't become universally accepted yet". It's been in use for 30 years! BTW, does anyone know who this Phil Rainer person is? His medical newsletter is very interesting but now I am wondering how much belief I should have in it. I sure don't need to hear that Tamoxifen may not be helpful just when I am about to start it. Bea Bea, I think they are referring to women who have not been diagnosed with breast cancer, but are at high risk for developing breast cancer. In these women, it's purely a preventative measure, not a treatment for an existing cancer. Jan > A friend sent me a copy Healthline by Phil Rainer and tonight the > following was in it: [quoted text clipped - 18 lines] > > Bea I quite agree, this does not apply to breast cancer patients. Tamoxifen or other hormone therapy roughly halves the risk of recurrence if the primary tumour is ER+, as most are. It also introduces a small risk of a serious side effect such as endometrial cancer or stroke. Even the serious side effects are generally treatable and not fatal, secondary cancer usually is fatal. The risk of these side effects is in the region of one tenth of the risk of recurrent cancer in someone who has had a primary cancer removed. So no problem there for bc patients, it is nice and clear, Tamoxifen is nearly always worth doing after surgery, certainly if the tumour was ER+. A few years ago it was mooted that if Tamoxifen was so good perhaps it was worth giving to people who -didn't- have breast cancer, to keep them from getting it. This throws the risk balance much more evenly as it means that the majority who would never have got bc anyway are still exposed to the side effect risk. Studies showed that the overall benefit was minimal, the process would kill nearly as many people as it saved. So it is only worth giving Tamoxifen in this way if you are sure you are at really high risk of breast cancer, a strong genetic history and all the other factors that suggest it is likely. Doctors are unlikely often to prescribe it in this way often because it is difficult to identify just how much risk a patient has, and to be confident that the risk balance is favourable. Tim Jackson > Bea, > I think they are referring to women who have not been diagnosed with breast [quoted text clipped - 24 lines] > > > > Bea The clip you sent us doesn't state Tamoxiphen doens't work but docs aren't prescribing it....you cant fault a drug if it was never given. http://www.nsabp.pitt.edu/ for the study I think they cited this a one of the largest studies done http://cis.nci.nih.gov/fact/7_16.htm - Dr Phil Rainer I did a google search couldm't find anything Rainer who was a MD, went to the AMA website- no Rainer ( but I don't do all 50 states) and Healthline there are numerous hosptial newsletters with this name. I also did a serach on Rainer and healthline and nothing came up Soory I couldn't find that perhaps someone else can. Futhermore Tamoxifen isn't useful against my case so I don't have a vested interest. Alex > A friend sent me a copy Healthline by Phil Rainer and tonight the > following was in it: [quoted text clipped - 18 lines] > > Bea Bea wrote: << >If you're a woman at high risk for breast > cancer, the drug Tamoxifen could save your > life. But a new study suggests many doctors > aren't prescribing it >> << Does anyone have any information on the "new study" the newsletter is referring to? I don't understand what it means that it "hasn't become universally accepted yet". It's been in use for 30 years! >> I am guessing the above refers to prophlyactic use of Tamoxifen. Although it has been in use for quite a long time, the findings re. the study which was done as to whether not it is effective in prevention just came out in the past year or two, I think. (I would research it but am half-asleep and have to get some things done soon--just got up and trying to wake myself up for 'training' walk). If you do a google search using words tamoxifen prophylactic prevention you will probably find the information. Tamoxifen is not completely without risk. It can reduce your risk of recurrent or metastatic breast cancer but there is also an increase of gynocological cancer(s)--i.e. endometrial, I believe. However, that supposedly is easily curable if caught early, and dr's who prescribe Tamoxifen are vigilant about monitoring. I have read that there may be an associated risk of something going on liver-related. I don't know if that means that applies to those who use it prophylactically --and/or if Tamoxifen is associated with its cause or just doesn't work to prevent that and it would have happened anyway. Tamoxifen is a good choice for reducing risk of recurrence if one is ER+ Although I opted to take an aromatase inhibitor, I did that because Tamoxifen may not have the protective effect in those who are also Her2+ >Although I opted to take an aromatase > inhibitor, I did that because Tamoxifen may > not have the protective effect in those who > are also Her2+ Kaye I'm Her2+ and ER+ too, Kaye. My onc opted for the Tamoxifen instead because of my joint and bone problems. I sure hope I am not wasting 5 years of my life taking it and it will help me anyway. BTW, I did some research on that Rainer's comment about Tamoxifen and I think you all were right about what he was talking about. He just should have been more specific and written that there are two ways some doctors give it. Giving it to high risk patients to prevent cancer did not seem to give the same results so I understood that many doctors stopped using it for this purpose. This is what he must have been referring to. Bea > I'm Her2+ and ER+ too, Kaye. My onc opted for the Tamoxifen instead > because of my joint and bone problems. > > Bea What effect does Tamoxifen have on joint and bone problems? Mary >What effect does Tamoxifen have on joint and > bone problems? >Mary I think you may have misunderstood my post. I was not stating that the Tamoxifen was the drug which I was concerned about for joint and bone problems. It was the Arimidex my Onc first wanted me to try. However, when he found out about my problems with joint pain and osteoarthritis, he felt that the Arimidex would make it worse and the Tamoxifen was a better choice for me to try. From what I have found out about both drugs, it seems the Arimidex causes more joint and bone pain. I was at a bc support group this week and one of the ladies who is on the Arimidex said she was having more joint and bone pain since being on the drug. For all I know, the Tamoxifen may be just as bad for me but I have to at least give it a try. Women have been taking it for 30 years so if it were that dangerous, they would have taken if off the market by now, IMO. Here's hoping I do well on it. And Su-Texas too! Best of luck to both of us with Tamoxifen, Su! Bea Bea wrote<< From what I have found out about both drugs, it seems the Arimidex causes more joint and bone pain. >> That is supposedly a side effect. I started getting some stiffness and mild discomfort about 5 months after I started the Arimidex. Then, 3 months later I started the Celebrex and have not had any problems with the above. However, Arimidex may accelerate bone deterioration--as in osteopenia and osteoporosis. I am not sure if it affects all that way, though. One private oncologist recommended that I get a yearly infusion of Zometa to prevent such. I am getting that every 3 months, and I believe that has helped. Before I started the Arimidex I also consulted with a private oncologist re. such. At the time he recommended Tamoxifen but if I had any concerns about blood clots suggested I go with Arimidex. I was very much concerned about blood clots because I have lower leg swelling of unknown cause. In addition Tamoxifen has a 25 to 30% failure rate. My husban hypothesized that being Her2+ might be a possible causative factor. Some of the research suggested that was a possibility, and my regular oncologist also thought that was possible. However, I was also on Herceptin, and the private oncologist I saw thought that the Herceptin would allow the Tamoxifen to be effective. He thought Arimidex would also be a good choice. The only way I was allowed Arimidex at that time was by refusing the Tamoxifen. I was uneasy about taking it because of possible associated liver-related events. My first CT scan showed a 1.5 cm lesion in the liver which might be a hemangioma. A tagged red blood cell study was done to rule out but report stated that there was not enough resolution to rule out or confirm in lesions less than 2.0 cm. No further testing was done. I then had chemo, etc. Later, we learned that treated liver lesions might resemble hemangiomas. Thus, because there was something in my liver that was never identified--I felt very uneasy about taking the Tamoxifen. > >What effect does Tamoxifen have on joint and > > bone problems? [quoted text clipped - 6 lines] > he felt that the Arimidex would make it worse and the Tamoxifen was a > better choice for me to try. I see. > From what I have found out about both drugs, it seems the Arimidex > causes more joint and bone pain. I've never heard that - or if I have I've forgotten :-) > I was at a bc support group this week > and one of the ladies who is on the Arimidex said she was having more > joint and bone pain since being on the drug. For all I know, the > Tamoxifen may be just as bad for me but I have to at least give it a > try. Women have been taking it for 30 years so if it were that > dangerous, they would have taken if off the market by now, IMO. I wouldn't be sorry to know that I'd been on Tamoxifen or Arimidex for the last five years. From what I've learned both are effective in their own ways. Nothing is without risk. Mary > A friend sent me a copy Healthline by Phil Rainer and tonight the > following was in it: [quoted text clipped - 18 lines] > > Bea There was a study over a year ago -- maybe three years -- that showed benefit in protecting women who were deemed at high risk of developing cancer for the first time; there were fewer new cases of cancer in the treated group. The benefits of any treatment must be weighed against the adverse effects. A woman physician, an expert in hormonal effects on brain function, commented on "The Infinite Mind" something like "I can envision all these 80-year-old women with perfectly healthy breasts who are too demented to know it." Failure to prescribe may not be the shocking negligence protrayed in the quote. |
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