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Medical Edge Newspaper Column from Mayo Clinic

NEW HORMONE THERAPIES FOR BREAST CANCER PATIENTS

DEAR MAYO CLINIC: I’m a breast cancer survivor and happy to be here! I’m 72 years old, have had one breast surgically removed and have been on tamoxifen for nearly three years to prevent recurrence. My doctor says I have to go off it when I reach the five-year mark — and I’m already worried about this. I’m scared the cancer will come back. Is there something else I can try that’s as good as tamoxifen? I know it’s wrong, but some days worrying about my future robs me of the joy of health I have today. — Oklahoma City

ANSWER: Yes, promising new hormone therapies exist for women following surgical or radiation treatment of breast cancer. Tamoxifen has been the standard therapy for about 20 years in both pre- and postmenopausal breast cancer patients. Many patients who do well with tamoxifen would like to take it for longer than five years. Unfortunately, results from clinical studies testing 10-year use of tamoxifen do not support that decision.

But there is good news: Effective new hormone therapies called aromatase inhibitors are available for postmenopausal breast cancer patients. Many are surprised to learn that postmenopausal women still make estrogen, which promotes the growth of certain kinds of breast cancer. The aromatase inhibitor stops this estrogen production. (Note: Premenopausal women don’t have the same treatment choices, because their ovaries are still producing estrogen.)

Three recent large studies of aromatase inhibitors, conducted at major medical centers and published between 2002 and 2004, involved about 19,000 postmenopausal women in the United States and Canada with hormone-receptor-positive breast cancer. From these studies, three new basic treatment scenarios have emerged:

— taking tamoxifen for five years, then considering taking an aromatase inhibitor for an additional time;

— taking tamoxifen for two or three years, and then switching to an aromatase inhibitor for the remainder of a five-year treatment cycle;

— taking an aromatase inhibitor exclusively for five years.

Results of the three clinical studies showed that aromatase inhibitors, either taken alone or following tamoxifen, were effective therapy. The advantages of aromatase inhibitors are twofold: They may be more effective than tamoxifen in preventing recurrence, and there is a lower risk of blood clots and uterine cancer with their use. However, all three studies reported joint and muscle pains as side effects, which were bothersome to about 5 to 10 percent of patients taking aromatase inhibitors. Another side effect reported in all three studies is increased risk for osteoporosis. It is not clear whether treatment with calcium, vitamin D or other drugs can prevent this.

Cost is another issue. Aromatase inhibitors cost $200 to $300 per month, compared to $40 to $100 per month for tamoxifen.

As you can see, the treatment for postmenopausal breast cancer patients has changed profoundly in recent years and no doubt will continue to change. By all means, discuss aromatase inhibitor treatment with your physician.

James Ingle, M.D., and Charles Loprinzi, M.D., Medical Oncology;
Mayo Clinic, Rochester, Minn.

Additional Resources:
Mayo Clinic Oncology
Appointment Information
More Information on Breast Cancer

SAND-PLAY SAFETY
Medical researchers remind parents to supervise children playing in sand. Two instances in which children were killed after being buried in sand emphasize the point that beaches, sandboxes, sand piles and natural play areas may be dangerous.
A recent research article in Mayo Clinic Proceedings examined two accidental deaths of boys who were trapped under sand. One 10-year-old died when the tunnel he was digging in his sandbox collapsed on him. He was buried for about 10 minutes before he was pulled from the sand. In the second case, a 10-year-old boy was buried in wet sand at a construction site after a 30-foot pile of sand collapsed on him. In both cases, the weight of the sand compressed the child’s chest and prevented proper breathing.
Doctors say that greater awareness by public health personnel, safety officials and parents may help prevent such potentially fatal accidents.

Additional Resources:
Safe Play

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.