Aromatase Therapy Timing Key in Breast Cancer Survival

Dear Octobergrace,

It's not as bad as it sounded to you. It is not saying there is no survival benefit to your AI treatment. It is saying that the meta-analysis (a statistical way of adding up the results of a bunch of different research studies, so we know what happened over a very large number of patients) found that even though these drugs reduce your chance of your cancer coming back, it's not clear that they raise your chances of living longer. My understanding from the article is that they think people with heart disease have taken the AIs for breast cancer and then died of heart disease, and that balances out the decreased cancer deaths due to the AI therapy. The article says this didn't show up in the individual studies, just in the combined data. That could mean that it's just one kind of people whose deaths are speeded up by the AIs, and only in the big data set did they have enough instances to show the problem. I'm no MD, so I hope someone will correct me if I'm misunderstanding it.

Here's my conclusion from the study. After a couple years of AI therapy, which won't be wonderful for our bones (I'm also frightened of osteoporosis), we should ask our oncologists whether a switch to tamoxifen will be a good idea.It sounds like people on tamoxifen should do the opposite after a couple of years... to avoid that "cumulative toxicity" which AIs may have and which they know tamoxifen has.

I also saw something (don't know if on breastcancer.org or elsewhere) saying one of the most common osteoporosis treatment drugs is looking like it reduces the risk of breast cancer returning! So, if you already have osteoporosis, check into that. Sorry I don't know the name of the med. Good luck!

As it turned out, my timing in hormonal therapy seems to be fortuitous..I started tamoxifen in 2001 for two years and the switched to arimidex right before it was approved by the FDA..I did a total of five years..at the time in 2006, I attended a Strong Women Summit and was told in private by a leading

breast cancer MD that was enough...seems she was right and I lucked out...I will be an 11 year survivor in a few weeks..

I have an appt. With an endocrinologist this month to advise my team re osteoporosis issues and continued use of aromatase inhibitors. I have asked about a change from Femara to Tomoxifin. I have no doubt that osteoporosis has as much potential to incapacitate and kill me as does breast cancer recurrence.

Thanks for posting the additional info.

Does the Fosamax increase your bone density a lot? I am so glad to hear you are doing well.

My husband the epidemiologist says 80% risk doesn't mean I'll be 80% sick, it means I can be one of the 20 unlucky ones who keep fighting, or one of the 80 lucky ones who walk away. (Or 10/90, or whatever they say my odds are.)

What has impressed me since my bc diagnosis is how much they damage you in the name of making you well. I believe my surgeon and rad. oncologist are top-notch and they are very happy with my outcome (so far) but I really feel damaged, and I know it will be more when I am spending 5 years on Femara ... or whatever AI/tamox combo ends up happening. As one of our sisters said on another board of bc.org, bc sucks.

This breastcancer.org site has a great chart comparing the side effects of the different AIs. They don't all increase heart disease risk :-)

 I have the understanding that  2 1/2 years on tamox and then 2 1/2 on an AI is a common practice for situations like yours. Maybe you can ask your onc about staying on the tamox for another year since you do well with it. Again, this website has research reports about that.

I used to work retail for years and it's like that -- on your feet all day. If you have to stand in one place a lot, it helps if you have a low stool and rest one foot on it at a time.

Take care and good night.

WhiteRabbit, that's an excellent point.....

I just started generic Aromasin a few weeks ago. Now I'm so confused! Should I be taking this at all? My bones are good and healthy, as is my heart. No other health issues at all. My bc showed up last year when I was 50, and was slow growing and hadn't spread. I wonder if the side effects (achy joints, foggy brain and wicked hot flashes) are worth it. Is the Aromasin going to offer me enough protection?

Achy in my joints every day and night. Joints vary, and since I'm on my feet all day, who knows? Just using motrin now since serious pain-killers scared me. Ugh.

Hi treeskier--I'd love to read some studies on the increased benefit of an AI.  In my case, due to my oncotype, it is about 2% (25% "increase" in BC survival on my stats according to onc).  I think I'm pretty confused by all of this.  Does anyone have a link to how it lowers chance of recurrence?

I also have osteoporosis in the spine now (thanks, chemo and insta-menopause).  I'm reading here that Aromasin doesn't seem to have bad effect on bone health.  So I'm revisiting the switch to an AI if necessary.

I read the article and want to see one about what happens to bc women who take nothing but Arimidex for 8 years!  My Onc refuses to take me off it or change anything.  He said last visit I need the "extra help" from the Arimidex due to the type of bc I have and I need to keep taking it.  My gyn is upset with me because I have developed a lot of vag dryness and problems and he insists I need to take something with a really small bit of estrogen in it.  My Onc got furious and now I am caught between two hard-headed doctors!  I already have Osteopena but my Onc feels the Arimidex is not deteriorating my bones enough to stop.  I guess he will wait until I need a wheelchair and then I can stop!  Is anyone else on this board taking just Arimidex for longer than 5 years and doing ok?  That article concerns me but mailing it to my Onc will just infuriate him and I may end up without an Onc!

I called the makers of Arimidex and asked them about dangers of taking Arimidex over 5 years and they said they don't have records of women staying on it longer than that so they don't know what happens.  Gee!  Maybe I can be an Arimidex long-term guinia pig if I survive much longer!

Any info you can provide on what happens longer than 5 years on Arimidex will be much appreciated.  I get bone density tests yearly and just take extra Vit D3 to protect bones but my fears are getting the best of me since I am soooo up in age!  Thanks for any advice.

Medigal

Fearless:  The nurse told me this last bone density showed a small increase but not enough to be concerned about.  She just said to increase my Vit D3 to 2000 IU from the 1000 I had been taking.  I can't take Calcium or any bone-builders  due to severe constipation problems and other pain they cause me.  I drink very little milk so they are amazed my bones are holding up so well.  I am just concerned by the fact I can find no one else taking Arimidex for this long and what else may be happening to my body that I don't know about.  

Medigal, it sounds like you are doing well on it - if it were me and I were doing that well, I would stay on it.    I know it's scary since it is longer than the 5 years that have been studied, but it sounds like you are being monitored well.

MJL:  That was a cream my gyn wanted to prescribe for me which made my Onc go zonkers. He said I am allowed "nothing" except Replens for my vag problems and he was sending a letter to my Gyn.  When I went last week to my Gyn for my vag problems, he just told me he could do nothing for me since I refused to use his estrogen cream and that it was only going to get worse!  He wasn't very nice to me and I would get another gyn but he is the only  one available on my healthcare plan! I am really in a fix so I bought more Replens and hope I can just help myself best as I can. 

On the breastcancer.org section on side effects of hormonal therapy, all 3 AIs are listed as having osteoporosis as a side effect. According to my MO and what I have read, the hormone estrogen plays some important part in formation of bone cells. AIs completely suppress estrogen so bone cells can't be built as well. (Tamoxifen just blocks the tumor cells from getting estrogen so your bones can still get it.) That doesn't match up with the recent research LtotheK mentioned.

Thank goodness the research reports on breastcancer.org are easy to search and are translated into regular English for us! If I find anything specifically helpful, I'll put it on the thread.

 I had a lot vaginal dryness and sensitivity during part of menopause, not nearly the burning that LtotheK has, but enough to make me able to imagine what she is talking about. I am afraid that if I were suffering that much, I might be willing to use whatever topical cream made it better, even if it had estrogen in it. Docs who don't have vaginas don't know how intensely distracting vaginal pain can be. Can't walk without it rubbing, can't sit without... Oh, man. I send my best wishes for you to have sweet relief!!!!

So we are on the same page, this topic discussed the newest study on Aromasin and bone loss.  I read it carefully, though admit I'm super-dubious. 

Here's the topic:Developed osteopenia in 1 year since Arimidex!