elynjacobs

Is Tamoxifen Right for Me? Is There an Alternative?

In Uncategorized on January 23, 2014 at 2:50 pm

Tamoxifen has been successfully used in the management of breast cancer for over twenty years.  However, as with any drug, Tamoxifen has benefits and risks associated with its use. The general opinion seems to be that the benefits outweigh the risks. For many men and women, choosing Tamoxifen may be the right choice for them.

For others the side effects are very real, and the risk is too high– namely the risk of developing uterine cancer, blood clots, muscle pain, mental fogginess and cataracts.  This can be especially true for those with certain early stage breast cancers.  Such concerns have led many to seek alternatives to hormone therapy.

pills tamoxifenHow can you know which is the right choice for you?  Be informed; empower yourself to educate yourself with information and options.  You may want to take advantage of one the risk/benefit calculators such as www.lifemath.net  to help you gain a better understanding of your individual risk for declining Tamoxifen, and weigh those risks against your concerns and reservations of taking the drug.

To help you understand how these calculators can help you, Dr Gwen Stritter, MD, an expert in clinical advocacy, shared with me two different scenarios and how the use of Tamoxifen would play out in each:

● Let’s take the case of someone with a 1 cm, stage I ER-positive breast cancer.  The proportional reduction in breast cancer death from using Tamoxifen for 5 years in a woman < 50 years of age is about 32% (Early Breast Cancer Trialists Collaborative Group, Lancet 1998).  The typical stage I ER+, node-negative patient at 40 years of age has a 6.3% risk of cancer death in the next 15 years without treatment (www.lifemath.net).  Adding Tamoxifen would decrease the mortality rate by 32% which means it would decrease to 4.3%, an absolute gain of only 2 percentage points of survival.  In this situation, it could make a lot of sense for someone to decline Tamoxifen and use only alternative approaches if they were getting uncomfortable side effects.

● Now let’s take another hypothetical example:  someone with a stage II, ER-positive, node-negative breast cancer.  The same calculation shows that there is a 20% chance of death in the next 15 years without treatment.  Adding Tamoxifen would decrease the mortality rate to 13.6%, an absolute gain of almost 7 percentage points.  If that seems like only a small gain, remember that gain is more percentage points than the risk of actual death in the untreated stage I case.  And, that translates to, on average, an extra 3 years of survival because of the Tamoxifen therapy.  If it were a stage II node-positive case, Tamoxifen would add on average 4 years of life.  If it were a stage III cancer, the benefits of Tamoxifen would be even greater – almost 6 years of life gained, on average.  Many men and women would tolerate more side effects for such a gain of survival.

For the stage I BC example, the worst-case scenario is only a 2% increased risk of death – avoiding Tamoxifen and using only alternative approaches with a reasonable clinical track record does not seem to be such a risk.  In higher stage examples, the risk of death would more than triple causing an average loss of 3 – 6 years of life.  Dr Gwen Stritter, MD

We can gain valuable information on our risk/reward by using one of these calculators, as well as by gathering information from our medical team– every bit of information you can gather will help you to make the most informed choice possible. However, while statistics can be useful for treatment recommendations, they do not always predict the outcome of an individual.  Every person and every cancer is unique with its own set of circumstances based on genetic and physiological characteristics associated with them.  The calculated results and other statistics do not factor in quality of life or the lifestyle choices and factors of the patient, so use such information to help you make choices, not to put a timeline on your life.

We also do not have any side-by-side studies that compare the use of hormone therapy versus holistic approaches.  Part of the reason is lack of funding—drug companies have little to no reason to fund such studies and there is comparatively little profit from the alternative approach.  So until the day comes when this scenario changes (don’t hold your breath), we are left to weigh the pros and cons and make the best decision for us, our cancer, and our own individual needs.

I just tried this out on myself, giving the information at diagnosis (as it was not available to me then). At 45 year old, I would have a 1.8% risk of cancer death in the next 15 years without treatment, and it would be expected that this cancer would shorten my life expectancy by 0.8 years (from 37.3 year to 36.5 years.)  Therefore the therapy would give me an additional 96 days.  In my case Tamoxifen might not be worth the risk.  Remember too…these are just averages—my actual risk could be higher or lower depending on my own unique circumstances. ej

If you choose Tamoxifen, you may want to consult an integrative or alternative doctor or a qualified coach for advice on nutrients that can help boost the efficacy and reduce the side effects of the drug—as well as improve your survival.  I am happy to help you or assist you with a referral; please leave a request here.

If you choose not to take hormone therapy, please know that managing estrogen and your breast cancer requires a comprehensive approach encompassing diet, exercise, stress reduction and other mind-body-spirit therapies. For more information on an alternative approach to hormone therapy, please read Natural Alternatives to Tamoxifen and view my video with Dr Kelly Turner, PhD, author and founder of The Radical Remission Project. To discuss options or for a referral, please leave a request here.

Please remember that managing cancer is not just about managing estrogen.  If you do not change the environment in which your cancer was permitted to grow, you may increase your risk of recurrence.   Addressing stress issues, diet, sleep habits, exposure to toxins, adrenal fatigue, thyroid and iodine deficiencies and other cancer responsive imbalances may make your terrain less hospitable to cancer.

Elyn

             ~~If you don’t know your options, you don’t have any~~

 

MEDICAL DISCLAIMER:  Reading the information in this post does not constitute a physician-patient relationship. The information included in this post is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Always consult with your healthcare provider regarding a medical condition or any treatments.

 Gwen Stritter, MD is a physician and clinical advocate/navigator who has been practicing intensive, personalized research and advocacy for those with life-threatening health problems for the past 13 years.  Her area of special expertise is integrative breast oncology. 

She is coauthor of the chapter on clinical advocacy (chapter 19) in the textbook, Patient Advocacy for Healthcare Quality: Strategies for Achieving Patient Centered Care (2007) and a frequent speaker at integrative oncology and breast cancer conferences.

While side effects of breast cancer therapy have recently caused Dr. Stritter to close her clinical practice, she has since committed herself to studying the effect of active integrative approaches on metastatic breast cancer survival and sharing this information with those whose lives have been touched by it.  With several other women living with breast cancer, she has started a non-profit, People-Powered Research, to do the clinical research that highly interests patients but is a not focus for the academic-pharma complex.

 Elyn Jacobs is a breast cancer survivor, professional cancer strategist, speaker, and the Executive Director for the Emerald Heart Cancer Foundation. Elyn empowers women to choose the path for treatment that best fits their own individual needs. She is passionate about helping others move forward into a life of health and well-being. Elyn has been featured on CNN Money, Talk About Health, and Breast Cancer Answers and has written for the Pink Paper, Breast Cancer Wellness, Integrative Oncology Essentials, Surviving Beautifully, Body Local and more, and writes the Options for Life column for the Natural Healing-Natural Wellness Newsletter.  Elyn hosts the Survive and Live Well Radio Show on the Cancer Support Network. Elyn lives in New York with her husband and two young boys. https://elynjacobs.wordpress.com/about/

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