Does Arimidex prevent mets at all?
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fixed it
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Thank you
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Hmmm. Well that was kind of depressing reading. It is so frustrating to figure these things out. I know it is all a gambit, to a certain degree. You read all the information and you hope to make the best decision for yourself based on the informatin that you have in hand.
I guess I do not understand how to reconcile the above articles with the numbers that are thrown around that if you have stage 0 or 1, your chance of survival are 98%. That seems kind of at odds with the numbers from the articles cited above. Or am I reading them wrong?
You can drive yourself crazy trying to piece the puzzle together, and someone keeps adding new pieces, and rearranging and even changing the puzzle on you
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Your chance of surviving 10 years with no evidence of disease is 98%. You have to read carefully because it might not be a bad as you think. For instance the statement below:
The recurrence rate among patients who did not receive adjuvant hormonal therapy was nearly 50% in node-positive patients and 32.4% in node-negative patients throughout the first 10 years after diagnosis.
But if you did do adjuvant hormonal therapy the numbers a quite different. I'm not sure if they are just talking mets or just recurrence, local & mets. A recurrence (not new breast cancer) in the breast after a lumpectomy may be part of these statistics.
Also according to the graphs we don't know 1/3 means they all get mets. Also they are saying of those 1/3 half of the recurrence happens 5 years after surgery (1/6).
As far as the Rueter article the study dates: 1985 and 2001. That's well before Herceptin was being used on early stage breast cancer! The other article seem to be looking at statistics before 2005. Again before Herceptin was standard care for early breast cancer.
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The regimens used for treatment of breast cancer have changed so much in the last few years, with the expanded use of herceptin and AI's, my regimen, TCH (Taxotere, carboplatin, herceptin), was only approved for use as adjuvant therapy in 6/2008, I don't believe there is a good source to find out what our true risk of recurrence is. My onc told me with all of my treatments he believes that I only have a 10% chance of recurrence in the next 5 years, that is if I can make it through 5 years on the AI's. I think that's pretty good, considering in Susan Loves latest Breast Book she has an old chart from 1985, I think, that shows that at that time I would have had a 46% chance of recurrence in 5 years, even with the chemo of the day. I guess only time will tell, we're the survivors (or maybe guinea pigs) of the future!
Last Herceptin in 2 weeks!!!!!!
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Lago, I really appreciate the help. And everyone else as well. This is all so very confusing. You can really talk yourself into a tangle without any effort whatsoever.
Linda, yeah on last Herceptin!! That is fantastic
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My frustration is that I can't find any stats on hormone blockers vs. no hormone blockers (lots of stuff on Tamox vs. AIs). I know it is not ethical to put women on empty placebos unwillingly so they can't do this kind of trial. But isn't someone tracking women with BC who declined hormone blockers for medical or other reasons?? My BS told me my cancer was very slow growing, could have been there 5-10 years before I felt the lump (which yearly mammos did not detect!). So how can they say it is the hormone blockers that prevent recurrence if a cancer can be growing undetected for 5-10 years? There must be a considerable group of women who decline hormone therapy. I would like to see the comparison of their stats with the Tamox and AI lady stats.
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"...continued use of tamoxifen after five years was associated with an increase
in serious adverse events, but no further efficacy benefits" - this quote from the second study sent by lago shows why oncs usually stop giving patients Tamoxifen after 5 years. There do seem to be a fair number of women continuing with Arimidex after 5 years. Is that because they have determined that the benefits outweigh the risks after 5 years for Arimidex?Also, if our adrenal glands are producing estrogen and raised emotions cause increased activity of the adrenal glands, should we be popping extra Tamoxifen or Arimidex instead of Ativan or Valium when we are upset? I did experience chronic stress during the year before my bc diagnosis and my tumour was 100% estrogen positive, but that may be a coincidence.
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LittleMelon I was experience lots of job stress since 2005. My BS said my fast growing tumor was around for 4 years. Yes I have always associated that stress with my tumor. Just too coincidental not to be related. It's not that I think stress causes breast cancer. I just think it hinders the ability of our system to fight off those cells. Just a theory. No real science behind it.
designermom one of the article I posted states:
"The recurrence rate among patients who did not receive adjuvant hormonal therapy was nearly 50% in node-positive patients and 32.4% in node-negative patients throughout the first 10 years after diagnosis."
While this doesn't directly compare with those that are taking hormone therapy we know that hormone therapy reduces our *own person risk by 50% for the first 10 years. Note that the article was talking about early stage breast cancer only.
* going back to what was said earlier. If your risk was 4% without hormone therapy then hormone therapy would reduce your risk by 2%
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Designer Monm
The studies you are looking for are the old ones, that were done back in the 1980s on Tamoxifen, which was THE wonder drug of its day.
Most of these studies are not available online - they are too old. You might try looking at the references in some of the articles about AI vs tamox to see if you can identify some papers that appear to address the issue, or maybe in a book like Susan Love's Breast Book and ask your public librarian if she can get you a copy - don't be surprised that there are all kinds of references out there that aren't on the web! Or maybe the resource center at your oncologist's/cancer center has this information available.But the reality is, doctors knew that, even in early stage patients, there were always patients who did not seem likely to get a recurrence, who got them anyway. It was, and remains, a small percentage - but a lot of people, because many women do get breast cancer.
These medications were intended to prevent these recurrences.Susie the Librarian
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Designermom,
Check out this study which is a meta-analysis of all relevant, randomized studies comparing women who got different types of treatment. This study looks at results 15 years out. There is a section on Tamoxifen vs. No Tamoxifen, so you can see specifically how it helped. There's a good chart on page 1704, and more specific info on page 1702.
This is a study my onc at Memorial Sloan Kettering printed out for me when I pressed her for more specifics and stats (and I was able to find a link to it through Google). Since it is an overview of all relevant trials and was done by the Early Breast Cancer Trialists' Group, it is considered very reliable.
Here's what they write in the abstract...
"For middle-aged women with ER-positive disease (the commonest type of breast cancer), the breast cancer mortality rate throughout the next 15 years would be approximately halved by 6 months of anthracycline-based chemotherapy (with a combination such as FAC or FEC) followed by 5 years of adjuvant tamoxifen. For, if mortality reductions of 38% (age 50 years) and 20% (age 50–69 years) from such chemotherapy were followed by a further reduction of 31% from tamoxifen in the risks that remain, the final mortality reductions would be 57% and 45%, respectively (and, the trial results could well have been somewhat stronger if there had been full compliance with the allocated treatments)."
http://www.ctc.usyd.edu.au/cochrane/publications/EBCTCGpaper.pdf
Also, just wanted to chime in on the question of "recurrence." Seems that different studies define it differently, some include distant/local/regional OR a new primary in contralateral breast (in other words, any return of any breast cancer anywhere in the body). Others are a little more specific and might not include, for example, a new primary in the other breast.
Regardless, the general stats are that about 1/3 of recurrences are local/regional, and 2/3 are distant metastases. So when you look at a number for recurrence, you can guesstimate that about 2/3 or those are distant, and 1/3 still in the chest or armpit area. This corresponds pretty well to mortality stats, since local/regional recurrences are not typically life-threatening, the way distant metastasis can eventually be.
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Also...
* Regarding progesterone receptors -- there hasn't been as much research on them, but docs do believe that the presence of PRs means that the estrogen receptors are functional, and therefore, hormonal therapy is more likely to be effective. So in general, I think that ER+PR+ has slightly better prognosis (i.e. lower recurrence rates) compared to ER+PR-. But hormonal therapy is all the more important for ER+PR+.
* Another interesting thing I've come across is that for hormone receptor positive cancers, the recurrence rates are about the same between years 0-4, and 5-15. So, let's say that 20 percent recur eventually. 10 percent will recur within the first 4 years after diagnosis, and the remaining 10 percent will be spread over years 5 to 15.
To the question of: are these hormonal treatments simply postponing recurrence? I asked my onc and she said that studies show they are NOT just holding them off, but preventing them (some of them, at least) altogether. The benefits of tamoxifen persist even long after you stop taking the drug.
All the numbers are confusing and hard to process. It's taken me months of dedicated study to get somewhat of a handle on things. I think our oncs try to make it easy for us by just simplifying and saying -- do this and you'll lower your risk of recurrence (which is X percent) by Y percent, so your ultimate risk of recurrence is Z percent.
But of course, many of us want a deeper understanding...
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We really need oncs we can trust.to help us with our decisions.I have great physicians but as we all know too well there is no way to see what is ahead for us. I have 2 more years on Tamoxifen and I am sure my med onc will do his best to keep me healthy.Good luck to us all. 0 -
lago, I Can Do, Beeb and anyone else that chimed in- Thanks for all the studies and links. I continue to research on hormone blockers and so much else BC related. I really appreciate your feedback. Off topic: Just today I picked up another RX for vitamin D as my levels are still low and my Onc agrees I should get them up. The pharmacist said it was vitamin D2 and I questioned why D2 was given to get D3 levels up. I think it converts to D2 but will research more. Dang, we should get paid for all this research, we would be millionaires!
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Designermom My D was extremely low a year prior to diagnosis. I was on prescription for a few months then supplement of D3. got it up to 40… barely acceptable. When I was then found to be slightly osteopenic they put me on calcium. The calcium I take also has some D with it. Now my D is just above 70 (little above normal). They are OK with that. So yes it can be reversed.
As far as the stats and doing our own research… like Beeb says you have to read in-between the lines and ask what those numbers are including. This is why it's best to bring in these studies to your doctors. They have read the research (hopefully) and can clarify what the study might or might not mean if it means anything at all.
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Designer Mom and anyone else who can help,
I'm wondering about the D3 and what to do. I got my tested (finally) and it's only 27. My onc didn't seem too concerned about the number after I said I was already taking a 1000mg pill each day. If I'm only at 27 and I know that was below normal, shouldn't I be taking more to help raise it?
I'm feeling kind of lost these days because I'm just on the Arimidex and don't really know what else I should be doing. Saw my Med Onc recently for a followup after I finished rads and she really didn't have much to say except she'd she me in another 3 months for a mammo.
Beeb75, I'm one who likes to know as much as I can about the studies but I'm getting scared I'm not reading statistics correctly, and I've probably way under estimated my real risks. I'm putting tons of faith into Arimidex because I never ended up doing any chemo, just rads.
It would be really good to know what other things can help prevent reoccurances at this point.
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lago, 40 is barely acceptable??? I must be so low at only 27. Maybe I need to find another onc.
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lago- Thanks for the vitamin D encouragement. Boy it takes a long time to get it up to an acceptable level!
lee7- Hi lee! I think many Oncs are slow to understand about vitamin D deficiency. I actually had to ask my Onc to test mine. Her response was that she would and 85% of her patients were deficient. Then why wouldn't that be a standard bloodtest!!! My D3 level was very low, only 16. It takes a lot of effort and time to inch D levels upward. I just retested and it is only 23 after 6 months of supplements, including Rx strength. There is lots of good information if you google "vitamin d council" They are a non profit that has lots of research and recommendations.
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Iago writes."The recurrence rate among patients who did not receive adjuvant hormonal therapy was nearly 50% in node-positive patients and 32.4% in node-negative patients throughout the first 10 years after diagnosis."
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Iago, those are very misleading relative risk statistics. You should be using the absolute risk statistics. You need to understand the difference. Some people on this thread clearly have done their homework. I thank them for pointing out the crucial difference.
Also, you might want to look into the overall survival statistics, not recurrence stats since some hormonals are known to cause more heart attacks and thus wash out any advantage. The overall survival stats are between 3% and 10% depending on lymph node status.
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Matty I suggest you read the article mentioned above, the full text pdf is freely available. I used the information in this article when making my decision whether or not to do chemo. The discussion of proportional vs absolute benefit statistics can be found on page.1690. Absolute benefit figures were if course greater for medium risk women compared to low risk women, I was age 65 at dx so close to the lowest, even so, there was enough of an absolute benefit to make chemo worthwhile so I did it.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2966544-0/abstract
Re overall benefit with adjuvant therapy, here's the quote from the summary:
"Overall survival would be comparably improved, since these treatments have relatively small effects on mortality from the aggregate of all other causes"
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I wasn't referring to combined therapies. That confounds assessing outcome.
I thought this thread was about Arimidex. My figures refer to hormonals as an adjuvant only. Best of luck to you.
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lee7 my vitamin D levels are being managed by my primary care doctor not my onc. My onc did have me tested again before I went on Anastrozole just to be sure they were not low. When they were a little high she had me contact my PC doctor. Maybe you should discuss this with your PC doctor. I think it's important that your D levels are normal when taking an Al. I do hear they can reduce joint pain, also there is a high the risk of osteoporosis on this drug.
Matty I think you need to read the entire article. I don't think you understand that quote at all.
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Iago,
You can't comprenhend any article without understanding the difference between relative risk and absolute risk. Someone in the above thread gave a nice tutorial on it. Check it out.
You have to know what is being measured. That is the first question to determine from a study or any statistics.
Once you understand the difference between relative and absolute risk, a light bulb will go off. Hang in there!
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Matty stop attacking me, trying to engage me in an argument and saying I don't know this or that. There is no indication in anything I have posted that indicates I don't know the difference.
This personal attack on me every time I post is getting old. If you really were really concerned about my post misleading people then I would think you would explain what it means instead of attacking/insulting me. The fact that you did not makes it look like you really don't understand my post but just making up a reason to post negative crap about me, again.
BTW there is nothing wrong with discussing relative and absolute statistics as long as you understand them. The quote is not talking about individual risk.
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Iago,
This thread is not about you. It is about getting your facts straight. Please don't make the issue of understanding relative risk vs absolute about you. It's too important. Others have tried to point out the difference and how crucial knowing what the absolute risk is to decision-making. I applaud them. Maybe they can explain it again.
I hope you will follow their lead or read the articles by the BCO information reviewers on relative risk. Good luck to you! I wish you only the best in your journey.
I'm out of here now and leave the discussion for others to carry on. Busy day with Mother's Day tomorrow!
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Matty again you attack me. You're the one who is singling me out. If you want this to be about what I quoted then be specific and explain the quote not say I don't understand… still waiting for you to do that.
I don't see anything that indicates I don't understand the difference between relative risk and absolute risk… yes I know the difference. You can stop being condescending now.
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my onc told me I had a 20% chance of recurrence and it dropped down to 10% if I take Arimidex for the next 5 years. I am having SE and am trying to decide what I want to do, So far I havent had much good luck with percentages, so maybe I had better keep taking the Arimidex.
Nancy
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I get my Oncotype DX score Monday. My Onc did her own calculation when I saw her last, but my calculation on CancerMath is very different. She used Adjuvant and I thought they were similar. I had all the needed information and came up with 6.2% with Aromatase and/or Tamoxifen. My Onc also gave me the incorrect staging figure. I called her on it and she agreed with me. I just looked at the NCCI guidelines. Mine was stage 1, hers stage 2. This is all very confusing.
Now I want to know how long Chemo protects you. Has anyone researched that? I know recurrence can happen under any circumstance, but all these calculations are massively confusing, considering the data used has to go back at least 15 yrs when treatment was so different. I think I trust tamoxifen the most. I"m post menopausal and have been since 1997. If your fighting cancer, you may be harming your heart and bones with Arimidex.
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MattyGroves, yes, I am just referring to Arimidex, not other therapies nor combined therapies. There is much documentation on chemo and other things since they have been around a lot longer. And I've already had chemo, so it's a done deal.
As far as mortality rates and dying of other things such as heart attack, etc - I only know I would rather die of those things than of cancer. So if they get me before cancer, that's fine by me! Although hopefully we will all be around for awhile!
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Lago, I just want to say I totally agree with you about the stress factor. Personally, I believe it was a combination of birth control pills (for over 20 yrs) and stress that either caused my BC or lowered my immune system to the point I could not fight it.
Also, with regards to Arimidex 50% reduction in early stage BC, I am not sure what defines early stage? I am IIA, but had 2/16 nodes positive with perinodal invasion. Is that still early stage?
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