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Preventive medicine for breast cancer

Fergus Walsh | 18:24 UK time, Monday, 28 March 2011


The idea of drug treatment to prevent cardiovascular disease is well-established. Not so with cancer. Now a panel of cancer experts, writing in Lancet Oncology have suggested that drugs such as tamoxifen could reduce the chances of developing breast cancer. You can read more about the story here.

Tamoxifen is a powerful medicine and the researchers make clear that it is not without side-effects. So women would need to think carefully before deciding whether they wanted to take the treatment long-term.

As with all medicines it comes down to an assessment of risks versus benefits, but that is especially important when healthy individuals take a treatment.

Professor Jack Cuzick, an epidemiologist at Queen Mary, University of London put the risk-benefit analysis this way: "For every 1,000 women on tamoxifen for 10 years, we estimate there would be 20 fewer breast cancers. But there would be three more womb cancers and six more deep vein thromboses."

So a key factor will be identifying women who are at increased risk of breast cancer. Among measures already taken into account are family history and increasing age. The researchers say increased breast density - visible on mammograms - could also be a useful assessment tool.

There are other factors which affect a woman's lifetime risk such as reproductive history and issues such as bodyweight, physical activity and alcohol intake. The Cancer Research UK website has a huge amount of information.

Tamoxifen is not licensed as a preventive therapy, and is off-patent. Professor Cuzick suggested this meant there was no great financial motive for the pharmaceutical industry to push for it to be licensed for prevention. He hopes current trials might eventually persuade NICE, the health watchdog, to back it as a preventive treatment.

Comments

  • Comment number 1.

    Knock Knock, who's their? Darlek. Darlek who? Exterminate, the Doctor is or enemy!

  • Comment number 2.

    In the article, the most important words are:

    “So women would need to think carefully before deciding whether they wanted to take the treatment long-term“.

    They should be also made aware of the following facts:

    1. Patients taking Tamoxifen run a high risk of developing thrombocytopenia (Low platelet count) LPC . If they do, either the Tamoxifen should be stopped for a few days or replaced with another drug e.g. Femara and the LPC monitored. (Between 2003/6, NICE said that not only were there clinical benefits, to be gained from switching all patients, who had been on Tamoxifen for 2-3 years, to Anastrozole, but it was also cost effective by reducing side effects.

    2. Patients over 65 with thrombocytopenia and/or easy bruising, should be checked for aneurysms. (The NHS is routinely screening only men over 65 for aneurysms. The ratio of deaths, in 2003, was less than 1.6 men to one woman).

    3. Between 2003 and 2007, over 25 newly discovered side-effects were added to the Patient Information Leaflet (PIL) by the makers.

    On 21 December 2009, my wife aged 77, who had been on Tamoxifen for nearly five-years died. During autopsy, it was found her aorta was riddled with undetected aneurysms. Although she developed thrombocytopenia in early 2008 and easy bruising in April 2009, no specific treatment or tests were carried out. She was subject to a watchful wait. In August 2009 I bypassed her GP and an oncologist stopped the Tamoxifen - by the next blood test my wife’s Platelet Count had returned to normal for the first time in 22-months, but unfortunately far too late to save her life.



  • Comment number 3.

    I developed breast cancer at the rather young age of 40. I was treated with a lumpectomy, radiotherapy, hormonal treatment (two years of Zoladex that induces an artificial menopause) and a five-year course of Tamoxifen. After some three years on Tam I developed shortness of breath and a pain in one of my calves. During a routine breast cancer follow-up when I mentioned these symptoms; the Dr I spoke to had me taken immediately to hospital. It was discovered I had developed DVT (deep vein thrombosis) and also a possible PE (pulmonary embolism). The culprit after extensive blood tests was probably the Tam. Today I am fine but this is why breast cancer patients require at least annual follow-ups. Tamoxifen if not without risks and anyone on it should be carefully monitored and made aware of the symptoms of possible complications.

 

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