Less chemo for breast cancer patients

The Road Less Traveled

At first it looked promising; a combination of good news and good logic concerning breast cancer treatment. But as they say: The large print giveth and the small print taketh away.

We’ll start with the logic, because that’s the part that turns out to be genuinely good.

Similar, but not the same

Last week I came across an Associated Press item with this intriguing title: “Breast Cancer Patients to Get Less Chemo.”

The fact that chemotherapy side effects can be devastating is well known. What’s less well known is the fact that this exceedingly harsh therapy has little or no effect at all on a certain type of breast cancer. But that hasn’t stopped many oncologists from using the therapy anyway. That’s the nature of the medical mainstream beast.

In the past, the chemo question for breast cancer was not “if,” but “how much.” And it was all about size. Generally speaking, smaller tumors received a less aggressive chemo protocol than did larger tumors. Within that mindset, little regard was given to the type of tumor. And that’s where we’re seeing much-needed changes.

In recent years, doctors have begun to recognize that hormone status should be the factor that determines treatment. About 75 percent of breast cancer tumors in postmenopausal women are driven by estrogen. For these women, treatment with tamoxifen (a synthetic hormone-like drug) that prevents estrogen from binding to breast cancer cells has been shown to be more effective than chemo, even if the cancer has spread to lymph nodes.

In women who have not yet reached menopause, gene damage is usually the cause of breast cancer. Hormonal treatments won’t help in these cases.

A test called Oncotype DX has been developed to reveal which patients will most likely respond to chemo or tamoxifen. And although the test is expensive (more than $3,000), insurance companies may choose to offer coverage on the chance of deferring costly chemo treatments.

Nowhere’s the catch

While it’s good to see doctors becoming better attuned to the different types of treatment that different cancers require, there’s still a strong disposition among conventional MDs to stick with pharmaceutical solutions.

Take, for instance, tamoxifen. The most common side effects are not life threatening, but according to breastcancer.org “they may still decrease your quality of life, sometimes to a considerable degree.” That’s because tamoxifen can prompt hot flashes, nausea, vomiting, weight gain, mood swings, depression and a loss of energy. And those are only the annoying side effects. The dangerous side effects include an increased risk of developing blood clots as well as uterine and liver cancers.

So at best, tamoxifen looks like the lesser of two evils, rather than a welcome refuge from chemo. Some doctors will prescribe aromatase inhibitors in place of tamoxifen, but this relatively new class of drugs may increase the risk of osteoporosis. Other side effects include hot flashes, joint pain and muscle aches.

Alternative in a cream

In a widely distributed online magazine article about tamoxifen, health researcher and psychotherapist Sherrill Sellman notes that convincing evidence shows how natural progesterone may play a key role in breast cancer treatment and prevention. Ms. Sullivan cites a 1995 trial in which women who used a topical progesterone cream significantly reduced breast cell multiplication rates compared to women who received estrogen or a placebo.

Other benefits many women enjoy from natural progesterone cream include:

• Bone support
• Depression relief
• Improved blood sugar management
• ncreased libido

Talk to your healthcare professional about using progesterone. And by all means, if you’ve been diagnosed with breast cancer, ask your doctor if your condition is estrogen driven before you discuss your treatment options.

Sources:
“Breast Cancer Patients to Get Less Chemo” Associated Press, 12/10/05
“Beware of the Dark Side of Tamoxifen (Nolvadex)” Sherrill Sellman, InnerSelf, innerself.com