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Whaddaya Mean, the Docs Aren’t Sure?

By Heather Millar

Confused Doctor

Last week, lots of headlines came out of the San Antonio Breast Cancer Forum. This happens every year, as breast cancer researchers gather in Texas to present their latest research.

Here’s the news flash that caught my eye: A new British study published in The Lancet concludes that breast cancer patients who take Tamoxifen for ten years, rather than the now standard five years, have a better chance of not dying from cancer.

Let me back up for those of you who are not marinated in breast cancer details as I am. Some breast cancers react to the hormone estrogen as if it were candy. For these patients, who have what’s called “estrogen-reactive” cancer, estrogen jazzes their cancer cells. Estrogen makes their cancer grow. So, after they’ve finished with the initial “slash, burn, and poison” of standard cancer treatment, these patients can take a number of drugs that interfere with estrogen. No estrogen means that cancer cells that might remain in the body and want to grow will have one less weapon at their disposal. Some of these drugs block the production of the hormone; others block the body’s ability to use the hormone. Tamoxifen is one of these drugs.

I take Tamoxifen. I’m now in year two of what I thought would be five years on the drug. I’ve moaned about Tamoxifen on this blog before. I guess I should be grateful that I don’t have the panic-attacks, mood swings, and sleep problems that I’ve heard other breast cancer patients suffer with Tamoxifen.

Mostly, Tamoxifen gives me cramps. Every day. Sometimes, the cramps hit my feet. Sometimes they hit the muscles under my chin, or my fingers. Sometimes, it’s my legs. Just try stretching out your chin or your ring finger! Also, Tamoxifen makes it really, really hard to keep your weight down. I haven’t reached zeppelin proportions, but I’m plumper than usual. Watching what I eat and running five days a week seem to have no effect on this. I’m on the brink of just admitting that I won’t be able to wear half the clothes in my closet until I stop taking the drug. Hooray for elastic waistbands.

So you can imagine how thrilled I was to learn that this new study says I should take Tamoxifen for ten years, not five. Will those now-too-small pants even be in fashion by the time I’m off the medication?

But, wait a sec, according to my oncology nurse practitioner, there have been many studies published on the topic of how long patients need to take Tamoxifen to give them the best chance of survival: In 2008, another study concluded than ten years on tamoxifen is better than five. Then, in 2009, another study said maybe seven years was best, echoing data from a 2005 study. Then, in 2010, a review of studies put it back down to five years.

So what’s a patient to do? Obviously, the question of how much tamoxifen is enough tamoxifen remains a subject of debate among oncologists. That’s also true of the value of treating early prostate cancer, or screening for lung cancer, or many other things. One of the hardest lessons of being a cancer patient, I think, is realizing that cancer is just 50 shades of gray. Many times, you reach a point where you have to make a treatment decision and there is no right answer. There is this data, and that data. There is your oncologist’s advice, and your preferences. Then, you just make a choice. No guarantees.

As with many studies, news reports are right to point out that this latest Tamoxifen study shows a benefit measured in a couple of percentage points. Nine years post-diagnosis, 15 percent of the women who took Tamoxifen for five years had died of breast cancer. Of those who’d taken the drug for ten years, 12 percent had died. That’s three percentage points. That’s not nothing. But neither would I say that it’s overwhelmingly conclusive.

So what will I do? I’ll get to five years, and consider whether I can put up with the side effects for a while longer. No doubt, several more studies will have been published by then. I’ll just make my best guess. Hopefully, I’ll be able to live with that.

Photo: Wavebreak Media

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