Tamoxifin and uterine cancer

Tamoxifen -- NYT article
Roseann,

I truly hope your friend has a "normal" case of uterine cancer, which is highly treatable.

Below is a copy of an article in the New York Times from December. It was written, apparently, to chastize women who are healthy, but at high risk of developing breast cancer, and who refuse to take Tamoxifen to prevent breast cancer. About half way down, it sumarize the risk to healthy women from taking Tamoxifen.

It says that among a representative group of 1,000 healthy 52 year-old women, 19 could be expected to get breast cancer, but 9 will avoid it if they take the drug. Sounds good. BUT here is the fine print. In order to prevent 9 cases of breast cancer:

"the drug would be expected to cause"
- 21 additional cases of endometrial cancer (common endometrial cancer is normally survived by 90%+, but from other research I've read, up to 20% of endometrial cancer caused by Tamoxifen can be a VERY deadly form of the cancer.)
- 21 would develop blood clots (beyond the normal number)
- 31 would develop cataracts (beyond the normal numbner)
- 12 would develop sexual problems (beyond the normal number)
- And 120 will develop hot flashes, changes in vaginal discharge or irregular periods (beyond the women who would normally be expected to develop all of these symptoms during menopause).


December 14, 2009
When Lowering the Odds of Cancer Isn’t Enough
By TARA PARKER-POPE
If someone invented a pill to cut a cancer risk in half, would you take it?
Who wouldn’t?
Apparently the answer is millions of women — people like Cindy Birkhold of Sarasota, Fla.
The pill is tamoxifen, and Ms. Birkhold, now 52, was considered an ideal candidate for it: she tested positive for a breast cancer gene, her mother had ovarian cancer, and her aunt had breast cancer. Yet rather than take tamoxifen, she opted for surgery to remove her breasts and ovaries.
“I even went so far as to get the prescription” for tamoxifen, she said. “But then I started reading more and decided this isn’t the way I’m going to go. I don’t like to take drugs.”
Such decisions have become a topic of growing concern among doctors and researchers, who are increasingly focused on treatments to prevent cancer in high-risk patients.
While many kinds of cancer are resistant to such treatments, tamoxifen is well documented to prevent breast cancer in many women at high risk for it. Now another drug, raloxifene, has been shown to have a similar effect, and a class of drugs called aromatase inhibitors may also be useful. And for men, finasteride has been shown to lower the risk of prostate cancer.
But none of these new chemoprevention drugs will do any good if patients do not use them. University of Michigan set out to learn why they don’t.
A woman is considered to be at high risk for breast cancer if she is over 40 and has a mother, sister or daughter with the disease, or has a history of atypical cells on a breast biopsy. Tamoxifen lowers a woman’s risk for developing breast cancer by interfering with the activity of estrogen in the body.
The researchers looked at 632 women whose five-year risk for breast cancer made them candidates for the drug. To find out whether the problem was one of information, the scientists created a detailed Internet-based decision tool tailored to each woman’s individual risk.
For instance, a 52-year-old woman who had her first child after age 30, and whose own mother had breast cancer, has a five-year risk of 1.9 percent, according to the Gail risk score, a widely accepted statistical model. That means among 1,000 similar women, 19 would be expected to develop breast cancer over the next five years.
If those women all took tamoxifen, however, 9 of those women would avoid breast cancer — and, as a bonus, 13 would avoid broken bones from osteoporosis.
It is true that tamoxifen can have side effects, some of them serious. Among 1,000 similar 52-year-old women, the drug would be expected to cause 21 additional cases of endometrial cancer, a cancer of the uterine lining that is typically treatable when caught early. An additional 21 would develop blood clots, 31 would develop cataracts and 12 would develop sexual problems. And while more than half of the 1,000 women would naturally develop hormonal symptoms like hot flashes, changes in vaginal discharge or irregular periods, tamoxifen would cause those symptoms in about an additional 120 women.
While these risks are not to be taken lightly, neither are the risks of failing to use tamoxifen; its benefits for breast and bone are substantial. Yet virtually every woman in the study said she would be unlikely to take the drug. Just 6 percent said they would consider it after talking to their doctors, and only 1 percent reported actually filling a prescription for it. Fully 80 percent cited worries about side effects.
“When the numbers were laid out for them in a way they could clearly understand, they weren’t interested in taking tamoxifen,” said Angela Fagerlin, associate professor of internal medicine at the University of Michigan and the lead author of the study, published in the journal Breast Cancer Research and Treatment. “They didn’t think the benefits of tamoxifen outweighed the risks.”
Dr. Fagerlin has also conducted a study of women and raloxifene, which has been shown to significantly reduce breast cancer risk but with fewer side effects. Although the data has not yet been published, she said the findings appeared to be similar.
Some women say they simply do not want to take a pill every day. In fact, though, most consumers are willing to take pills for prevention if they are convinced of the benefits. Millions of women take daily birth control pills, for example, and few people seem reluctant to take multivitamins — or aspirin to prevent heart attacks.
But in the case of anticancer drugs, a phenomenon known as omission bias appears to be at work. People tend to worry more about a low risk of harm from something they do (like taking a pill or a vaccine) than about a higher risk of harm from doing nothing.
In a seminal 1994 study of vaccination trends for whooping cough, researchers from the University of Pennsylvania found that parents gave far more credence to hypothetical concerns about side effects than about the very real danger of an unvaccinated child’s becoming severely ill with the disease.
“I think this involves complex human psychology,” said Dr. Larry Norton, deputy physician in chief for breast cancer programs at Memorial Sloan-Kettering Cancer Center in New York. “A number of studies have shown that people are more concerned about losing something than they are about gaining something.”
Dr. Norton said he was optimistic that new research into aromatase inhibitors, which lower the amount of estrogen in the body, would lead to new prevention options with less bothersome side effects. Meanwhile, he said, it was unlikely that large numbers of healthy women would ever be persuaded to take tamoxifen as a breast cancer prevention drug.
“It’s not a matter of being right or wrong; it’s about what’s happening now,” he said. “The drug has been available for a long period of time, and the public is as educated as it can be, and we still haven’t seen a great use of the drug.”
Tamoxifen was discovered by ICI Pharmaceuticals[2] (now AstraZeneca) and is sold under the trade names Nolvadex, Istubal, and Valodex. However, the drug, even before its patent expiration, was and still is widely referred to by its generic name "tamoxifen

sunny_girl said:

Tamoxifen -- NYT article
Roseann,

I truly hope your friend has a "normal" case of uterine cancer, which is highly treatable.

Below is a copy of an article in the New York Times from December. It was written, apparently, to chastize women who are healthy, but at high risk of developing breast cancer, and who refuse to take Tamoxifen to prevent breast cancer. About half way down, it sumarize the risk to healthy women from taking Tamoxifen.

It says that among a representative group of 1,000 healthy 52 year-old women, 19 could be expected to get breast cancer, but 9 will avoid it if they take the drug. Sounds good. BUT here is the fine print. In order to prevent 9 cases of breast cancer:

"the drug would be expected to cause"
- 21 additional cases of endometrial cancer (common endometrial cancer is normally survived by 90%+, but from other research I've read, up to 20% of endometrial cancer caused by Tamoxifen can be a VERY deadly form of the cancer.)
- 21 would develop blood clots (beyond the normal number)
- 31 would develop cataracts (beyond the normal numbner)
- 12 would develop sexual problems (beyond the normal number)
- And 120 will develop hot flashes, changes in vaginal discharge or irregular periods (beyond the women who would normally be expected to develop all of these symptoms during menopause).


December 14, 2009
When Lowering the Odds of Cancer Isn’t Enough
By TARA PARKER-POPE
If someone invented a pill to cut a cancer risk in half, would you take it?
Who wouldn’t?
Apparently the answer is millions of women — people like Cindy Birkhold of Sarasota, Fla.
The pill is tamoxifen, and Ms. Birkhold, now 52, was considered an ideal candidate for it: she tested positive for a breast cancer gene, her mother had ovarian cancer, and her aunt had breast cancer. Yet rather than take tamoxifen, she opted for surgery to remove her breasts and ovaries.
“I even went so far as to get the prescription” for tamoxifen, she said. “But then I started reading more and decided this isn’t the way I’m going to go. I don’t like to take drugs.”
Such decisions have become a topic of growing concern among doctors and researchers, who are increasingly focused on treatments to prevent cancer in high-risk patients.
While many kinds of cancer are resistant to such treatments, tamoxifen is well documented to prevent breast cancer in many women at high risk for it. Now another drug, raloxifene, has been shown to have a similar effect, and a class of drugs called aromatase inhibitors may also be useful. And for men, finasteride has been shown to lower the risk of prostate cancer.
But none of these new chemoprevention drugs will do any good if patients do not use them. University of Michigan set out to learn why they don’t.
A woman is considered to be at high risk for breast cancer if she is over 40 and has a mother, sister or daughter with the disease, or has a history of atypical cells on a breast biopsy. Tamoxifen lowers a woman’s risk for developing breast cancer by interfering with the activity of estrogen in the body.
The researchers looked at 632 women whose five-year risk for breast cancer made them candidates for the drug. To find out whether the problem was one of information, the scientists created a detailed Internet-based decision tool tailored to each woman’s individual risk.
For instance, a 52-year-old woman who had her first child after age 30, and whose own mother had breast cancer, has a five-year risk of 1.9 percent, according to the Gail risk score, a widely accepted statistical model. That means among 1,000 similar women, 19 would be expected to develop breast cancer over the next five years.
If those women all took tamoxifen, however, 9 of those women would avoid breast cancer — and, as a bonus, 13 would avoid broken bones from osteoporosis.
It is true that tamoxifen can have side effects, some of them serious. Among 1,000 similar 52-year-old women, the drug would be expected to cause 21 additional cases of endometrial cancer, a cancer of the uterine lining that is typically treatable when caught early. An additional 21 would develop blood clots, 31 would develop cataracts and 12 would develop sexual problems. And while more than half of the 1,000 women would naturally develop hormonal symptoms like hot flashes, changes in vaginal discharge or irregular periods, tamoxifen would cause those symptoms in about an additional 120 women.
While these risks are not to be taken lightly, neither are the risks of failing to use tamoxifen; its benefits for breast and bone are substantial. Yet virtually every woman in the study said she would be unlikely to take the drug. Just 6 percent said they would consider it after talking to their doctors, and only 1 percent reported actually filling a prescription for it. Fully 80 percent cited worries about side effects.
“When the numbers were laid out for them in a way they could clearly understand, they weren’t interested in taking tamoxifen,” said Angela Fagerlin, associate professor of internal medicine at the University of Michigan and the lead author of the study, published in the journal Breast Cancer Research and Treatment. “They didn’t think the benefits of tamoxifen outweighed the risks.”
Dr. Fagerlin has also conducted a study of women and raloxifene, which has been shown to significantly reduce breast cancer risk but with fewer side effects. Although the data has not yet been published, she said the findings appeared to be similar.
Some women say they simply do not want to take a pill every day. In fact, though, most consumers are willing to take pills for prevention if they are convinced of the benefits. Millions of women take daily birth control pills, for example, and few people seem reluctant to take multivitamins — or aspirin to prevent heart attacks.
But in the case of anticancer drugs, a phenomenon known as omission bias appears to be at work. People tend to worry more about a low risk of harm from something they do (like taking a pill or a vaccine) than about a higher risk of harm from doing nothing.
In a seminal 1994 study of vaccination trends for whooping cough, researchers from the University of Pennsylvania found that parents gave far more credence to hypothetical concerns about side effects than about the very real danger of an unvaccinated child’s becoming severely ill with the disease.
“I think this involves complex human psychology,” said Dr. Larry Norton, deputy physician in chief for breast cancer programs at Memorial Sloan-Kettering Cancer Center in New York. “A number of studies have shown that people are more concerned about losing something than they are about gaining something.”
Dr. Norton said he was optimistic that new research into aromatase inhibitors, which lower the amount of estrogen in the body, would lead to new prevention options with less bothersome side effects. Meanwhile, he said, it was unlikely that large numbers of healthy women would ever be persuaded to take tamoxifen as a breast cancer prevention drug.
“It’s not a matter of being right or wrong; it’s about what’s happening now,” he said. “The drug has been available for a long period of time, and the public is as educated as it can be, and we still haven’t seen a great use of the drug.”
Tamoxifen was discovered by ICI Pharmaceuticals[2] (now AstraZeneca) and is sold under the trade names Nolvadex, Istubal, and Valodex. However, the drug, even before its patent expiration, was and still is widely referred to by its generic name "tamoxifen

Hi Sunny girl
I read this article in December. I think The journalist, TARA PARKER-POPE is very irresponsible person who has misinterpreted actual scientific facts and statistics.Patients should not make their decisions based on the article from New York Times.

New Flower said:

Sorry for your friend
She can visit uterine board at CSN. We have discussed this issue earlier so she can search on Tamoxifen and will find old posts.She can check this out:http://csn.cancer.org/node/181214. I have been on Tamoxifen myself for 11 months. I have discussed this issue with my gynecologist, he believes it is very rare event (1%), especially if patient stays on Tamoxifen for less than 5 years.Did they do endometrial biopsy for her? Sorry
New Flower

Uterine cancer is one of the
Uterine cancer is one of the side effects of tamoxifen. However, they say it isn't common. I am so sorry that your friend has this. Wishing her good luck!

Hugs, Leeza

treatable how?
My onc also said a side effect of Tamoxifen can be uterine cancer in a small number of women. But, he said, it is also easily treatable. Ok, ladies, how is uterine cancer treatable? By removing my uterus from my body?
~~Connie~~

Marcia527 said:

Yes. My sister had uterine
Yes. My sister had uterine cancer. It had not spread to the nodes.

There are always risks...
... with everything. Even aspirin. Each of us makes our own individual decisions, every step of the way.

For me - I've always weighed the risks, one against the other.

roseann4 said:

Thanks!
Thanks for all your responses. Her doc wanted to see her immediately which may indicate a concern that it is related to the tamoxifen. If so, it sounds like it could be very aggressive.

Roseann

Keep us updated on her
Keep us updated on her Roseann. Praying for her!

Leeza