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Today’s newspapers are filled with reports of a new study that found the drug Aromasin could prevent breast cancer. I just read it and am not convinced.
Aromasin is an aromatase inhibitor. This means that it blocks a woman’s ability to make estrogen (the main female hormone) if she has gone through menopause. It won’t block estrogen production from the ovaries, which is why it only works in post-menopausal ladies. It does this by blocking the enzyme aromatase that makes estrogens in a woman’s fat cells. I’m not sure we know why these fat cells make estrogens, but because of this, a post menopausal women will make about 10 percent of the estrogen she used to make before she went through menopause. This means, of course that fat women will make more estrogen and skinny women, less.
The investigators studied about 4500 women who had gone through menopause. Some of them had a higher than average risk of breast cancer for their age. Half of the women were given the drug for 5 years while the other half received a placebo. At the end of the study, the researchers reported a 65 percent drop in the number of breast cancer cases in the treated group.
Sounds great doesn’t it? But we are talking about an extra 21 women out of 2275 who developed breast cancer. And in all of these women the cancers were Stage 1, meaning they were small and hadn’t spread to lymph nodes. The cancers also had certain chemical characteristics that strongly suggested they were low grade – meaning they were unlikely to spread. These cancers were not going to be killers.
Standard treatment for these 21 extra women would be lumpectomy, radiation to the breast and five years treatment with the drug they would have taken to prevent the cancer. We have no idea whether any lives were saved. Indeed, I think not. Yes, one out of one hundred women were spared the need to go through unpleasant treatment for breast cancer, but the drug didn’t save their lives and the other ninety-nine out of one hundred women took the drug with no benefit.
We also have to look at side effects. We know all too well that women who go through menopause experience symptoms. They get hot flashes, sleeplessness, and fatigue. Another side effect is vaginal dryness, which can make sex uncomfortable. Getting rid of their last remaining traces of estrogen can’t help the situation. The authors reported that women taking the drug had a bigger problem with these symptoms except for the vaginal dryness. And frankly, I am always skeptical of these symptom reports. They might have been worse. There were no face-to-face interviews where we might have learned the real facts. Instead there were questionnaires that the women filled out, which might not have thoroughly explored how they felt.
I am sure that Pfizer, who makes Aromasin will market docs heavily to give the drugs to all their post-menopausal patients. There are at least two other drugs on the market that work like Aromasin and I am sure there will also be some push to put women on them. But I would beware.
Next they will be asking us men to take drugs to cut down on our testosterone levels so we don’t get prostate cancer.
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3 comments:
Just a note: aromatase inhibitors are still under patent and are heavily marketed by their manufacturers as being 2 to 3 percent more effective than tamoxifen. Nonetheless, ASCO published new guidelines saying aromatase inhibitors were promising drugs that at some point should be part of most breast cancer patients' treatment, but did not spell out which drugs should be used for which women and when.
Previous studies have also shown a high dropout rate for the drugs, specifically for muscle and joint pain (musculoskeletal problems) as the primary reason. And "chemo brain" is part of the language now. The culprits include very high doses of chemotherapy and the combination of chemotherapy and supplementary hormonal treatments (like aromatase inhibitors).
I am so confused with all of these drugs marked to inhibit estrogen secretion. I am a woman I have gone through menopause. I was diagnosed with Stage 3 Grade 3 Breast Cancer.\
I have been on ARIMIDEX, TAMOXIFEN and lastly Letrozole.
ARIMIDEX and Letrozole are cousins so my Oncologist has told me. The amount of bone and joint pain is horrendous and debilitating. I was taken off both I developed some bleeding issues with Tamoxifen So now I am being told that I have to have my Ovaries removed to prevent my body from producing additional estrogen. Frankly I don't want surgery. And really are having my ovaries removed an assurance that I won't develop a secondary cancer? And what about Aromasin.. Are these drugs the cure for Breast Cancer? I am very confused frustrated and not sure what options I have available. Many women I speak with are just as confused. Perhaps someone could explain in a way that we can understand without the medical jargon adding to the confusion Thank You Alli.........
Yes, Aromasin,Arimidex and Letrozole are similar drugs in that they block estrogen production. If you are still having periods they do no good because your ovaries are producing estrogens, which is NOT blocked by these drugs. There are drugs that block estrogen production by the ovaries such as Lupron (an injection).None of these treatments are guarantees that the cancer won't come back. They just lower the chance that it will.
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