way to prevent breast cancer is chemoprevention

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BZO63
BZO63 Member Posts: 5
edited June 2014 in High Risk for Breast Cancer

Most well kept secret of medicine is the chemoprevention for breast cancer.

An exellent study concluded in 1998 showed that ( The national adjuant surgical breast and bowel project) demostrated ; Tamoxifen can prevent breast cancers by 50% and ER positive cancers by 70% in pre and post menapausal high risk women.

Since then ignorance has kept this information limited. Primary care physcians has dropped the ball and since there is no drug company to push this indication , tamoxifen prophylaxis is forgotten.

Many physicians still are very unconfortable with it, they errogenously believe it is a high risk medication.

Actually it's most scared side effects of endometrial cancer and blood cloths are very rare in younger premenapausal women.

ACOG ( American College of Obstetericians and gynecologists) Committe Opinion published on June 2006, states :Premenopausal women treated with tamoxxifen have no known increased risk of uterine cancer and as such require no additional monitoring beyond routine gynecological care)

In postmenopausal woemn there is a very small increased risk for endometrial cancer. If a women alllready had hysterectomy , she could be a good candidate.

For other postmenapausal women Raloxifen ( also known as Evista) is as effective in preventing breast cancers and will not cause uterine cancer.

Also Aromasin ( An aromatose inhibitor) is shown to decrease risk of breats cancer by 70% in postmenopausal wone in 2011, this artcle published in new England Journal of Medicine

Another medication called lasofoxifene ( which is not approved by FDA in US yet but approved in Europe) shown to decrease breast cancer by almost 80%.

Off course many are aware bilateral mastectomies could prevent breast cancer by 95%. However this is a very mutilitating way , it is interesting while chemoprevention has not grab the attention of media while bilateral prophylactic mastectomies by celebrities are highly published.

MY FRIENDS WITH HIGH RISK, PLEASE DEMAND CHEMOPROPHYLAXIS FOR BREAST CANCER. GOOGLE CHEMOPROPHYLAXIS FOR BREAST CANCER AND TAKE ARTICLES WITH YOU , IT IS LIKELY YOUR PHYSICIAN WILL NOT BE FAMILIAR WITH IT OR VERY SCARED FROM IT. IT IS A MISPLACED FEAR. if all women that are high risk are treated there will be 30000 less breast cancer cases per year.

This is an ongoing problem that everyone is ignoring , these therapies has potential of saving thousands of lives.

Medical community has to get used to screen and treat high risk women. If we do not insist it seems they have no incentive to do it. It is like treating high cholesterol with statins and treating atrial fibrialltion with rat poision ( warfarin) to prevent heart attacks and strokes. Not different at all but not done.

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  • Beesie
    Beesie Member Posts: 12,240
    edited February 2013

    BZO, there is no secret about taking Tamoxifen or Evista as preventatives for breast cancer. There's lots of discussion about that on this website - the topic probably comes up in at least one or more posts every single day.  

    While chemoprevention can reduce the risk of breast cancer, there are certainly pros and cons to considered. It's true that the risk of very serious and/or long term side effects is quite low, however the risk of quality-of-life side effects is quite high and this is an important consideration for many women. 

    Ultimately everyone who is high risk should assess for herself whether a therapy like Tamoxifen or Evista is right for her. It is a highly individual decision and I don't think it's appropriate to tell all high risk women that they should "demand chemoprophylaxis".  It is the right approach for many women but it's not right for everyone. 

    Edited for typos only. 

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  • Moderators
    Moderators Member Posts: 25,912
    edited February 2013

    Thanks Beesie for your response. BZO, we ask that members share their story, and decisions, but please refrain from providing medical advice. 

    Best, The Mods

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  • BZO63
    BZO63 Member Posts: 5
    edited February 2013

    It is still quiet a secret , I know from myself and my friends who are high risk due to family history. I am a physician and a very good one certified on all specialities I practice including primary care. I have never heard about it. None of my physicians; internist , GYN, my radiologists who reads my mamogram and personally comes in the room and tells me the results and then tells me I need a MRI due to dense breasts and being high risk told me about it.

    Eductaional materials for primary care certifications do not cover the subject. MKSAP 15 the most important and famous review manual for Internal Medicine Certification do not mention about it, not a word, no evidence chemoprophylaxis exists.

    My two friends who do  have family history of breast cancer in theri mothers and aunts, never offered or heard such a thing until they heard from me. They are both going to breast high risks clinics.

    I told my sister about it. she questioned her GYN about it. Her gyn's response was " No that willl put you in to menapause" . then she demanded she be send to a breast surgeon and after again insisting for it started on Tamoxifen.

    So far so good no side effects and she feels nothing different.

    I was diganosed with breast cancer ER positive at age 48. I am still going trought the tretament which is brutal. I may die from this disease

    When risks and benefits are compared, I will take TAmoxifen anytime compared to breast cancer.

    It is true physicians do not know about it except few specialists. I recent study showed that 77% of family physicians are looking to chemoprevention unfavorably. Why? Because they do not know about it.

    In medical community chemoprevention is still a secret. I am telling you I am in that community. Women do not know it either, when I go to support groups, when I tell them about chemoprevention for the sake of their sisters and daughters, first repsponse is that they do not believe me. Because no one has ever told them , breast cancer survivor women can not believe they were never told about it by their physicians. They initially always think I am making this up or I must be a fanatic or has some grudge agaianst medical establisment

    No I am telling the truth , out there is real life women do not know chemoprevention. So many women is dying because of it. So many women are going trough breast cancer needlessly because of it.

    She women should demand information about chemoprevention , otherwise they are not likely to get it.

    The company that has developed Lasofoxifene ( which at this time seem to be a very promising medication due to helping with vaginal dryness, decreasing breast cancer risk considerably and decreasing cardiovascular events like strokes and heart attatcks, increasing bone density) did not want to apply to FDA with the indication breast cancer prevention becasue they believe there is no interest in chemoprevention and they will not be able to sell it.

    Chemoprevention is the elephant in the room that medicine is ignoring. Please help me make this option known with your resources, do not bad mouth chemoprevention and exagerate it's side effects. Yes it can have side effects , alll medicine do but information should reflect the facts. Women know aboout it do not want it as they are so scared from it.

    There has to be some pressure to route women who are good candidates for this opportunity

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  • ballet12
    ballet12 Member Posts: 981
    edited February 2013

    BZO,  I am surprised that you reported that women attending high risk breast clinics were never informed about Tamoxifen.  It was in clinical trials for high risk women back in the mid 90's and used as a breast cancer treatment well before that.  There are two separate issues here:  One is whether physicians know about medications and are reluctant to prescribe them to individuals who are physically well although high risk, and the second is whether they are uninformed.  In addition, there is "high risk" and "high risk".  There are individuals who are very high risk because they carry BRCA genes, which puts their risk of bc very high, as well as individuals with known family histories of multiple relatives in the immediate family and/or one degree away from that.  Other individuals might have more moderate risk, such as having ADH or family history of one family member with post-menopausal bc.  I'm sorry you have to go through bc treatment and wish you the best. 

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  • BZO63
    BZO63 Member Posts: 5
    edited February 2013

    Thank you for your well wishes. Unfortunatelly BRCA patients are not good candidates for chemoprevention at this time, as their risk is still to high even with chemoprevention.So they are still oferred bilateral mastectomy.

     Risk is calculated using gail risk index ( go to www.cancer.gov/bcrisktool) a risk index over 1.7% make a woman eligible to consider chemoprevention. Gail risk index is a series of questions of risk factors. It aske about first degree relatives with breast cancer but does not consider how old were those relatives were when they are diagnosed. also it does not include estrogen levels.

    As any physician you may know about chemprophylaxis of breast cancer or gail risk index. Unless they are specialists in oncology or breast surgery I bet they will n ot know about it.

    There is a huge ignorance among primary care physicians, internists, GYN, and family practioners, this is where the prevention ball is dropped.

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  • april485
    april485 Member Posts: 3,257
    edited February 2013

    I think most of the women diagnosed with BC here and who are ER/PR+ are given the option of taking Tamoxifen or an AI. I will be prescribed this medication as part of my treatment. I am highly er+ (>95%) and pr= (>60%) so my medical oncologist wants me to take this medication. Tamoxifen has been prescribed for years to high risk women. I knew about it years ago even though I was not considered high risk.

    There is an entire thread dedicated to the side effects of these drugs. There are many and some of them are very severe. Some people opt out after trying hard to tolerate them. Even if you are a doctor, I feel this is an individual choice and quality of life has to be factored in here as Beesie said in her post. It is not the only tool in the arsenal and some people can barely walk due to the joint pain being beyond severe. I am praying that I tolerate them well, but if I don't, you can bet that I will opt out.

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  • Cowgirl13
    Cowgirl13 Member Posts: 1,936
    edited February 2013

    BZO, i'm sorry but i believe you are here to stir the pot.  I'm wondering if there is some volunteer work to could do instead of starting all this. 

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