Should you be taking tamoxifen?

April 24, 1998|By KATE COLEMAN

Joyce Hill is a breast cancer survivor. Five years ago she had both breasts removed and six months of chemotherapy. She has been taking a drug called tamoxifen since then.

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Tamoxifen has been used for the past two decades to treat breast cancer, according to National Cancer Institute.

The drug, taken orally - one pill twice a day - is "quite efficient" in preventing the recurrence of breast cancer, said Dr. Frederic H. Kass, director of John R. Marsh Cancer Center at Robinwood Medical Center in Hagerstown.

On April 6, National Cancer Institute announced results of the Breast Cancer Prevention Trial, a study designed to see whether tamoxifen prevents breast cancer in women at increased risk of developing the disease. Those results showed a 45 percent reduction in the incidence of breast cancer among the high-risk participants who took it in the trial.

Kass isn't surprised. It's been known for a long time that tamoxifen prevents recurrence of breast cancer in women who already have had it, he said. "It makes sense that it will work."


But he called the data "awfully preliminary".

"It's interesting information. Where it fits in remains to be seen," Kass said.

Kass said he was asked some questions about the study, but, despite the flurry of news reports about the results, he didn't get any calls from women asking if they should be taking the drug.

In the trial, women at increased risk for developing breast cancer have taken tamoxifen or a placebo daily for about four years. Because the risk of breast cancer increases with age, women ages 60 and older were eligible on the basis of age alone. The risk of the others was determined by a computer calculation based on factors including family history, the number of times a woman had breast lumps biopsied or whether a woman had a type of noninvasive breast cancer.

Hill, 55, has experienced no side effects from taking tamoxifen, although some are possible. The Williamsport resident said she doesn't even read the literature in the package, not wanting any negative thoughts in her mind.

Garnet Hall has been on tamoxifen for about a year. Diagnosed with cancer in Sept. 1996, the 59-year-old resident of Falling Waters, W.Va., had a mastectomy, chemotherapy and 32 radiation treatments. Hall said she lost her hair and didn't have much energy during her chemotherapy, but she considers herself "pretty fortunate" in not getting sick on the medication. Hall blames some water retention and weight gain on tamoxifen, but hot flashes she already was experiencing were no worse after she started taking the drug.

That's not the case for Kathleen Middaugh-Shockey, who's been taking tamoxifen since January. The 46-year-old resident of Greencastle, Pa., began a chemo-induced menopause after her second chemotherapy treatment. Her hot flashes have occurred more frequently since she started taking tamoxifen. She's also gained some weight, but will continue the medication. "I'm doing what I'm told," she said.

T9C Dinterman - her name, which doesn't mean anything, was given to her by a preacher - took tamoxifen after her 1989 surgery for breast cancer. The Hagerstown resident was off it for a while when she had brain surgery unrelated to her breast cancer, but she started taking it again in 1993 without side effects. Active at 73, Dinterman works as a hairdresser four days a week. She says tamoxifen is expensive - about $1,200 a year - and is not covered by Medicare.

Although the Breast Cancer Prevention Trial showed that tamoxifen prevented the development of breast cancer in a significant number of healthy women, it also showed that the drug increased older women's chances of developing endometrial cancer and blood clots.

"This is a real advance, but it is no magic bullet," said National Cancer Institute Director Richard Klausner, M.D., in the April 6 press release.

In communications with Y-ME of the Cumberland Valley, the local chapter of the breast cancer information and support organization, Fran Visco, spokesperson for National Breast Cancer Coalition, a breast cancer advocacy group headquartered in Washington, D.C., acknowledged excitement, but urged caution about the study. Women at high risk of breast cancer need to determine whether benefits outweigh the risks of taking tamoxifen.

National Cancer Institute and the Pittsburgh-based research network that conducted the trial are developing information to help individuals - with the help of their health-care providers - decide if tamoxifen is the right choice for them.

In time, with further study, researchers may define a risk group that can benefit from the drug, Kass said.

Joyce Hill regarded the news of the study results as "marvelous" - especially for women with breast cancer who have children.

"People have to look at the 'C' word not as a death sentence," she said.

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