By: Jean Johnson for Fibroids1Two thousand women in the United States alone will be diagnosed with breast cancer this year.
I’m not sure if I’m one of these women yet, since the second mammogram I’ve had in as many weeks will be tomorrow. But I must say, when the letter from the imaging center came in the mail yesterday informing me that the screening mammogram I had “needs further evaluation… of potential abnormalities,” I put writing this article at the top of my list. Indeed, on matters of health just as matters of death, it’s one thing to ponder their nuances from afar. When your turn comes however, and you are asked by the universe to step up to the plate, the attention is entirely riveted.
| Take Action |
Reduce Your Risk
According to the American Cancer Society, some risk factors for breast cancer cannot be changed, such as aging, time of menses and genetics. However there are some lifestyle changes that can reduce your risk for breast cancer.
Obesity – staying at a healthy weight will decrease your risk
Not having children – or having your first child after 30, puts women at a slightly higher risk for breast cancer
Long-term HRT: Studies have shown the use of combined estrogen and progesterone therapy for longer than five years increases your chance for breast cancer.
Alcohol – consuming more than one and a half drinks per day increases your risk.
Physical activity – some studies have shown simply walking one hour per week can reduce your risk.
The National Cancer Institute offers a risk assessment tool that factors in family history, age, childbirth, and prior breast problems at www.cancer.gov.
|
So now, even with the slightest hint that I could join the sisterhood, I realize how grateful the 41,000 United Kingdom women who will receive a breast cancer diagnosis this year must be about their government’s decision to recommend widespread use of a new class of drugs effective against the growth and recurrence of breast cancer in post-menopausal women. (A caveat before we continue: While it’s certainly comforting to have one’s government approve a particular therapeutic approach, Joanne Rule, chief executive for the charity Cancerbackup, told the BBC that, “It is important to remember that if a woman and her clinician decide that a certain treatment is suitable, there is nothing to prevent Primary Care Trusts [within which physicians, dentists, and opticians in the UK’s national healthcare system work] from prescribing it as they do not need to wait for NICE guidelines.”)
Tamoxifen, Aromatase Inhibitors, and the New England Journal of Medicine
Currently, the standard approach to treating breast cancer is a mastectomy followed by a five year regime of tamoxifen, a drug that blocks estrogen in a different way from the aromatase inhibitors. Tamoxifen has been the drug of choice – the gold standard treatment for breast cancers over the past quarter century.
Results of a 5,000 patient study with five years of follow-up , published in a 2004 issue of The New England Journal of Medicine, however, demonstrated that the women who took one of the aromatase inhibitors that block estrogen had fewer recurrences of the cancer after surgery than did those who took tamoxifen.
As far as the statistics go, the women taking the aromatase inhibitors had a “32 percent risk reduction of breast cancer recurrence compared to those who remained on tamoxifen,” according to a 2004 report in Business Week . “Ultimately, 91.5 percent of patients on aromasin [one of the three aromatase inhibitors approved for use] were free of breast cancer for the full five years after surgery, compared with 86.8 percent of those remaining on tamoxifen.”
While aromatase inhibitors were approved for use in the United States in the late 1990s, accepted protocol was to use them only after a five-year course of tamoxifen, a drug that prevents estrogen from attaching to cells. Some researchers, however, wondered about the wisdom of the approach and completed some initial trials prior to the 2004 study which paved the way for in recognizing the efficacy of the aromatase inhibitors.
Since this newer group of drugs blocks aromatase, which the body uses to produce estrogen, they interfere with actual estrogen production at a fundamental level. Thus, unlike tamoxifen which simply blocks a tumor’s ability to use estrogen, the aromatase inhibitors actually decrease the amount of estrogen in the body.
The American Cancer Society offers the following insights on aromatase inhibitors:
Three Flavors: These 3 aromatase inhibitors stop estrogen production in postmenopausal women and have been approved for use in treating early and advanced breast cancer: letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin).
For Post-Menopausal Women Only: The aromatase inhibitors work by blocking an enzyme responsible for producing small amounts of estrogen in postmenopausal women. They cannot stop the ovaries of premenopausal women from producing estrogen. For this reason they are only effective in postmenopausal women.
Fewer Side Effects: The aromatase inhibitors have fewer side effects than tamoxifen because they don’t cause endometrial cancer and very rarely cause blood clots.
Osteoporosis: The aromatase inhibitors can cause osteoporosis and bone fractures because they remove all estrogens from a postmenopausal woman.
The Cancer Must Be “Hormone Receptor Positive”: Many doctors prefer aromatase inhibitors over tamoxifen as the first hormonal treatment for postmenopausal women whose breast cancer has come back, if the cancer is hormone receptor positive.
A Revolution in Our Understanding
“There aren’t too many cancer studies that come along that are this important,” Stephen Jones, M.D. – of the Charles A. Sammons Cancer Center at Baylor University Medical Center, chair on the U.S. Oncology Breast Cancer Research and clinical professor at the University of Texas Southwestern in Dallas – told Business Week. “This really changes the standard strategy of putting a woman on five years of tamoxifen.”
UK Approval
“Preliminary guidance” is the wording the U.K.’s National Institute of Health and Clinical Excellence (NICE) is using to back the widespread use of the aromatase inhibitors. The BBC cites the class of drugs as having been proven in studies to be “a fifth more effective in preventing breast cancer than tamoxifen.”
Until recently, the drugs have been in accepted use only in Scotland, with women in Wales and England still languishing in the tamoxifen realm.
Jeremy Hughes, chief executive of Breakthrough Breast Cancer, however, appreciates both the old and the new approaches to therapy. “The current gold standard treatment tamoxifen has already had a big impact on women’s lives,” he told the BBC in June 2006. “These new treatment options will be an important addition to the armory of therapies available to treat women with the disease.”
That’s clearly good news to the sisterhood – or the “clan of one-breasted women” as the Utah writer Terry Tempest Williams put it. Although experts are quick to assure us that heart disease is the more formidable killer, there’s something about breast cancer that really jangles the chain. Here’s hoping women everywhere benefit from the recent research and get the best treatment available.
