Re: Estrogen and breast cancer
From: Terrence.Jones@kp.org
Thu Jul 29 12:12:37 2004
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Joanne, there is some data on SERM's over time. The 8 year extended
outcome analysis on Raloxifene (MORE) continues to demonstrate reduced
breast cancer rates (>60% reduction) - no evidence, as yet of the
'resistance' effect initially suspected. Am told that FDA might formalize
additional indication sometime next year. As always - tweaking the data
can raise issues, but the magnitude of effect, in this setting, reduces
some of this (healthy) skepticism. tj
islesannie@yahoo.com (Joanne Bulley, MD)
Sent by: ob-gyn-l@obgyn.net
07/29/2004 06:11 AM
Please respond to ob-gyn-l
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
cc:
Subject: Re: Estrogen and breast cancer
I am convinced that for the majority of us (women) who will get breast
cancer -- will get it ... period. There is a lot of evidence
(partidularly now the estrogen only arm of the WHI) that indicates it is
not the estrogen that induces the cell to become cancer.
I am also convinced that the function of the SERMs - Tamoxifen and
Raloxifene - on reducing estrogen receptor positive breast cancers - is
one of delaying not preventing ever getting it. But there is no data
for that - so that is not what I tell my patients.
It is my opinion - not fact - that we live long enough that some of
these things just happen.
Look at the prostate cancer data. It appears that if men live long
enough about 75% will eventually get it. Do we know yet if that is
testosterone exposure - and what man would go wihthout his testosterone
until he already has prostate cancer? I know men who quit their Lupron
or whatever the other GnRH drug is - they'd rather let the cancer have
its way than not have sex!
We are still looking for the cause of these age related diseases and
illnesses. I think estrogen probably helps breast cancer be less
aggressive (like Dan Braun commented) and if it helps the general wel
beeing be better for someone - then go for it.
If I have a patient that is convinced she will stay on estrogen no
matter what - then I let her know my philosphy and let her know that it
is not any sort of scientific data but philosphy and I will support her
in her decision. But I no longer tell women that they should definitely
plan on estrogen. I tell them some info - tell them to gather their own
information and ask question of me whenever needed and we will cross
that bridge with whatever data is available at the time of need.
Whew! I got a bit long winded there!
Joanne
At Wed, 28 Jul 2004, art fougner, md wrote:
>
>Another factor is genetic predisposition. Since none of these studies
>report BRCA status, legitimate questions remain.
>
>art
>
>At Wed, 28 Jul 2004, Braun, R. Daniel wrote:
>>
>>Actually, does not the same issue apply to Estrogen Replacement Therapy
>>and endometrial carcinoma? All those who got endometrial CA while on ERT
>>had stage I Grade I lesions.
>>
>>Dan
>>
>>"Sound is like water. If you drill one hole in the wall the sound will
>>leak right through."
>>
>>- JAY BRAUN, a band member by love, a soundproofer by necessity.
--
Joanne Bulley, MD
Keene, NH, USA
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<br><font size=2 face="sans-serif">Joanne, there is some data on SERM's over time. The 8 year extended outcome analysis on Raloxifene (MORE) continues to demonstrate reduced breast cancer rates (>60% reduction) - no evidence, as yet of the 'resistance' effect initially suspected. Am told that FDA might formalize additional indication sometime next year. As always - tweaking the data can raise issues, but the magnitude of effect, in this setting, reduces some of this (healthy) skepticism. tj</font>
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<td><font size=1 face="sans-serif"><b>islesannie@yahoo.com (Joanne Bulley, MD)</b></font>
<br><font size=1 face="sans-serif">Sent by: ob-gyn-l@obgyn.net</font>
<p><font size=1 face="sans-serif">07/29/2004 06:11 AM</font>
<br><font size=1 face="sans-serif">Please respond to ob-gyn-l</font>
<br>
<td><font size=1 face="Arial"> </font>
<br><font size=1 face="sans-serif"> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net></font>
<br><font size=1 face="sans-serif"> cc: </font>
<br><font size=1 face="sans-serif"> Subject: Re: Estrogen and breast cancer</font></table>
<br>
<br><font size=2 face="Courier New">I am convinced that for the majority of us (women) who will get breast<br>
cancer -- will get it ... period. There is a lot of evidence<br>
(partidularly now the estrogen only arm of the WHI) that indicates it is<br>
not the estrogen that induces the cell to become cancer.<br>
<br>
I am also convinced that the function of the SERMs - Tamoxifen and<br>
Raloxifene - on reducing estrogen receptor positive breast cancers - is<br>
one of delaying not preventing ever getting it. But there is no data<br>
for that - so that is not what I tell my patients.<br>
<br>
It is my opinion - not fact - that we live long enough that some of<br>
these things just happen.<br>
<br>
Look at the prostate cancer data. It appears that if men live long<br>
enough about 75% will eventually get it. Do we know yet if that is<br>
testosterone exposure - and what man would go wihthout his testosterone<br>
until he already has prostate cancer? I know men who quit their Lupron<br>
or whatever the other GnRH drug is - they'd rather let the cancer have<br>
its way than not have sex!<br>
<br>
We are still looking for the cause of these age related diseases and<br>
illnesses. I think estrogen probably helps breast cancer be less<br>
aggressive (like Dan Braun commented) and if it helps the general wel<br>
beeing be better for someone - then go for it.<br>
<br>
If I have a patient that is convinced she will stay on estrogen no<br>
matter what - then I let her know my philosphy and let her know that it<br>
is not any sort of scientific data but philosphy and I will support her<br>
in her decision. But I no longer tell women that they should definitely<br>
plan on estrogen. I tell them some info - tell them to gather their own<br>
information and ask question of me whenever needed and we will cross<br>
that bridge with whatever data is available at the time of need.<br>
<br>
Whew! I got a bit long winded there!<br>
<br>
Joanne<br>
At Wed, 28 Jul 2004, art fougner, md wrote:<br>
><br>
>Another factor is genetic predisposition. Since none of these studies<br>
>report BRCA status, legitimate questions remain.<br>
><br>
>art<br>
><br>
>At Wed, 28 Jul 2004, Braun, R. Daniel wrote:<br>
>><br>
>>Actually, does not the same issue apply to Estrogen Replacement Therapy<br>
>>and endometrial carcinoma? All those who got endometrial CA while on ERT<br>
>>had stage I Grade I lesions.<br>
>><br>
>>Dan<br>
>><br>
>>"Sound is like water. If you drill one hole in the wall the sound will<br>
>>leak right through."<br>
>><br>
>>- JAY BRAUN, a band member by love, a soundproofer by necessity.<br>
<br>
--<br>
Joanne Bulley, MD<br>
Keene, NH, USA<br>
</font>
<br>
