I do feel that most oncol/hematol's have gotten the message that Tamox
confers no benefit after five years and the risk you mention continue.
If you look at what is covered by insurance, however, I suspect Tamox
will come out ahead even with the visits and problems you mention.
You are correct. There are less of the problems you describe but more
fractures and angina. A complicated matrix.
--
________________________________
Gregor
Sent: Friday, October 28, 2005 2:35 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Breast cancer
Sam,
Will aromotase inhibitors be price competitive to tamoxifen if one
factors in all the gyn referrals for tamoxifen spotting, sonos for endo
thickness, pippelle bx's etc? Also, will there be a lower risk of blood
clots? Not at all trying to flip here, but it does seem tamoxifen
generates a ripple effect of surveillance issues. Will it be same, in
between, or greatly differenct with this newer class of agents?
Hank
"Atkinson, Samuel M" <ATKINSONS@mail.ecu.edu> wrote:
My answers to your questions.
1.The classically quoted doubling time for breast cancers is 4
mos. Allowing for 5 mos and statistical variation, a 2 mm lesion can
well be hidden from view. In 5 mos it will be 5-6 mm and visible. When
a cancer is detected, it has probably been present for 5-7 years, a
piece of information the WHI people ignored for publicity sake or
ignorance. Thus the positive nodes at surgery.
2Yes.. Her chemRx. May be delayed a week or to to allow the wbc
to recover or marrow stimulants can be given.
3. The main difference is cost. Tamox is off patent and
generic. Arimedex is the opposite and terribly costly. The data shows
a slight improvement in survival with Arimedex but the question of cost
vs benefit is unsettled. They are both estrogen receptor modulators.
The data does show an increase in survival after five years on Tamox,
stopping it and then adding Arimedex. There is no advantage to more than
five years on Tamox.
4. Hope this helps. By the time breast cancer is detected
it is already a systemic disease in most people opinion..thus the
recommendation for irradiation locally and systemic chemo.
5. MRI is a better detector of breast cancers but cost is
prohibitive except in high risk/familial ca pts. Finding out if one had
the gene is probably money better spent than routine MRI's of breast.
6. Sam Atkinson
________________________________
________________________________
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf
Of GA12L@aol.com
Sent: Friday, October 28, 2005 4:22 AM
To: Multiple recipients of list OB-GYN-L
Subject: Breast cancer
My mother had a mamogram in January this year which was clear.
End of May she found a thickening of the skin and went to see GP. She
then had another mamogram and a biospy that revealed invasive lobular
breast cancer. She had a mastectomy they took 8 lymph nodes and found
cancer in the first 4 but not in the last 4. She's now having 6 sessions
of chemo (she's now had 4 as of yesterday) she will then have 4 weeks of
radiotherapy and then arimidex for 5 years.
What I want to know is why didn't the mamogram pick the cancer
up in January or is it possible for it to have developed and grow so big
in 5 months?
Her white cells are now 2.2 will she be able to complete her
last 2 courses of chemo?
What is the difference between Tamoxifen and Arimidex?
Will my mum be okay?
Thanks,
Gail
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