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Read this in the news and thought it was worth passing on. At least we are not talking 5 years on. The last part was interesting about natural aromatase blockers. Sorry for the length.
(Nolvadex) has been a very effective part of postsurgery breast cancer treatment. Its benefits were confirmed in the 1998 Breast Cancer Prevention Trial, with results showing 49% fewer diagnoses of invasive cancer in the group of women taking tamoxifen. Given this success rate, researchers in 1998 began to look at its use for women considered to be at high risk for breast cancer -- those with a family history, problematic breast biopsies and other factors. But a recent study published in Neurology clouded the picture for women who were considering taking tamoxifen prophylactically. It showed that tamoxifen increased risk for strokes -- in particular, ischemic strokes (those caused by clots).
The study, from Duke University Medical Center, analyzed nine prior studies and found that seven strokes had occured per 1,000 patients taking the drug. Study coauthor Cheryl D. Bushnell, MD, called the findings statistically significant.
The reason for the connection with stroke is that one side effect of tamoxifen is increased clotting. According to Maura N. Dickler, MD, a specialist in breast cancer treatment at Memorial Sloan-Kettering Cancer Center in New York City, doctors were aware of the risk long before this study. The Duke University study is simply confirming the clotting risk. Dr. Dickler told me that earlier studies showed increased risk for clots in the legs (deep vein thrombosis) with the potential consequence of pulmonary embolism (a clot breaking loose and going to the lungs, often with fatal consequences). Earlier studies also showed increased risk for endometrial cancer, a rare form of uterine cancer and strokes. However, those earlier studies did not show ischemic strokes to be as great a risk as the most recent study does.
However, she says it's important to remember that this study is a different type than previous ones that reach different risk/benefit conclusions. The new study is a meta-analysis, which is to say it analyzes earlier data and draws a conclusion, a process that typically reflects bias and other selection problems that can affect outcome. Clinical trials, on the other hand, test prospectively by having one group take a drug over time while a second group takes a placebo -- with neither group knowing which is which. At the end, study authors collect data and evaluate the performance of the drug in question. The 1998 prevention study was a clinical trial that took place over a five-year period with more than 13,000 women participating. Although this study did show an increased risk for the tamoxifen group, it was not as high as in the Duke study.
DECISION TREE
Most importantly, all studies ultimately lead to the same implications for women seeking to take tamoxifen for prophylactic reasons, says Dr. Dickler. The therapy requires taking the drug for five years -- the women in this group will have to decide if the benefits strongly outweigh the risks. Women must not take the drug if they have risk factors for clotting or strokes, heart disease, diabetes or have had a prior stroke -- these are greater medical risks than breast cancer. But even for women without such risk factors, there are other considerations. Tamoxifen has quality-of-life side effects that include headaches, nausea, loss of libido, painful intercourse and vaginal discharge. A woman must ask herself if she is willing to endure this kind of discomfort for the sake of possibly preventing cancer in the future.
Women who do opt for tamoxifen should see their oncologist every six months, says Dr. Dickler, at which time the doctor should review all side effects with her and arrange for a liver function test. In particular, be alert to leg pain -- it may be a manifestation of disrupted calcium metabolism and perhaps a clot in your legs. Because the danger of clotting is particularly high after surgery, it's critical to suspend use of tamoxifen for at least two weeks prior to any surgical procedure.
In the not-too-distant future, it is possible that the risk/benefit of tamoxifen therapy will become a moot point for many women -- including even some who are being treated to prevent a recurrence of breast cancer. Dr. Dickler says that the medical world is increasingly moving toward a type of drug called aromatase inhibitors for women with early-stage breast cancer to prevent recurrence after surgery. These drugs do not appear to increase the risk for stroke, and if testing bears out their safety, it is possible that they might be the new drugs of choice for high-risk women as well. Aromatase inhibitors block the creation of the estrogen metabolites thought to be the true inducers of cancer in some, whereas tamoxifen blocks estradiol (estrogen).
According to Daily Health News contributing editor Andrew L. Rubman, ND, natural aromatase inhibitors (in particular, di-indole methionine, or DIM, derived from cruciferous vegetables) are currently available in health-food stores and might be worth considering if a woman is at increased risk for breast cancer.
(Nolvadex) has been a very effective part of postsurgery breast cancer treatment. Its benefits were confirmed in the 1998 Breast Cancer Prevention Trial, with results showing 49% fewer diagnoses of invasive cancer in the group of women taking tamoxifen. Given this success rate, researchers in 1998 began to look at its use for women considered to be at high risk for breast cancer -- those with a family history, problematic breast biopsies and other factors. But a recent study published in Neurology clouded the picture for women who were considering taking tamoxifen prophylactically. It showed that tamoxifen increased risk for strokes -- in particular, ischemic strokes (those caused by clots).
The study, from Duke University Medical Center, analyzed nine prior studies and found that seven strokes had occured per 1,000 patients taking the drug. Study coauthor Cheryl D. Bushnell, MD, called the findings statistically significant.
The reason for the connection with stroke is that one side effect of tamoxifen is increased clotting. According to Maura N. Dickler, MD, a specialist in breast cancer treatment at Memorial Sloan-Kettering Cancer Center in New York City, doctors were aware of the risk long before this study. The Duke University study is simply confirming the clotting risk. Dr. Dickler told me that earlier studies showed increased risk for clots in the legs (deep vein thrombosis) with the potential consequence of pulmonary embolism (a clot breaking loose and going to the lungs, often with fatal consequences). Earlier studies also showed increased risk for endometrial cancer, a rare form of uterine cancer and strokes. However, those earlier studies did not show ischemic strokes to be as great a risk as the most recent study does.
However, she says it's important to remember that this study is a different type than previous ones that reach different risk/benefit conclusions. The new study is a meta-analysis, which is to say it analyzes earlier data and draws a conclusion, a process that typically reflects bias and other selection problems that can affect outcome. Clinical trials, on the other hand, test prospectively by having one group take a drug over time while a second group takes a placebo -- with neither group knowing which is which. At the end, study authors collect data and evaluate the performance of the drug in question. The 1998 prevention study was a clinical trial that took place over a five-year period with more than 13,000 women participating. Although this study did show an increased risk for the tamoxifen group, it was not as high as in the Duke study.
DECISION TREE
Most importantly, all studies ultimately lead to the same implications for women seeking to take tamoxifen for prophylactic reasons, says Dr. Dickler. The therapy requires taking the drug for five years -- the women in this group will have to decide if the benefits strongly outweigh the risks. Women must not take the drug if they have risk factors for clotting or strokes, heart disease, diabetes or have had a prior stroke -- these are greater medical risks than breast cancer. But even for women without such risk factors, there are other considerations. Tamoxifen has quality-of-life side effects that include headaches, nausea, loss of libido, painful intercourse and vaginal discharge. A woman must ask herself if she is willing to endure this kind of discomfort for the sake of possibly preventing cancer in the future.
Women who do opt for tamoxifen should see their oncologist every six months, says Dr. Dickler, at which time the doctor should review all side effects with her and arrange for a liver function test. In particular, be alert to leg pain -- it may be a manifestation of disrupted calcium metabolism and perhaps a clot in your legs. Because the danger of clotting is particularly high after surgery, it's critical to suspend use of tamoxifen for at least two weeks prior to any surgical procedure.
In the not-too-distant future, it is possible that the risk/benefit of tamoxifen therapy will become a moot point for many women -- including even some who are being treated to prevent a recurrence of breast cancer. Dr. Dickler says that the medical world is increasingly moving toward a type of drug called aromatase inhibitors for women with early-stage breast cancer to prevent recurrence after surgery. These drugs do not appear to increase the risk for stroke, and if testing bears out their safety, it is possible that they might be the new drugs of choice for high-risk women as well. Aromatase inhibitors block the creation of the estrogen metabolites thought to be the true inducers of cancer in some, whereas tamoxifen blocks estradiol (estrogen).
According to Daily Health News contributing editor Andrew L. Rubman, ND, natural aromatase inhibitors (in particular, di-indole methionine, or DIM, derived from cruciferous vegetables) are currently available in health-food stores and might be worth considering if a woman is at increased risk for breast cancer.
