Chemoprevention for Breast Cancer

October 2011 will mark the 25th anniversary of the National Breast Cancer Awareness Month organization. Over the past quarter of a century, millions of organizations, companies, healthcare providers, patients, cancer survivors, and supporters have raised funds and most importantly awareness about breast cancer. A great deal has changed over these last 25 years. Mammography has improved to detect even earlier cases of breast cancer when treatments can lead to higher survival rates.

All those pink ribbons help to raise much-needed research funds and critical awareness about the benefits of early detection and possible risk factors that may increase your chance of developing breast cancer. Knowledge is powerful, and when women know what their risk factors are, they can be proactive about ensuring they stay as healthy as possible. A risk factor is simply a condition or set of conditions that may increase your likelihood of acquiring a disease. Risk factors do not mean that you will get breast cancer, and most women who get breast cancer have no known risk factors.

Some women are at higher risk than others of developing breast cancer in their lifetimes. Women who have had a previous breast cancer are at higher risk of developing a subsequent breast cancer. All women are at increased risk of developing breast cancer as they age, and the majority of breast cancers occur in women over the age of 50. Family history, heritage, race, and genetics all are factors that may increase a woman’s chance of developing breast cancer. Obesity and alcohol consumption can be a risk factor. Environmental factors like exposures to radiation and hormones can also increase the risk of getting breast cancer. There are many excellent resources to find out more in depth information about what your risk factors might be, including the American Cancer Society’s website: www.cancer.org.

Women who find that they are among the highest risk factor group may want to discuss with their health care provider the topic of chemoprevention for breast cancer. Over the last several years, a few medications that have historically been used in the treatment of breast cancer are now being investigated for their possible preventative qualities. These drugs fall into a few different categories and work in unique ways to lower breast cancer risk. Tamoxifen and raloxifene are called selective estrogen-receptor modulators or SERMs, and, as the name suggests, modulate or interfere with the estrogen in the body. Researchers believe that estrogen can stimulate the growth of breast cancer cells.

Both of these drugs are used to treat specific types of breast cancers which are estrogen-receptor positive. Tamoxifen has been studied for several decades and has been shown to reduce the incidence of estrogen-receptor positive cancers by as much as 48 precent in women who took it as a preventive therapy. However, as with any medication, there are known side effects, some of which are significant. Women taking tamoxifen are at increased risk of developing some gynecological cancers and major blood clots. Raloxifene works similarly to tamoxifene in interrupting the estrogen path that is critical for the growth of certain breast cancers. Raloxifene is a newer drug and has not been shown to be associated with the gynecological cancers but so far does not seem to have the same success rate as tamoxifene. Raloxifene also increases the risk of significant blood clots which can become life threatening.

The Federal Drug Administration has approved both tamoxifene and raloxifene for use as a medication to reduce breast cancer based on evidence from various studies conducted over many years. Women with an elevated risk of breast cancer need to work closely with their health care providers to calculate both their risk factors for breast cancer as well as their likelihood of developing health conditions from the side effects of these potent medications. Your health care provider will use many indices to determine your risk/benefit analysis including age, menopausal status, gynecological history and health including your Body Mass Index. Not all women with a high breast cancer risk will be good candidates for either drug.

Just as SERMs have changed how breast cancer is treated and prevented, newer drugs called aromatase inhibitors, such as exemestane, letrozole, and anastrozole are currently being used to treat breast cancer and are being studied for possible chemoprevention uses. These drugs work to stop aromatase, which is an enzyme used by the body to convert other hormones into estrogen. Early studies show that these agents may have fewer detrimental side effects like gynecological cancers and blood clots. Currently these drugs are just used as chemotherapy following surgery for breast cancer, and the FDA is awaiting results from a couple of studies to decide whether they will be approved for chemoprevention use.

Americans are well acquainted with chemoprevention. Think of the millions who are prescribed hypertension medicines or cholesterol-lowering medications to prevent the chance of having a heart attack or stroke. We have long known what causes cardiovascular disease and have prescribed medicines to help minimize an eventual event. Thanks to many Octobers of fund raising and research, we now have better ideas about what might cause some types of breast cancer and can prescribe medications that just might prevent this disease, too. 

Dr. Hardy is a solo physician at Atlantic Ob/Gyn with locations in Chesapeake and Virginia Beach. For more information, please call 463-1234 or visit www.atlanticobgyn.com.

 

 

 

 

 

 

 

 

 

Dr. Hardy is a solo physician at Atlantic Ob/Gyn with locations in Chesapeake and Virginia Beach. For more information, please call 463-1234 or visit www.atlanticobgyn.com.

Timothy J. Hardy, M.D.

Dr. Timothy Hardy, M.D. has been practicing medicine in the community for many years. He received his medical degree from Eastern Virginia Medical School and founded his own practice, Atlantic OB-GYN, in 1990, where he has been providing women with exceptional care ever since. Website: www.atlanticobgyn.com
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