Stage 1, grade 1 and pre-menopausal
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VR - great finds on the her results from the oncotype results.
I am with you ladies - MO and BS seem bored.
So far I just have a prescription for tamoxifen but my next MO appt is in 2 weeks so I have a bunch of questions for him!0 -
Good luck Hawk! Don't forget that transvaginal ultrasound if you haven't had it already!
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Joy and Voraciousreader,
I just got an e-mail back from my MO that my FISH result is negative for HER2/neu. When I got my pathology report two weeks ago, my FISH result was pending.
Based on the treatment guidelines on the nccn report, I just have to REALLY wait for the result of the Oncotype. Thanks, Voraciousreader for your leads on what to read. I feel more confident on the path that my MO and I are taking.
It so good to know that I am not walking on this alone - as no one should be.
I'll keep you posted.0 -
MarGie... Double great news. You are HER2 negative and feel more confident! Once you have a protocol in place... You should be feeling even better!
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MarGie so happy about your HER2 negavtive results.
So far my MO has been pretty engaged. Although I am getting ready for a BMX which he thought was a very good idea. Should have had it to begin with but BS is another story. I am getting Zometa every 6 months for three years so after that maybe he will be bored with me.
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Sherry.... Good luck with your surgery! Hope it goes smoothly!
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MarGie Good news on the FISH result. And you're right - the oncotype dx will help to determine treatment. Hope that you're feeling okay about everything so far.
Sherryc Hope that your surgery goes well. I had a BMX in November, and recovery for me went faster than I thought it would. Where is Gonzales? I used to live in the northern Houston area.
VR Do the Lupron injections limit you physically, in any way?
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Joy...I'm not sure what you mean by the Lupron limiting me physicially. If you are referring to did my body go ape shit about the immediate shutdown of the estrogen flowing through my body....then the answer is, "No." But that's been my experience. Some women have reported having had a rough go of it. The first few months, I had mild hot flushes...Didn't interfere with my quality of life. Considering my beloved mother is close to 87 and swears she is still suffering from menopausal symptoms, I'd say, life is pretty good by me. My biggest issues so far from this journey have been uterine polyps...which began before my diagnosis and have been exasperated by the Tamoxifen. Interestingly, the doctors believe the Lupron actually helped them....And the second issue that I had, which was MAJOR was a frozen shoulder and a rotator cuff tear following my lumpectomy surgery. I had had problems several years ago with my other shoulder, so this came as no surprise.
I will say, though, two years out, aside from recurring polyps, I feel great. Most days, I walk 3 miles. If I don't walk, I get stiff. That might be due to menopause. However, I feel as healthy, or even more healthy now than I did before I began this journey. My only complaint is that I feel as though I have too many doctor appointments for a "healthy" person. Now that I don't have to run by the oncologist's office for my monthly Lupron shot, hopefully, that feeling of always running to the doctor will diminish, I hope, a drop.
When you meet with your oncologist...may I also suggest that if you do decide to do the ovarian suppression, to discuss doing Zometa infusions for several years, as well. You might want to refer to Dr. Gnant's Austrian study. Good luck!
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VR I realized after posting that my question about being affected physically, was vague. Did the injections make you move differently? Did you avoid exercise after getting an injection? I'm pretty active - just wondering whether this would have an impact. Goserelin is apparently some type of a "string" device inserted in the belly, from what the onc tells me. Interesting recommendation on the Zometa, I'm reading up on it.
Is Lupron usually given for just two years? And is estrogen level monitored while on it?
Sorry to hear of the frozen shoulder and rotator cuff issues. I've had minor rotator cuff tears in both shoulders and they are so slow to heal. Hope that your shoulders are better now?
edited for spelling error~
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I know that some doctors prefer ovarian suppression using 3 month devices whether it be G or L. However, my doctor prefers the monthly injections. I never had a problem. Just dropped my draws and went about my day afterwards. Never waited more than a minute or two for the injection....I'm very active, as well. Again, this was my experience. I'm sure there have been women who have had less than optimal experiences.
My doctor's stragedy was to do the L for TWO years based on the fact that my mother and sister went through menopause around age 55. Last month was my two year mark and my 55th birthday, so we stopped the L and began checking my estrogen levels. We will be monitoring my estrogen levels and if they rise, then I will once again resume the L injections. I don't think it's necessary to monitor the estrogen levels while taking it, as long as you don't get symptoms of menses. Usually, your periods stop following the second monthly injection. That's also one of the reasons why if you do injections rather than an ooph they prefer you take Tamoxifen because an AI would not be beneficial if you are still menstruating.
There's some debate about how long you can take the injections. Some doctors will recommend not to be on them longer than 2 years, while other doctors might agree to have you on it longer. Some younger women who choose the injections eventually have an ooph because they are young and at the completion of several years of O/S they might still be young enough to ovulate. So you need to look at your family history and guesstimate when you MIGHT be entering menopause and figure it out from there with your doctor.
The Zometa studies, IMHO are very compeling.
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Remember though, one thing....the results of the SOFT trial are still pending and we don't know whether O/S offers an advantage. Likewise, depleting the body of estrogen can create issues down the road. So make sure you look at your family history of heart and bones as well and make a decision with your doctor from there....
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Thanks, VR. I understand that there was European trial (German?) that studied O/S. Is the SOFT trial similar to this one?
You have so much knowledge and I appreciate your willingness to share. I have a lot to think about re. suppression vs. ooph, and Zometa.
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The SOFT trial concerns O/S and is a global study. Gnant's Austrian study is also global and concerns the use of Zometa in the premenopausal population.
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Hi Everyone,
New to all this and overwhelmed with so many DX's and treatments. I was just wondering if anyone already had a hysterectomy with their ovaries still there at least 10 years ago and now have been DX of : stage1, grade1, IDC and if this will be taken into consideration for chemo or no chemo? sooooo confused.
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Could you please rephrase your question? Do you still have your ovaries? And are you referring to yourself because your info mentions DCIS Stage 0, Grade 2.
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Joy--Gonzales is 2 1/2 hours east of Houston off of IH10. My MO just put me on Zometa. I will get it every 6 months for three years. The has been following these studies and really felt I was a good candidate for it. I still have my ovaries and am pre menaupausal so I am on Tamoxifen.
Bern25 I had my uterus removed 17 years ago but I was young at the time so they left my ovaries in tack. I am stage 1 grade 1 IDC. Not really sure what your questions is but will be happy to answer any you may have.
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What is a Zometa infusion like? Any SE's?
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joy I had no SE's. They had me take a claritin and pepcid the day off and two days following and drink lot's of water before during and after. Worked and never had a SE. If you do have SE's they are usually mild flue like symptoms.
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So from the little that I've read, Zometa was initially used as a bone strengthening med. I'm wondering if it's the same type med as Reclast, Boniva, et al. And then additional benefits were found with use of Zometa, which is less recurrence for pre-menopausal BC patients. I'm not willing to do a bone strengthening med, unless it would benefit me greatly.
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joy...Many women have asked if those meds are the same as Zometa. Yes and no.. They're all in the family of bone strengthening drugs and are at different strengths. Gnant's study specifically uses Zometa so that's why other oncologists are using it rather than any of the other drugs. When you mention you don't want to use it unless it would benefit you greatly, I wholeheartedly agree with your logic. Here's some information from breastcancer.org's website about the latest findings:
SAN ANTONIO (MedPage Today) -- All but the youngest patients with hormone-sensitive breast cancer had significant improvement in disease-free survival (DFS) when they received zoledronic acid (Zometa) in addition to endocrine therapy, results of two large trials showed.
The two trials -- known as ZO-FAST and ABCSG-12 -- both showed about a 30% reduction in the relative risk of progression in women treated with zoledronic acid, which also improved overall survival (a secondary endpoint) in the ZO-FAST trial. A comparison of immediate versus delayed initiation of the intravenous bisphosphonate demonstrated a significant advantage for starting the drug at the same time as endocrine therapy.
Subgroup analyses showed that only patients younger than 40 did not have improved DFS when treated with zoledronic acid, as reported here at the San Antonio Breast Cancer Symposium.
"The anticancer effects of adjuvant zoledronic acid are now well established in endocrine-responsive patients," said Michael Gnant, MD, of the Medical University of Vienna in Austria, referring to positive results from ZO-FAST, ABCSG-12, and a third trial -- AZURE -- that has been previously reported.
"Bone-targeted treatments may modify the bone microenvironment and may affect cancer stem cells," he added. "Adjuvant zoledronic acid is a successful treatment approach in early breast cancer and should be considered in patients who fit these trials' inclusion criteria."
Long-term results from the ZO-FAST trial showed a 34% improvement in DFS (a secondary endpoint) in postmenopausal breast cancer patients who received zoledronic acid at the same time as the aromatase inhibitor letrozole, compared with women whose treatment with the bone-targeted drug did not start until occurrence of a prespecified clinical event.
Gnant reported findings from ABCSG-12, an Austrian study, after 84 months of follow-up. The presentation updated and affirmed results Gnant and colleagues reported earlier this year.
ABCSG-12 involved 1,800 with early-stage premenopausal breast cancer patients treated with endocrine therapy but no chemotherapy. Following surgery, all patients received goserelin and were randomized to tamoxifen or anastrozole with or without zoledronic acid, continued for three years.
The primary endpoint was DFS.
The patients had a median age of 45, and 22% of the study population was 40 or younger. Additionally, 78% of the patients had T1 disease, 67% had no nodal involvement, 80% had histologic grade 1 or 2, and fewer than 4% were estrogen-receptor (ER) negative.
In the overall analysis, the data reflected a 28% reduction in the DFS hazard for patients treated with zoledronic acid (P=0.01). Gnant said the 84-month results mirrored those of previous analyses: a 26% reduction in the hazard after 48 months of follow-up (P=0.01), 32% after 62 months (P=0.008), and 27% after 76 months (P=0.02).
Subgroup analysis showed a consistent trend in favor of treatment with the bisphosphonate, as results were similar regardless of nodal status, endocrine agent, ER expression level, grade, or stage.
The only exception was the subgroup of patients who were 40 or younger (HR 0.87, P=0.527). Older patients had a statistically significant 34% improvement in DFS (P=0.013).
Gnant said the results are consistent with those of the AZURE and ZO-FAST trials, both of which involved postmenopausal patients.
ABCSG-12 also demonstrated the effectiveness of first-line endocrine therapy for early breast cancer without the use of chemotherapy, he added, as the study population had a seven-year overall survival exceeding 95%.
Zoledronic acid given concurrently with endocrine therapy was associated with a 34% improvement in DFS compared with delayed initiation of the bisphosphonate, according to an exploratory analysis of the ZO-FAST study, said Richard de Boer, MD, of the Royal Melbourne Hospital in Australia.
ZO-FAST involved 1,065 women with early-stage, hormone receptor-positive breast cancer. All the patients were either postmenopausal or amenorrheic due to chemotherapy.
All patients received the aromatase inhibitor letrozole (Femara) and were randomized to start zoledronic acid immediately or to delay therapy until a decline in bone density T-score to less than -2, clinical fracture, or asymptomatic fracture at 36 months.
The patients had a median age of about 57, tumor stage of 0 or 1 in 58% of cases, and involvement of one to three lymph nodes in about 58% of patients. The primary endpoint was change in lumbar spine BMD at 12 months. Secondary outcomes included BMD at 36 and 60 months, disease recurrence, fractures, and safety.
Patients assigned to immediate zoledronic acid had an increase in BMD compared with a decline in the delayed-therapy group, resulting in a difference of 5.9% after 12 months. The pattern persisted during follow-up to 60 months, when the between-group difference reached 10.0%.
The unplanned analysis of DFS showed a advantage for immediate therapy only in the overall population. De Boer said the study's 888 "truly menopausal patients" had a 29% improvement in DFS, and the "recently menopausal" subgroup of 177 patients had a 66% improvement, but neither difference achieved statistical significance.
An analysis of 670 women who were older than 60 or were more than five years postmenopausal showed a 37% improvement in DFS, which also did not reach statistical significance (P=0.052).
An exploratory analysis of overall survival showed a nonsignificant 31% reduction in the hazard in women who received immediate zoledronic acid. The overall result included a 35% improvement (P=0.1035) in truly menopausal patients and a 41% increase in the hazard among the recently postmenopausal subgroup (P=0.7046).
Acknowledging the exploratory nature of the analysis, de Boer said the DFS benefit observed in ZO-FAST is consistent with the improvement observed in AZURE and ABCSG-12.
"The data support the hypothesis that the anticancer potential of zoledronic acid might be best realized in a low-estrogen environment," said de Boer.
ABCSG-12 was supported by Novartis and AstraZeneca.
ZO-FAST was supported by Novartis.
Gnant disclosed relationships with AstraZeneca, Novartis, Pfizer, sanofi-aventis, Roche, Schering, and Amgen. Other investigators disclosed relationships with AstraZeneca, Novartis, Roche, sanofi-aventis, Amgen, Cephalon, and GlaxoSmithKline.
DeBoer disclosed a relationship with Novartis. Other investigators disclosed relationships with Novartis and Amgen. Investigators included employees of Novartis.
Primary source: San Antonio Breast Cancer Symposium Source reference: Gnant M, et al "Long-term follow-up in the ABCSG-12: significantly improved overall survival with adjuvant zoledronic acid in premenopausal patients with endocrine receptor-positive early breast cancer" SABCS 2011; Abstract S1-2.
AND THIS IS WHAT BCO HAS TO SAY ABOUT THE STUDY:
SABCS: Bone Drug Gives DFS Boost in Breast Cancer
Zometa (chemical name: zoledronic acid) is used to strengthen bones and lower the risk of breaking a bone and other bone complications in women diagnosed with metastatic breast cancer that has spread to the bones.
Earlier research suggested that Zometa also might help stop breast cancer from spreading to the bones by making it harder for breast cancer cells to grow in bones and might help reduce the risk of the cancer coming back (recurrence) in women diagnosed with early-stage breast cancer.
Results from three studies all suggest that Zometa can help reduce the risk of cancer recurrence when it's included from the start in treating hormone-receptor-positive early-stage breast cancer in postmenopausal and older premenopausal women.
Results from the three studies were presented at the 2011 San Antonio Breast Cancer Symposium.
The Austrian Breast Cancer Study Group (ABCSG) XII trial
More than 1,800 premenopausal women diagnosed with stage I or II hormone-receptor-positive breast cancer participated in this study. After surgery, all the women were treated with Zoladex (chemical name: goserelin) to stop the ovaries from making estrogen (medical ovarian shutdown) and with hormonal therapy. Half the women were randomly assigned to also get Zometa; the other half didn't.
After 7 years of follow-up, breast cancer recurrence was less likely in women who got Zometa compared to women who didn't. Overall, the time the women lived without the cancer coming back (disease-free survival) was 28% better in women who got Zometa. Still, in a finer analysis, the researchers found that only women older than 40 benefited from adding Zometa to the treatment plan. In women older than 40, disease-free survival was 34% better in women who got Zometa. In women younger than 40, disease-free survival wasn't better in women who got Zometa.
The Zometa-Femara Adjuvant Synergy (Zo-FAST) Trial
More than 1,060 women diagnosed with early-stage hormone-receptor-positive breast cancer were in this study. All the women were postmenopausal or weren't having menstrual periods because ovarian function declined due to chemotherapy treatment before surgery. After surgery, all the women got the hormonal therapy Femara (chemical name: letrozole). Half the women also started on Zometa right after surgery (immediate Zometa group). The other half started Zometa if/when they had a decline in bone health (delayed Zometa group). Although the focus of the study was on bone health and using Zometa, the researchers also looked at recurrence risk.
After 5 years of follow-up, recurrence was less likely in women who started Zometa right after surgery compared to women who started Zometa only if they had a decline in bone health. Overall, disease-free survival was 30% better in women in the immediate Zometa group compared to women in the delayed Zometa group.
The Adjuvant Zoledronic Acid to Reduce Recurrence (AZURE) trial
More than 3,355 women diagnosed with stage II or III breast cancer were in this study. The women were both pre- and postmenopausal. After surgery, all the women were treated with hormonal therapy and/or chemotherapy to reduce the risk of recurrence. Half the women were randomly assigned to also get Zometa; the other half didn't get Zometa. Half the women were followed for more than 5 years; the other half were followed for shorter periods of time.
Overall, women who got Zometa were just as likely to have a recurrence as women who didn't get Zometa. Still, when the researchers compared the outcomes of women who were more than 5 years into menopause to the outcomes of premenopausal women and women fewer than 5 years into menopause, they found Zometa did reduce recurrence risk in the women who were menopausal longer. Disease-free survival was 25% better in women 5 or more years into menopause compared to the other women.
Right now, Zometa isn't routinely prescribed to reduce recurrence risk in women diagnosed with early-stage, hormone-receptor-positive breast cancer and it isn't approved for this use. Still, the results of these studies suggest that using Zometa after surgery could help reduce recurrence risk in some postmenopausal women. So it's possible doctors will start using Zometa in this way.
Zometa -- and other bisphosphonates -- may make sense for postmenopausal women to strengthen bones that may be weakened by some breast cancer treatments.
Bisphosphonates used to prevent or treat osteoporosis include:
- Actonel (chemical name: risedronate)
- Boniva (chemical name: ibandronate)
- Fosamax (chemical name: alendronate)
- Reclast (chemical name: zoledronic acid -- the same active ingredient as Zometa)
Reclast is given intravenously once a year. The others are pills taken by mouth.
If you've been diagnosed with early-stage breast cancer, you may want to ask your doctor if a bisphosphonate makes sense for you. If you're a postmenopausal woman, your doctor may recommend a bisphosphonate to strengthen your bones or treat osteoporosis. The studies reviewed here suggest that taking Zometa also could lower your risk of cancer recurrence when started right after surgery. If you're prescribed a bisphosphonate, know that some of them need to be taken in a specific way and all may cause serious side effects; make sure you and your doctor talk about how to take the medicine.
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VR Thanks for this. I am understanding that Zometa will reduce recurrence in pre-menopausal women, but it looks like the reduction effect would be just in the bones. So a recurrence could still happen in the liver, brain, locally or elsewhere? I've seen the effects of long term use of bisphosphonates, and I'm not convinced that this should be used even on a short term basis unless there is a compelling reason. For those that are affected by a greater chance of recurrence, this would be of benefit.
I will ask my MO about it. I'm not sure that this will be of great benefit to me though.
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From what I have read zometa reduces distant recurrence at many sites not just in bone and it seems to have anti tumour effects beyond its effects on bone. Zometa also protects against bone loss in pre menopausal women undergoing ovarian suppression. Bisphosphonates have been used safely for decades now. Joy I am not sure what concerns you about long term effects of bisphosphonates. The main reason it is not yet used routinely in BC is because it is so expensive!
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Annicemd thanks for your comment. That is the way my MO explained it to me. I did not do chemo because the onoctype DX predicted I would only get about a 2%-3% benifit from it. From the studies I have read on the Zometa and from what my MO said the Zometa gets me much more benefit. Was not sure if my insurance would pay because it is so expensive and really has not been approved for this use. But MO office called it in and they immediatley approved it. I saw the EOB and it was about 2K for the infusion. I will get it every six months for 3 years.
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Hi Sherry, glad you got funded for zometa, it is v expensive but the data are compelling in women over 40 and it is a walk in the park compared to chemo! I am on it 6 monthly for 3 years too.
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I'm concerned about bisphosphonates because of degenerative bone issues (jawbone) and increased fractures with long term use. I am at risk of osteoporosis, small boned, fair-skinned, family history of it. This will be an added concern once my ovaries are suppressed. I'm not sure how to pull up studies or trials to research this. Long term use is considered 5+ years, from what I understand.
Right now I'm doing everything possible to minimize the risk of osteoporosis, including supplements and weight bearing exercise. The reduction of recurrence risk for me is so minimal that I wouldn't consider Zometa for this reason. For many, Zometa is a logical choice. For my situation, I'm not willing to go that route.
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Joy....Before I was diagnosed with BC, I had read Harvard trained, John Abramson, MD's book Overdosed America and was very concerned about taking bisphosphonates. Chapter 13 of his book deals with bisphosphonates:
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" In 1995, Fosamax, the brand name for alendronate, was the first of the new generation of drugs approved by the FDA for the treatment of osteoporosis. Fosamax works by attaching itself to the surface of bone, interposed between the osteoclasts and the bone the osteoclasts are trying to absorb. Randomized clinical trials of Fosamax published in medical journals show dramatic reductions in the relative risk of hip fracture for women with osteoporosis. In a study published in JAMA in 1998, for example, women with an average age of 68 and a T score of - 2.5 or less who took Fosamax for four years were 56 percent less likely to suffer a hip fracture than women in the control group.
This sounds like very good news for women with osteoporosis, but how many hip fractures were really prevented? With no drug therapy at all, women with osteoporosis had a 99.5 percent chance of making it through each year without a hip fracture -- pretty good odds. With drug therapy, their odds improved to 99.8 percent. In other words, taking the drugs decreased their risk of hip fracture from 0.5 percent per year to 0.2 percent per year. This tiny decrease in absolute risk translates into the study's reported 56 percent reduction in relative risk. The bottom line is that 81 women with osteoporosis have to take Fosamax for 4.2 years, at a cost of more than $300,000, to prevent one hip fracture. (This benefit does not include a reduction of less serious fractures, including wrist and vertebral fractures. Most vertebral fractures cause no symptoms.)
[. . . ]
What about using these drugs to prevent osteoporosis? Fosamax and Actonel were approved by the FDA to treat women with osteopenia based on studies that showed that they significantly increase the bone density of these women. It is important to remember, however, that bone density is only a surrogate end point; the real reason for taking these drugs is to reduce fractures, and hip fractures in particular. The study of Fosamax published in JAMA in 1998 (mentioned earlier) also included women with osteopenia. Did Fosamax reduce their risk of fracture? The results show that the risk of hip fractures actually went up 84 percent with Fosamax treatment.* The risk of wrist fractures increased by about 50 percent (that figure may be statistically significant -- but this can't be determined from the data as presented in the article).
How can it be that drugs approved for the prevention and treatment of osteoporosis succeed in increasing bone density but have such limited impact on reducing hip fractures? The answer can only inspire awe at Mother Nature's elegance. There are two types of bone. Eighty percent of the body's bone is made up of the hard and dense outer layer called cortical bone. In some areas of the body, bones also have an internal structure of trabecular bone, which works like an organic three-dimensional geodesic dome, providing additional strength in the areas of the skeleton most vulnerable to fracture, such as the hips, wrists, and spine.
The lacelike structure of trabecular bone creates a much greater surface area than the densely packed cortical bone and therefore allows the former to be more metabolically active when the body needs calcium. Its greater metabolic activity also makes trabecular bone more vulnerable than cortical bone to the changed balance between osteoclast and osteoblast activity. As a result, when bone mass starts to decline in women, trabecular bone is lost more quickly than is cortical bone. Once the architecture of these internal struts is lost, there is no structure left onto which calcium can be added. (See Figure 13-1.) The new bone, formed as a result of taking the osteoporosis drugs, is then formed primarily on the outer part of the bone, the cortical bone. This increases the score on the bone density test but does not necessarily contribute proportionately to fracture resistance."_________________________________________________________________________________
Like you, I am petite and worried about fractures. Before my BC diagnosis, I would not even consider getting a bone density test after I had read Dr. Abramson's book!! I had NO confidence in this class of drugs for bone protection! However, AFTER I was diagnosed with BC and I read Dr. Gnant's study and saw the protection that Zometa gave for BC, AND THAT NO ONE, 7 YEARS AFTER COMPLETING THE COURSE OF ZOMETA TREATMENT HAS HAD A FRACTURE OR JAW ISSUES ATTRIBUTABLE TO ZOMETA...I am now COMFORTABLE taking the Zometa.
Like ANY drug, it is necessary to determine your personal risks and benefits, when deciding whether or not a drug is right for you. I consulted 3 oncologists before deciding whether or not I wanted to take the Zometa. In fact, there was more discussion about taking the Zometa than there was about doing chemotherapy! With a Stage 1, Grade 1 bc there is always that risk of OVER treatment....My doctors all felt that going the route of OS/Zometa was better than doing chemotherapy. They all thought it would give me the most benefit with the least risks. Furthermore, I am TRYING to complete 5 years of Tamoxifen and that's recently become a challenge because my uterus is doing funky things. My uterus LIKED to grow things BEFORE my diagnosis and now it LOVES to grow even more things. My internist would like me to try to continue with the Tamoxifen rather than switch to an AI because of concerns for my heart, which AI's increase your heart risk. My goal is to finish 5 years of Tamoxifen and then CONSIDER taking an AI after that. I'm hoping that in 3 more years there will be more clinical evidence showing whether or not there is a need for 10 years of endocrine therapy....
And while I'm at it, I'd like to pitch the best MEDICAL book that I've read since reading Dr. Abramson's book and that is Eric Topol, MD's new book, The Creative Destruction of Medicine. I just finished reading the book and I am considering reading it all over again!!!! It's THAT good. Dr. Topol is one of the United States' premier physicians and has written a book about his vision of the future of medicine. The glimpses that he gives us is AMAZING. I can't give this book enough accolades:
http://www.amazon.com/Creative-Destruction-Medicine-Digital-Revolution/dp/0465025501
Good luck with your decision Joy. We've all been there. I think putting together a protocol is the hardest part of dealing with a BC diagnosis. I'm happy with my decisions so far, and like I told all of my doctors, if I have problems with side effects, then I would revisit my decisions...like I'm doing now with the Tamoxifen. Watchful waiting requires more time spent at doctors, but I'm happy right now to keep as many body parts as possible.......
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VR Thank you for this information. You are a pro at researching - wish that I had the knowledge and time to do what you do. About Zometa - what I read here confirms what I have heard. I'm still wary about taking this type of drug to reduce the risk of osteoporosis. If risk of recurrence was a bigger issue, I might consider it for that reason. I will ask my MO about it and see what he says.
Perhaps the Dr. Gnant study included BC patients that had shorter term use of Zometa, and some of the negative side effects had not occurred.
Just wondering, is Eric Topol an oncologist?
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Eric Topol was chief of cardiology at the US's premier heart hospital, The Cleveland Clinic. Following the vioxx debacle, which he talks about in the book, he moved to Scripps in San Diego, California.
Regarding Gnant... I would guess that the Zometa was given for a shorter period.0 -
Joy osteonecrosis of the jaw is exceptionally rare with bisphosphonates and tends to be associated with poor dental hygiene/major pre-existing dental problems in those isolated cases when it has been reported and this is not a cumulative dose effect. The increased risk of fracture with very long term use is mostly theoretical as far as I am aware and not something that is seen with 3 years use.
I agree with VR that deciding on your treatment plan is very individual and very hard for each of us and you should not feel pressured to go with any particular treatment. You have great stats and it is very true that over-treatment is a potential issues for some of us stage one gals. Good luck with your decisions0 -
Thanks annicemd. It is hard to decide on treatment, whether it's appropriate and enough, or too much. I'm grateful that there are choices.
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