I saw the medical oncologist last week and he was impressed I knew about cyp2d6 testing but said it really did not work for post menopausal woman. I am taking tamoxifen as it is the only approved AI for DCIS. I don't really have side effects which he said was normal at my age. Even though I do not have hot flashes etc he said history shows it works on menopausal women. It was the only thing available for years. Said he would do the test for me but the insurance would not pay and he thinks the results are meaningless for me. He does think it is great for the majority of women taking it - young woman. Have you heard the test is not accurate for older women. Of course few "elderly" (i just do not consider myself this) take tamoxifen but wonder if any of you know about this.
He knows I really do not like this drug and worry about uterine cancer. Said I could stop it - no bad answer - my recurrance would go from 6% to about 11- 12% - not too bad. He also suggested thinking about Evista which would not keep DCIS from coming back but protects against the invasive cancer - just as good as tamox but no uterine cancer - just the strokes - LOL.
I am still popping the tamox but thinking of the evista or just stopping. Any ideas??
Connie
DarbysMOM
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AnnNYC Joined: Aug 2007 Posts: 1567 |
May 15, 2008 03:25 pm, edited May 15, 2008 03:29 PM
by AnnNYC
AnnNYC wrote:
Connie, I have never heard anyone say what you report your onc to be saying. Age shouldn't make any difference in the ACCURACY of the test -- it is a genetic test that could be done accurately using the cells of a fetus or a 100-year-old person. It is my understanding that the CYP2D6 test is not usually recommended for PRE-menopausal women, because there isn't really an alternative to tamoxifen for premenopausal women (other than removal of ovaries, after which the women can take aromatase inhibitors). One of the biggest testing companies, DNA Direct, says the test is not usually recommended to PRE and PERI menopausal women. That means it IS used for POST menopausal women: http://www.dnadirect.com/patients/tests/tamoxifen/testing_for_you.jsp Also -- tamoxifen is not an aromatase inhibitor (AI). AIs include Femara, Arimidex, Aromasin. Currently, clinical trials are being conducted to evaluate whether AIs are effective in preventing invasive cancer in women who have had DCIS that is estrogen-receptor-positive (ER+). A lot of doctors (and patients) make the logical leap that, since AIs are so effective in preventing recurrence of ER+ early IDC, AIs will have similar effectiveness for DCIS -- but this is currently an "off-label use" for AIs, meaning the FDA will not say AIs are effective for DCIS because the clinical trial results aren't in yet. (see: http://www.dcis.info/treatment-hormonal.html ) Dx 3/9/2007, IDC, <1cm, Stage I, Grade 2, 0/5 nodes, ER+/PR+, HER2- |
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TenderIsOur… Joined: May 2007 Posts: 3023 |
May 15, 2008 04:35 pm, edited May 15, 2008 04:45 PM
by TenderIsOurMight
TenderIsOurMight wrote:
Evista definitely is a consideration given its lack of uterine lining stimulation and bone neutrality, in addition to limiting breast dcis progression/recurrence/other. It is strange it came out a bit higher on the stroke adverse effect (an apparent true adverse effect, not study limitation, maybe suggesting some as yet unknown cerebral-cardiovascular system affect). If you do not have high blood pressure, Leiden factor 5 or other pro blood clot state, or smoke or other known risk factors, family history or such, maybe further discussion of Evista with your oncologist may be a nice solution for you. Tender It cannot be emphasized too strongly that treatment of each patient is a highly individualized matter. (FDA-approved labeling for warfarin (Coumadin) NDA 9-218/5-105)
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NativeMaine… Joined: Mar 2007 Posts: 482 |
May 15, 2008 05:07 pm
NativeMainer wrote:
Have your doc's office check again--my insurance company won't pay for the test for me because I am pre-menopausa, but it will pay for it if a woman is post-menopausal. I think your doc has his info backwards. dx 3/07, Stage 2, Grade 2 IDC, 2.8cm, ER+PR+, Her2(-), SN-, lumpectomy & rads
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