Arimidex
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Arimidex helps to lower estrogen levels which can also be achieved by natural sources, but one thing that arimidex or natural sources doesn't help with is the risk of recurrence just from radiation. Those women who fair better are the ones who refused radiation, it seems.
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Edited to add:
Well, I rushed here to delete this comment, but the knives and branding irons were already out!
I just wanted to add that I was very depressed when I wrote this comment after learning on this website that cancer comes back around the 10 year period for women who have had radiation. I felt depressed thinking how come the doctor never mentioned this to me and that maybe I could have gone for mx and no rads. So I thought gosh here we are trying to reduce recurrence with a drug that has difficult se's for some people, only to be bitten in the butt in 10 years time!
Thankfully one of the gals kindly pointed out that radiation has become more refined now with less dosage than say 10 years ago, and that the risks have been drastically reduced. I think it was Pj from Fla. I felt much better after reading her comments.
Cheers ladies and have a great day.
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I just completed my 2nd week on this med. I have experienced warm/hot flashes many nights altho' I take it in the morning. I have a mild headache 24/7 and very dry eyes but I had that before and it is just worse but it is summer too.
I was really worried about joint pain because I have one injured knee problem but so far so good. I have been taking the glucosamine cocktail for many years.
If this is It I can live with it very well.
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Radiation after lumpectomy is the standard of care. Refusing radiation if you have had a lumpectomy is rejecting the best modern medical care has to offer. The following is from the Aetna site who would save a ton of money by suggesting women forego radiation.
Radiation therapy (sometimes called radiotherapy) almost always is recommended after lumpectomy to destroy any cancer cells left behind and to prevent local recurrences in the breast. Without radiation therapy, the odds of a local recurrence increase by about 25 percent. These recurrences can predict cancer spread to other parts of the body, especially when they occur within the first three years after surgery. Radiation therapy is also sometimes recommended after mastectomy, depending on the size and other characteristics of the breast tumor.Although many patients worry that radiation treatment can cause cancer, this is extremely rare with today's high-tech machines. There is no risk of becoming radioactive or losing your hair due to radiation treatments. Fatigue is a common side effect of radiation, and many women experience swelling or a sensation of heaviness of the breast. Most of these changes in the breast are temporary and will go away within a few months to a year. Some women, however, notice that their breasts are smaller and firmer after the treatment, and this can be permanent. Radiation therapy is not given to pregnant women because it can cause birth defects.0 -
Painterly, If you are saying is that the refusal of radiation gives you a better chance of survival then by your thinking all radiation should be refused....that would mean all mamos, US's, xrays, CT's, PET's and MRI. Another words all diagnostic tools. Give me radiation please !!! I'm sure that you utilized these things for your own DX. Are you being a little hypocritical? The final decision for any and all treatment and diagnostics is totally up to the individual and it is not up to us to try and influence them in their decisions. The most we should do is support them in the decisions they do make.
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PJ12345, thanks for your post re the Arimidex. Two of the authorsof your next posting , Burstein and Winer, are the brilliant docs at Dana Farber, where I am treated. We all have to make our own decisions, as Mollyann has said. I thought I found a chart somewhere where you punch in your age, your diagnosis, etc and get a longevity print out as to how effective the AIs are, but I'll be darned if I can find it. I have read a great deal on the AIs and am going to continue taking them. And I think they have been around long enough that they are not experimental in nature. Dana Farber is one of the most eminent treatments centers and I have to conclude that they know what they're talking about.
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Painterly is correct. There is no survival advantage to radiation therapy after lumpectomy. Rads only prevents recurrence in the breast in about 12 women out of 100 over the next 5 years. At year 6 onward there is no local tumor benefit. Although radiation can create cardiovascular disease because it nukes the coronary arteries so women may die sooner from a heart attack than they would from breast cancer. You can look that up
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OK, people, you all can believe whatever you want, but I am going to stick with the recommendations of my oncologist, who has years of training and experience, and whom I know studies and researches my own particular situation before he makes his recommendations. I also want to point out that there have been and are countless scientists who have dedicated their lives to finding better cancer treatments, and thousands and thousands of our sisters who have willingly entered clinical trials, who have put their own lives on the line, to make sure that the 'standard of care' treatment recommended to you is, indeed, the best way to go with the knowledge available at the time.
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Janeluvsdogs. Did you actually read my post?
JO. Thank you I heartily agree.
chrissyb
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agreed! Well said, Ruth....
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So, we have a vote then. Evidence should not be considered?
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For 50% of women with breast cancer (right siders) radiation does not threaten the heart in any way. For the other 50% there is some concern. HOWEVER, modern radiotherapy is much safer and more focused in targeting the tumor track and bed. My BC was on the left side...but I CANNOT IMAGINE FOREGOING RADIOTHERAPY!!!
I suppose I could have chosen mastectomy to avoid rads. But statistical evidence shows that there is no improvement in SURVIVAL with MX; it does give better odds against a recurrence SLIGHTLY. So if you are really afraid of radiation, you could choose MX... although sometimes radiation is still indicated. :-(
I cannot imagine foregoing hormonal therapy.
After all, I took birth control pills more than 5 years to prevent pregnancy. They are a form of hormonal therapy. I took estrogen replacement therapy (premarin) more than 5 years to ease my way through menopause. I'm sure I would do both again. It is a form of hormonal therapy. Pregnancy and menopause did not threaten my life. Breast cancer does! I'm taking an AI for 5 years.
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Hi. I have a question for Claire in Seattle. I agree with you on all of your post. The only thing I havent heard much information on is the asprin therapy. I already take an 81mg baby asprin a day. It is something I started when I was on Tamox (for the blod clotting issues) and then just continued when I switched to Arimidex. Could you give me some information on the studies you read or where to find them? Thanks
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This was posted on BC.org recently.
Aspirin Benefit Seen in Established Breast CancerThis study suggests that pre-menopausal women who take two or more aspirin each week in the years after a diagnosis of early-stage breast cancer have a better prognosis than women who don't take aspirin. The women who took aspirin were less likely to die from breast cancer or any other cause and also less likely to develop metastatic breast cancer. Metastatic breast cancer is advanced-stage breast cancer that has spread to parts of the body away from the breast, such as the brain or bones.The results are from the very large and ongoing Nurses' Health Study (NHS). The NHS is monitoring more than 110,000 pre-menopausal female nurses for a number of health factors, including medicines used and breast cancer risk and outcomes. Some of the women in the study have been followed for more than 20 years.Inflammation contributes to many diseases, including cancer. So researchers wondered if taking non-steroidal anti-inflammatory (NSAID) medicines:aspirinibuprofen (brand names include Advil, Motrin, Nuprin)naproxen sodium (brand names include Aleve, Anaprox)could reduce breast cancer risk. Research has shown that regular use of NSAIDs can lower the risk of colon cancer.Other research has suggested that regularly taking aspirin and other NSAIDs could lower breast cancer risk. But in 2009, NHS results showed that pre-menopausal women who regularly took over-the-counter NSAIDs didn't have a lower risk of breast cancer risk compared to pre-menopausal women who didn't regularly take NSAIDs. Breastcancer.org reported on the2009 NHS results.In the NHS results reviewed here, the researchers asked a different question: could regular use of aspirin or other NSAIDs affect prognosis in women already diagnosed with breast cancer? To answer that question, the researchers looked the medicine histories of 4,164 women in the NHS who had been diagnosed with early-stage breast cancer.Compared to women who didn't take aspirin regularly after breast cancer diagnosis and initial treatment, women who took an average of two to five aspirin per week were:71% less likely to die from breast cancer60% less likely to develop metastatic breast cancer47% less likely to die from any causeAnd women who took an average of six or seven aspirin per week were:64% less likely to die from breast cancer43% less likely to develop metastatic breast cancer46% less likely to die from any causecompared to women who didn't take aspirin.Women who took an average of one aspirin per week (or less) had the same risk of developing metastatic breast cancer or dying from breast cancer as women who didn't take aspirin.Regularly taking aspirin BEFORE being diagnosed with breast cancer didn't affect prognosis; only taking aspirin AFTER diagnosis and initial treatment improved prognosis.Women who regularly took NSAIDs other than aspirin had somewhat better survival than women who didn't take NSAIDs, but the survival benefits weren't as strong or certain as those seen with regular aspirin use.The researchers also looked at whether acetaminophen (brand name: Tylenol), which isn't an NSAID, affected breast cancer prognosis -- it didn't.Aspirin and other NSAIDs reduce inflammation by blocking the activity of the cylcooxygenase-2 (COX-2) protein. The COX-2 protein also has been linked to the metastatic spread of cancer. The researchers think aspirin's COX-2 blocking effect might explain the improved prognosis.The researchers believe that most of the women in the NHS who took aspirin were taking low-dose aspirin (81 mg per day) to lower their risk for heart attack and stroke. Many doctors recommend low-dose aspirin for this purpose. Their doctors did NOT recommend aspirin use to treat breast cancer.It's important to know that both aspirin and chemotherapy can increase your bleeding risk. The women in the NHS who took aspirin after diagnosis usually waited until any chemotherapy was completed to start taking aspirin.The results of this large study suggest that regular, low-dose aspirin may have a role in treating breast cancer. Still, more research is needed to better understand how to safely use aspirin in a breast cancer treatment plan and the benefits it may offer. Regular aspirin use can cause serious, possibly life-threatening intestinal bleeding. Aspirin should be taken only at the recommendation of and under the supervision of your doctor. This is especially true for women getting other breast cancer treatments, such as chemotherapy.0 -
The study was published in JCO in February 2010 by Michelle Holmes and team and was an observational study.
Here is one sentence from the conclusions:
"We found that aspirin use after a breast cancer diagnosis was associatedwith a decreased risk of distant recurrence, breast cancer death, and death from any cause."
They did not mention dosage other than you need to take more frequently than 3x per week. I discussed this with my oncologist (who is also an internist) and his recommendation was one regular aspirin daily to be sure. There was a significant benefit for both ER+ and ER-, as well as for each stage.
Taking aspirin is not an issue for someone who does a lot of outdoor activities and is normally hurting anyway. So I take one or two at bedtime.
On the topic of radiation, I have to assume my lungs will heal. Yes, I could feel some soreness there, but it is going away. In fact, I was fine doing the Seattle-to-Portland (cycling 200 miles over 2 days) just 6 weeks post final rad. My breast is still healing, and that is to be expected too. But I feel strong and fit now, so am thrilled.
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No worries here regarding altering my therapy due to any one point of view. Knowledge is power and I appreciate your shares. Naturally, we're all coming from different directions, based upon medical advice, what we read and what we think.
Shoot, I even got stuck between two oncologists who were 180 degrees apart on my chemotherapy! I had significant complications after most treatments; one onco agreed with my instinct that the chemo would kill me before the cancer. My surgeon refused to remove the port, sending me for a second opinion on the chemo who, coincidentally, agreed with her that I should push on. What a nightmare!
Anyway, I welcome all information and dump it into my mix of knowledge. Research will go on forever; we do the best we can on any given day with what we have.
I have a note to ask my oncologist next month about the aspirin therapy I'd also recently read about.
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Just read pj's post.
I did not take aspirin until finished with my last cycle of chemotherapy, and I know from past history that I tolerate it well. In fact, I was taking a lot more a year ago when I had a miserable shoulder pull from a x-country skiing mishap.
I did review my post active treatment plans with everyone on my medical team to make sure they were on board. They were fine.
I would suggest reading the study as well as the BCO synopsis.
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I take a low dose asprin daily, for the proven heart health benefit (with my doctor's approval); so if it helps lower the BC risk, that is an added bonus! (I did not take it during chemo for the above mentioned reasons.)
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thank you ladies for the asprin info! I am glad I have been taking it.
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Thanks PJ12345 for your post on radiation therapy.
Yes, JO5 and Ruthbru we all have to make our own decisions. The ladies here are wonderful in bringing forward results of studies that we can read and do further research that will allow us to make the right decisions for ourselves. And yes JO5, we cannot be swayed by what we read here but only use it as a starting point for further investigation.
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Well! Well! How come that poll which states 50% of women don't continue on their Arimidex or ALs did not bother to poll US? They seemed so interested in those who quit that they forgot about the other 50% (US!) who don't! Negative polls like that can scare patients who may really need to try the meds so I think they should have at least a comment about the other women who do really well with the Arimidex etc. I read the studies then I make my own personal decisions about what to do with the advice of my Onc.
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Medigal, it wasn't a poll, it was a study. They looked at the pharmacy records of all the women prescribed and AI or tamoxifen at a certain HMO (Northern California Kaiser) to determine if they were actually filling the prescriptions as indicated. You can find the study on pubmed -- the full version is free so go ahead and read it before making comments all over this board about it. It actually is a very well done and large study. And cost was not an issue since they women all had a low copay through their HMO.
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Mollyann, I am not sure why you are so adamant that AIs do not show an overall survival benefit. They have been shown to have a slight edge over tamoxifen on overall survival and tamoxifen has been shown to have a significant edge over no hormonal treatment for ER+ cancers. A quick google leads to numerous studies showing this. There are no studies comparing AIs directly with no treatment because it would be unethical to withhold a proven treatment (in this case tamoxifen) from trial subjects. But you are sorely misinformed if you believe there is no overall survival benefit to AIs and tamoxifen. The question of whether AIs used alone or in sequence with tamoxifen offers a greater overall survival benefit than tamoxifen alone is still being explored.
I tried to copy and paste links to several studies here, but for some reason it won't copy and paste for me today, and I'm not going to type out the long addresses, but really it was very easy to find -- google tamoxifen survival.
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revkat, you are mistaken. Your "quick google" only compares Tamoxifen with Arimidex for recurrence-- not overall survival. Go back and reread.
There are no studies that show Arimidex improves OS Overall Survival. This has been discussed many times. Dr. Eric Winer spoke at the San Antonio Breast Cancer Symposium and discussed this. A patient of his on this group posted the video of him saying this. He said the two studies to evaluate Arimidex for survival are ongoing but not conclusive. Maybe you can find it.
At least Tamoxifen has been studied for overall survival because it has been around so long.
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Hi Mollyann,
I located the transcript, and my read is that Dr Winer talks about the TIMING of using AIs making little difference, but certainly does not dispute the benefit of hormonal therapy.
In the questions, he says that it does not make any difference WHICH of the aromatase inhibitors a woman chooses in terms of effectiveness.
Here is the link to the entire transcript. - Claire
http://www.lbbc.org/data/transcript-file/LBBCsanantonioupdate10.pdf
Relevant text is below.
Two of the trials that were presented or updated looked at the question of whether, for a woman with estrogen receptor-positive breast cancer, we are better off giving an aromatase inhibitor as the initial therapy-this is to prevent a recurrence-or we're better off giving tamoxifen followed by an aromatase inhibitor.
In one of these studies, which is called the TEAM trial [http://www.abstracts2view.com/ sabcs09/view.php?nu=SABCS09L_1839], half of the women received exemestane, or Aromasin, and half of the women received tamoxifen initially and then were switched to Aromasin after two to three years. The other study, which is called the BIG 1-98 study [http://www.abstracts2view.com/sabcs09/ view.php?nu=SABCS09L_639&terms=], used the same approach with the drug letrozole.
The studies essentially produced the same result. They concluded that it doesn't really matter when you use the aromatase inhibitor. The use of an aromatase inhibitor is better at some point in time than the use of tamoxifen alone in a postmenopausal woman. It's a different story in premenopausal women. But in postmenopausal women, the use of an aromatase inhibitor at some point in time helps a little bit-but it doesn't matter whether you give it up front or after a couple of years of tamoxifen.
To my mind, what matters most when you're picking the right therapy for a patient-whetherthat's an aromatase inhibitor or tamoxifen followed by an aromatase inhibitor-what matters most is to pick the therapy that she is likely to have the fewest side effects from and, therefore, is mostlikely to [continue taking]. So, to my mind, [these study results are] really good news, because [they] up a number of different options for women.
[This means] that there isn't one absolute way that we have to care for people, but [rather that] there are a number of different approaches that we can take.
Of course, the goal is to try to minimize side effects so that people will [continue to] take the medications they're on.
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Are you arguing that there is no overall survival benefit to taking hormonal therapy (either AI or tamoxifen) versus no therapy? If so you are wrong.
Are you arguing that there is no overall survival benefit to taking an AI over tamoxifen? Then, yes, although studies are still ongoing and many have shown a slight benefit to the AIs.
Are you arguing that since they haven't done studies that directly compare overall survival between AIs and no therapy that there is no overall survival benefit? Then you don't understand the ethics of medical research.
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No Revkat, I am in violent agreement about the benefits of AIs. This should be evident from my prior posts.
I was just trying to accurately portray Dr Winer's comments which I fear have been taken out of context. But from your comment, I suspect I could have been clearer.
The text is worth a read, as did learn some things about BC treatment that I didn't understand as well up to this point.
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opps, Clair, I was responding to Mollyann. Sorry.
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Well said, Ruth. Thank you.
I've been taking Arimidex for almost 1 year now. The side effects are manageable. I'm grateful that we have these options available that were not around 27 years ago when my mother died of bc.
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Claire_in _Seattle,
Thank you for your trouble in finding this transcript. But unfortunately, that's not the subject material he was discussing. I don't recall who was interviewing him but she was very professional, perhaps another physician.
It seems like it should be pretty easy to follow those taking Arimidex and those not, but the researchers are very fussy in wanting a placebo group. Anyway, we should know eventually. Until then, they are guessing and hoping.
Thanks again for your concientious effort.
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This has long been one of my favorite BCO threads. I always knew I could come here to seek support and sympathy for my Arimidex pains, and discuss the latest research findings on AI's, and even compare notes about prices of generic "anastrozole".
But that's not so true anymore. I am wondering two things about the turn this thread has taken.
1) My first question: Why do women who have decided unequivocally that they will NOT take Arimidex or other estrogen suppressors (for whatever reason) find it necessary to wander over here and argue with us that they are right, and we are wrong for taking them? (I would ask why those same women are so adamant that the therapies we have decided to use are not supported by adequate scientific evidence, while the ones most of them have chosen are pretty much absent completely from the medical research literature... but that would be another argument for another forum.)
2) My second question: Why did it take me so darn long to figure out how to use the "ignore" feature?
otter
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