Arimidex (aromatase inhibitors) for women over 60

JaneQPoppy

I apologize if this has been covered elsewhere. Searching on my kindle is challenging when there is so much info.

Can anyone point me to studies or share anecdotal information (like the recommendations you got) about whether it is advisable for women over 60 to go on aromatase inhibitors. AFTER radiation. My MO wants me to do both.

I had a lumpectomy about three weeks ago. Tumor<1.5 cm, 5 lymph nodes totally negative, ER/PR+, HER2 negative. I'm 67, postmenopausal for 16 years, no HRT, and I was only on birth control pills for 13 years about 30 years ago.

I am about 30 lbs overweight, which I am tackling with conviction. I mean, how much estrogen can I possibly have left, say 3 months from now and after I lose weight?

I seem to recall something about Arimidex and women over 60...

Thx.

BrooksideVT

I'm guessing you have not yet received your oncotype results? This test looks at the genetics of your particular tumor and shows your personal risk of recurrence with and without arimidex and chemo. Actually, the test uses tamoxifen; arimidex results will be even better. Like you, I was 67 and "comfortably" overweight. My tumor was stage 1, grade 1, and the mitosis (reproduction) rate was 1. My oncotype showed my recurrence rate without the AI was 30%, which I saw as huge. With the AI, the risk was cut in half. I was surprised at my high risk of recurrence, but continue to be thankful that this test was there. Without it, I might easily have skipped, or started and subsequently abandoned, the AI.

The oncotype also showed the impact chemo would have, which turned out to be 3%, so I was thankful that was not recommended. My friend had similar statistics to yours and mine. Her onc was stunned to find her oncotype come back high, and she had four rounds of chemo and will be on an AI for ten years.

As for postmenopausal estrogen levels, please keep in mind that most of us find our recurrence risk is cut in half by taking arimidex. It is true that those of us who are 70-ish and above are likely to have less aggressive tumors. this is good. Even better, we can take an AI.

JaneQPoppy

Sorry, I said this on another thread, but forgot to mention it here. My MO doesn't plan to do the oncotype test. She didn't see any point in it, as my numbers were so low. My situation is similar to yours. Off the top of her head (with no oncotype), the MO said my risk for recurrence would be cut from 20% to ~8% WITH RADIATION. But after radiation... if I'm down to 8% at that point... do I need to cut to 4%?

This is what I said in the Refusing Radiation thread:

"The radiologist I saw (before I met the MO) said the MO would probably order the oncotype test, but when I asked her, she said my numbers were so low, there was no need to. That it wouldn't give any further information.The MO still wants me to have radiation AND 5 years of Arimidex. I can kind of see the radiation. but not the Arimidex-- seems like too much."

I know the Arimidex cuts the risk way down. but if my risk with my numbers after radiation is, say, 8%, and the Armimidex cuts it down to 4%, is it worth the side effects? Yeah, if we were going from 20% to 10%, sure.

I'm going to see another radiologist next week. Should I ask for the oncotype test even though the MO vetoed it?

ruthbru

Even after menopause, estrogen is still pumped out in the adrenal glands. What grade was your tumor? Yes, losing weight can help but I guess no matter what your numbers say or weight is, I would give it a try. The lower the recurrence risk, the better......somebody is unlucky enough to be in that 4% (or whatever) and you don't want it to be you if you can help it. Also you can always quit if you have bad side effects. I was in my 50s, but have two local friends who were diagnosed about the same time as me at ages 64 and 68. We all did 5 years of Arimidex without any major problems, and around to tell the tale.

Suzannecarol

I wonder why your doctor didn't go ahead and order the onco test. From what I have read it would have helped you make a decision about the radiation. Does it cause a problem to do the test? I am very new to it so do not know very much about it.

BrooksideVT

I'd ask everybody about the oncotype! I believe only an MO will/can order it, but everybody else can sure weigh in with opinions. Keep in mind that the numbers your onc is quoting are generic, while the oncotype is specific to your particular tumor. Maybe you might consider a second MO opinion?

And do not worry about side effects that may or may not happen. Most of us who post here gripe about our AI's, but there are many thousands who have no side effects at all.

JaneQPoppy

Suzannecarol said:

"I wonder why your doctor didn't go ahead and order the onco test. From what I have read it would have helped you make a decision about the radiation. Does it cause a problem to do the test? I am very new to it so do not know very much about it."

What the MO told me:

"My MO doesn't plan to do the oncotype test. She didn't see any point in it, as my numbers were so low."

I don't think it causes a problem to do the test. She said didn't see any point in it and wondered why the first RO suggested it. I guess in her mind the purpose of the oncotype test is to determine if the tumor is aggressive. She said all my numbers indicated a non-aggressive tumor. I'm going to see a different RO next week, and i will ask her about it and possibly ask her to do it. It seems to me that extra info could be helpful.

The tumor was grade 2.

I would certainly like to hear from more people who breezed through Arimidex (and the like). The Arimidex thread totally freaked me out.

ruthbru

An oncotype is used to help determine if an early stage estrogen positive woman should do CHEMO, it doesn't have anything to do with radiation. If you have a lumpectomy, you need radiation; that is part of the deal. All the statistics for survival/non-recurrence factor a lumpectomy PLUS radiation. Most people DO NOT have horrible SEs from Als!!! It's just natural that those who have difficulties are the ones talking about it, the rest of them are just out living their lives.

*except geeky ones like me, who stay around to point that out.

Suzannecarol

That is very different from what I was told and I am only going by my BS and research I have read. I have DCIS. Chemo has never been mentioned for my treatment. Radiation was mentioned along with the pill at my first visit. After my lumpectomy he ordered the oncotype test and said if my number was low no radiation so I saw it as it did help determine if I would have radiation. I have read about DCIS and the controversy over being over treated. Before the oncotype test radiation was suggested, now with this test it is not always used.

SpecialK

suzannecarol - the Oncotype Dx test for DCIS is a different test from the Oncotype Dx test for invasive cancer.  The DCIS test is a recurrence prediction test to determine treatment for DCIS, the test for invasive cancer determines how much chemo will help when added to hormonal therapy.

BrooksideVT

Jane, the oncotype is designed for us early stagers. The reason it is so frequently prescribed is that individual tumor behavior does not always jibe with the information tumor pathology can provide. The test indicates the probability of nasty surprises and helps us determine treatment choices. Have you googled the test yet?

I haven't exactly breezed through arimidex, but I mostly find it to be perfectly OK. Mostly I have pretty minor issues with it, but, after two years, with gripes, and with holidays (yes, your onc with suggest a couple of weeks off from time to time), I'm doing just fine. I know some entries in these boards can be alarming, but, on the other hand. we're a very supportive group and nobody has to feel alone with her side effects.

Suzannecarol

Thank you girls. I was beginning to wonder about my doctor after reading ruthbru's post. He seemed very positive and glad I could have it done. There is so many different things to learn but I am learning everyday. I hesitate to type too much on here as I am very new to this. I don't want to EVER give out wrong information.

SpecialK

Suzanne - don't worry, we all are unclear in the beginning - there is a lot to know and the learning curve is steep - many are still reeling from the surprise of diagnosis too!  If you are ever unsure about something just type it in the form of a question - someone will usually come along and answer it.

ruthbru

And I don't know anything about DCIS, so don't listen to my advice if that is your diagnosis!

lalala

Hello Jane.  I had lumpectomy last January 2014, 6 rounds of chemo (due to tumour in sentinel node), 1 month of rads and started on my five year term of Arimidex (anastrazole) this past September.  I am 64 and had an early menopause at 45 due to ovary removal due to recurrent cysts (and then the other ovary simply stopped working); so I too wondered how much estrogen could possibly be left in me.  Apparently enough for + tumours to grow.  The first few months were painful - mostly knee pain and joint pain in my thumbs and middle fingers; but as winter ended and I was gaining back my strength and getting outside more the joint issues are tolerable without any meds.  My 6 month post active treatment tests in March (blood, bone scan, chest xray and diagnostic mammo) showed that I am doing well so far.  Onco said to monitor blood pressure and eat healthy as the Arimidex sometimes leads to increases in bp, lipids, cholesterol, etc.  Next tests will be in September and depending on those results will re-evaluate whether to commit to another year.  For me making commitments for shorter periods of time works better than assuming that I HAVE TO take the AI's for 5 years. As we all find out in this journey, anything can happen in 5 years - good or bad, new research, new treatments, new genetic marker tests.

Did anyone watch the PBS special this past week on Cancer?

Suzannecarol

Oh Ruth, as I said there is so much to learn. I had no idea! I did not know there were so many types of BC. It is all so overwhelming sometimes and scary for lack of better words but I sure love this site all the women here. We have a bond that many cannot understand. My family is doing their best to support me as best as they know how. One thing that surprised me ( just the way I am) is I found I did not respond to "so and so had cancer and she is fine now and has been for 10 years." My family (husband mostly) kept coming home with those strories. For some that may be the ideal thing to say, for me I thought but there are no guarantees I will be like that. I have done the same thing when my sister's husband had throat cancer. I will not do that again to anyone. From now on I will say, "I am here for you, let me help you in any way I can."

ruthbru

I was just going to come back & apologize for not noticing your diagnosis. Yea, you learn a lot. The one that made me want to strangle people was 'God doesn't give you more than you can handle'....which might be useful to some, but my vision of God is not one of him/her sitting up there deciding what sort of rotten things to do to people.

 I tried to cut people some slack though; because I know, for sure, that I said some stupid things to people myself BC (before cancer).....if they say something, at least you know they care about you and wish you well.

Suzannecarol

Ruth, no need to apologize at all!! This is how we learn. If you had not said what you did then I wouldn't have learned what I did from the other responses and I do like learning. My husband is one of those knows almost everything and the sad thing is he really does. I can't tell you how many times I correct him only to be wrong. He is so good about it. He just cracks a joke. SO, I am use to being wrong. LOL

I don't like for people to say things like that either or to hear someone say God saved us and I see the ones he didn't??? We had a tornado go through a town close to us a year ago and one of our friends lost their son, another couple lost their two little kids, ages 7 and 5. I don't understand any of it.

JaneQPoppy

Ruthbru said: "An oncotype is used to help determine if an early stage estrogen positive woman should do CHEMO, it doesn't have anything to do with radiation. If you have a lumpectomy, you need radiation; that is part of the deal. All the statistics for survival/non-recurrence factor a lumpectomy PLUS radiation. Most people DO NOT have horrible SEs from Als!!! It's just natural that those who have difficulties are the ones talking about it, the rest of them are just out living their lives.'

I wasn't asking about the oncotype for radiation, just for AI's. I know I'm supposed to have radiation.

My diagnosis was IDC.

savgigi

Just wanted to add that radiation reduces the risk of local recurrence - the cancer coming back in the same location or nearby. The aromatase inhibitor reduces the risk of local recurrence and a new cancer in either breast.

grammakathy

Jane - I was 63 when I was diagnosed with IDC, stage 1c, grade 2, tumor that was 2.0cm. My Oncotype test came back at 11 and chemo was not recommended. My risk of recurrence with tamoxifen is 11% and it seems worth it to me. Of course the fact that my tumor was ER and PR receptive at 100% made it even easier to decide. I started on arimidex and couldn't sleep so my Oncologist switched me to Tamoxifen. I'd rather have the benefits of Arimidex but he says Tamoxifen is almost as good. I really am glad I had the Oncotype test. It's expensive but insurance should cover it because chemo costs more. If I had said I wouldn't do chemo under any conditions though, he said there was no sense in doing the Oncotype. Maybe your doctor thought that was your frame of mind? Take care.

JaneQPoppy

Grammakathy said: "If I had said I wouldn't do chemo under any conditions though, he said there was no sense in doing the Oncotype. Maybe your doctor thought that was your frame of mind?"

No, I didn't have a frame of mind at that point, having only been on this path for about three weeks.

Thanks for your comments.

Kicks

Our bodies do product estrogen 'forever' at least some degree. (Men do too.). Also we take it in in many things we eat.

I have been on Femara/letrozole for 5+ yrs and will be on it forever. I was 63 when DXd IBC. I was 19 yrs post natural menopause, about 3 mths HRT fr a short fime and probably about 2 yrs birth control 'way back when'.

Remember that BC has MANY different DXs with different prognosis and TX plans. We are each unique and there is no 'One Size Fits All' as to what is best for us. We all go into this journey starting at different overall health levels which does come into play how we handle 'things'.

JaneQPoppy

Kicks said: "Remember that BC has MANY different DXs with different prognosis and TX plans. We are each unique and there is no 'One Size Fits All' as to what is best for us."

So true. It's virtually literally impossible to find someone in exactly the same situation as oneself with all of the same parameters.

Suzannecarol

Jane, This came from Breastcancer.org

I am early stage estrogen positive.

DCIS is the most common form of non-invasive breast cancer. DCIS usually is treated by surgically removing the cancer (lumpectomy in most cases). After surgery, hormonal therapy may be recommended if the DCIS is hormone-receptor-positive. Radiation therapy may be recommended for some women. Doctors aren't always sure which women will benefit from radiation therapy.

If you've been diagnosed with DCIS, the Oncotype DX test can help you and your doctor make a more informed decision about whether or not you need radiation therapy.

http://www.breastcancer.org/symptoms/testing/types...

JaneQPoppy

What is the purpose of the oncotype test if you have IDC? What decision is that supposed to help with?

SpecialK

Jane - the Oncotype Dx test for invasive cancer is a different test than the one for DCIS. The test for invasive cancer indicates whether there is benefit of adding chemo to hormonal therapy. Your score assumes you will be taking Tamoxifen or an aromatase inhibitor. Linked is info for both tests, info for the test for invasive is first.

Edited to add a different link that is shorter   Click on the breast cancer assay part.

http://www.oncotypedx.com/

 

BrooksideVT

SpecialK, the site dropped the end of your link--it does that. I think it allows only a limited number of characters in a web address.

Jane, If you just drop the, ".aspx" you'll get to the general area of the website. If you enter only www.genomichealth.com you'll be able to explore the entire site and see why the test is recommended for those of us with IDC.

Also, this website will give you a good overview: www.breastcancer.org/symptoms/testing/types/oncoty...

The site did it again! That web address is meant to end, "oncotype_dx."

JaneQPoppy

Brookside- that's a helpful site.

This (from the site) is informative:

---

Who is eligible for the Oncotype DX test?

You may be a candidate for the Oncotype DX test if:

• you've recently been diagnosed with stage I or II invasive breast cancer
• the cancer is estrogen-receptor-positive
• there is no cancer in your lymph nodes (lymph node-negative breast cancer)
• you and your doctor are making decisions about chemotherapy.

Most early-stage (stage I or II), estrogen-receptor-positive breast cancers that haven't spread to the lymph nodes are considered to be at low risk for recurrence. After surgery, hormonal therapies such as an aromatase inhibitor or tamoxifen are prescribed to reduce the risk that the cancer will come back in the future. Whether or not chemotherapy is also necessary has been an area of uncertainty for patients and their doctors.

If you've been diagnosed with early-stage, estrogen-receptor-positive breast cancer, the Oncotype DX test can help you and your doctor make a more informed decision about whether or not you need chemotherapy. (Some research also suggests the test may help postmenopausal women with estrogen-receptor-positive breast cancer that has spread to the lymph nodes make chemotherapy decisions. Talk to your doctor if you are in this group.)

---

This seems to say that the Oncotype test is for determining whether to do chemo. The between-the-lines assumption seems to be that radiation is a given (since it isn't even mentioned) and so are aromatase inhibitors (which "are prescribed"). Am I correct on that? That since my MO has decided I don't need chemo, that the test would, in fact, (just as she said) yield no information that would impact our treatment plans for me?

SpecialK

jane - radiation is not assumed for Oncotype Dx.  The decision for radiation is based on surgery type, tumor location and size, and nodal status.  Oncotype is used for deciding on systemic therapy, specifically chemo, and whether there is benefit in adding it to hormonal therapy.

JaneQPoppy

Then maybe I do want the test, because I'm not sold on the need for Arimidex. Hence this thread.

ETA. Are aromatase inhibitors considered "hormonal therapy"? I'm assuming so.