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Femara Tops Tamoxifen for Early Stage Breast Cancer

According to a recent article  in The Lancet Oncology and Breast Cancer Org–Many postmenopausal women take hormonal therapy medicine — either an aromatase inhibitor or tamoxifen — after breast cancer surgery and other treatments for hormone-receptor-positive, early-stage breast cancer. Hormonal therapy medicine can reduce the risk of the cancer coming back (recurrence). Treatments given after surgery are called “adjuvant” — in this case adjuvant hormonal therapy.

The latest results from the BIG 1-98 trial found that the aromatase inhibitor Femara (chemical name: letrozole) was better at reducing the risk of recurrence and improving survival compared to tamoxifen when taken for 5 years as the first hormonal therapy after surgery.

The results were published early online on Oct. 21, 2011 in The Lancet Oncology.

In the BIG 1-98 trial, more than 8,000 postmenopausal women diagnosed with early-stage, hormone-receptor-positive breast cancer were randomly assigned one of four treatments after surgery:

  • 5 years of Femara
  • 5 years of tamoxifen
  • 2 years of tamoxifen then 3 years of Femara (sequential therapy)
  • 2 years of Femara then 3 years of tamoxifen (sequential therapy)

Half the women were followed for more than 8 years; the others for shorter times. The researchers then compared the outcomes of the different treatments.

Using two types of statistical analysis, the researchers found that women who got 5 years of Femara had:

  • better disease-free survival (living without the cancer coming back)
  • better overall survival (living whether or not the cancer came back)

compared to women who got 5 years of tamoxifen.

Women who got either of the sequential therapies (Femara for 2 years, then tamoxifen for 3, or tamoxifen for 2 years, then Femara for 3) had about the same recurrence risk, and the same overall survival, as women who got only Femara for 5 years.

Research continues to show that an aromatase inhibitor is the best hormonal therapy medicine after breast cancer surgery for postmenopausal women diagnosed with early-stage, hormone-receptor-positive breast cancer. Still, tamoxifen can be a good choice depending on a woman’s unique situation. Side effects and cost may make tamoxifen a better choice for some women. Sequential therapy also may allow some women to get the benefits of Femara without taking it for all 5 years.

When you’re deciding on a treatment plan after breast cancer surgery, keep two things in mind:

  • Every woman responds differently to treatment. What works for you may not work for someone else.
  • Your treatment plan isn’t written in stone. You can always switch medicines if another treatment has greater benefits and fewer side effects.

If you’re a postmenopausal woman being treated for hormone-receptor-positive, early-stage breast cancer, ask your doctor about the differences in benefits and side effects of aromatase inhibitors and tamoxifen. If you’re currently taking tamoxifen, discuss whether switching to an aromatase inhibitor makes sense for you. Together, you can decide on a treatment plan that is best for YOU.

 

Stress and the Immune System

Why do many people feel so much more stress at this time of year? We tend to blame worsening traffic, crowded malls, and incessant commercials pushing holiday consumption, but a key culprit is our own memories, according to Ronald Nathan, PhD, clinical professor at Albany Medical College in New York. “When we think about the holidays, we dwell on the past and what went wrong, or we romanticize it and make it impossible to re-create,” he says.

He counsels people to carefully examine their thoughts and expectations, and not drive themselves crazy finding “the perfect gift” or planning “the perfect party.” “Instead,” he says, “lower your expectations, and overestimate — rather than underestimate — your time.”

Easing up on yourself over the holidays is important because the connection between stress and illness is real, says Simon A. Rego, PsyD, an assistant professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine and associate director of psychology training at Montefiore Medical Center in Bronx, N.Y.

“The controversy that stress causes disease is pretty much over. We’re now teasing out how stress does it,” he says. In fact, a new study explains how stress may weaken the immune system. Each cell contains a tiny “clock” called a telomere, which shortens each time the cell divides. To counter this effect, the body also produces an enzyme, telomerase, which protects the cell and prevents further shortening by adding more DNA to the end of the telomere.

So far, so good — but under stress, the body pumps out cortisol, a hormone that suppresses this protective enzyme. The study found that people under chronic stress have shorter telomeres, which, researchers say, means they are more vulnerable to a host of ailments.

Health effects of stress

How to reduce the wear, tear, and misery that holiday stress can inflict? When your holiday to-do list stretches longer than Santa Claus’s beard, eliminate whatever is unnecessary. Doing so may reduce your risk of:

-Heart disease, including heart attacks

-Skin conditions, including psoriasis and shingles

-Digestive disorder flare-ups, such as symptoms of irritable bowel syndrome, ulcerative colitis, and Crohn’s disease

-Immune disorders, including flare-ups of multiple sclerosis and lupus

-Anxiety, depression, and insomnia

-Worsening pain, if you already have a pain disorder such as arthritis, back pain, and muscle spasms”

Make sure to read our article on Massage Therapy for Stress Relief!

By: Charlotte Libov

Don’t Let “Stressmas” Ruin The Beauty of Your Holiday Season!

Keep Holiday Stress to a Minimum: Learn to Say No

Before your holiday stress levels start to rise, learn these 4 simple tactics for saying no to unnecessary obligations.
By
Reviewed by Louise Chang, MD

For many of us, the holidays were magical in childhood, carefree times to be savored. But then we grew into hordes of harried adults, falling victim to the season’s high expectations. Holiday stress has become as much a tradition as the Christmas ham.

“People are overcommitted,” says Marc D. Skelton, PhD, PsyD, a psychologist in Laguna Niguel, Calif. “Christmas and other holidays around this time are always supposed to be fun, and you’re supposed to do a good job in terms of entertaining friends and family.”

In an attempt to live up to the season’s tall orders, “people will just run from pillar to post,” he says. It’s not even “Christmas” anymore, some of his clients lament. It’s “Stressmas.”

We also overload ourselves with inherited traditions, even when they no longer fit into our busy lives, says Elaine Rodino, PhD, a psychologist in Santa Monica, Calif. If one’s mother “baked a thousand cookies and gave them to everyone she knew,” Rodino says, “people feel obligated to follow the same kinds of things.”

But there is a secret to cutting holiday stress: Just say no.

You don’t have to bake all those cookies, Rodino says. “You can start your own traditions.”

And you can learn to say no to lots of other demands, too, including party invitations that don’t entice or a whopping gift list that could clean out a mall.

Holiday Stress-Reduction Tip: Decide What Matters Most

“The spirit of the holidays is gratitude and giving,” says Patti Breitman, co-author of the book How to Say No Without Feeling Guilty.

Only a Scrooge would dispute that generosity is admirable. “It’s very satisfying to offer support to the people we love, help out a neighbor, or do something positive for the community,” Breitman writes. But “the conflict arises when we continually agree to things that please everyone but ourselves or when we commit to tasks for which we have no time or desire.”

By saying “yes” to every holiday invitation and demand that comes your way, you could wind up exhausted and possibly broke. Instead, reflect on what you cherish most about the holidays, experts say, whether it’s sending greeting cards to maintain relationships, tree trimming, baking, religious observances, seeing family and friends, supporting a charitable cause, or just relaxing.

When you know your priorities, you can turn down the less important things, Breitman says. “It’s easier to say ‘no’ if you know what you’re saying ‘yes’ to.”

How to Say No to Holiday Stress

1. Say No to Parties That You Don’t Want to Attend

First, “Lavishly thank the person for inviting you,” Breitman says.

Then apply the “less is more” rule, she says. Skip the long-winded explanation in favor of something short, sweet, and general: “I’m sorry, but I already have plans for that day.”

1. Say No to Parties That You Don’t Want to Attend continued…

“Your plan may be to take a bubble bath because you’re stressed out. Or you’re renting a movie and having hot cocoa with your family,” Breitman says. “No one has to know what your commitment is.”

If the other person insists on knowing why you can’t come, the burden of prying will be on him, Breitman writes in her book. Don’t fall into the trap of coming up with new and creative excuses, she says. Instead, paraphrase yourself: “I won’t be able to come” or “I already have something on my calendar.”

 Don’t lie and make up an excuse, Skelton says. “You don’t want to hurt someone’s feelings, so you come up with anything, but later, it might come back to bite you.” In other words, you’ll feel embarrassed if you’re caught, and you’ll damage the relationship, too.

If you receive an invitation from someone you genuinely want to see — just not during the hectic holiday season — suggest an alternative, Breitman says. For example, you can say, “I can’t make it to your party, but let’s have lunch after the holidays.”

2. Say No to Out-of-Control Gift-Giving

“Nothing saps the holiday spirit like having to run around and buy gifts you don’t have time to shop for, can’t afford, and that nobody really needs anyway,” Breitman says.

If you’re fed up, you can opt out of family gift-giving traditions “if you don’t mind looking like ‘the Grinch who said no to Christmas,'” she says.

Or you take a more tactful approach. Consider drawing names for a gift exchange or buying one gift for a household instead of individual presents. Or experiment with novel alternatives:

  • Pool your money and invest in a professionally done family portrait, with prints for everyone.
  • Replace material things with a memorable holiday experience. Rent a house in a vacation spot or national park, or gather everyone to attend a special holiday play or performance.

Gift cards to family and friends can be a godsend. But Breitman offers another twist — especially for those on your list who don’t need another cheese gift basket or motorized tie rack.

Tell them, “I’m starting a new tradition. Instead of giving gifts, I’m going to make a contribution to an organization in your honor.”

3. Say No to Unwanted Houseguests

Your cousin — the one who recalls at every family gathering how you got stuck in the dog door trying to sneak out of the house in high school — wants to move his brood into your home for a week, but you know that you’ll end up getting on each other’s nerves.

“Keeping houseguests away is a lot easier than getting rid of them,” Breitman warns. “Once they’re under your roof, it’s almost impossible to evict someone in a graceful, guilt-free manner.”

Some preventive tactics:

  • “You’re coming to town? Fantastic! A great new hotel just opened — you’ll love it!”
  • “Sorry, the house is in no condition for guests right now.”
  • “I can’t wait to see you. Do you need recommendations on a good place to stay?”

4. Say No to Taking On the Work for a Big Holiday Celebration

Are you the family’s Martha Stewart? The one who knocks herself out every Christmas to prepare an elaborate feast for the extended clan?

If festive entertaining leaves you frazzled, Breitman suggests a change of scenery. For example, say, “Everyone has been coming here for Christmas for years, but I need a break. Either someone else can do it or we’ll all go out to a restaurant.”

If you still plan to host, but don’t want to shoulder the entire burden, the word “tradition” carries extra clout during the holidays, Breitman says. Use it to your advantage. Tell your guests, “I’m starting a new tradition. This year, everyone will bring one dish for the meal.”

Because others are busy, too, “Make sure that they understand that no one has to make it from scratch,” Breitman says.

It’s fine if Grandma’s soup came from the deli or your nephew shows up with store-bought dinner rolls. As Martha likes to say, it’s a good thing.

Leading Breast Cancer Organization Comments on Long Term Mammography for Breast Cancer Survivors

BREASTCANCER.ORG SAYS:

Women who’ve been diagnosed with breast cancer are at risk for the cancer coming back (recurrence) and also have a higher-than-average risk of being diagnosed with a new, second breast cancer. So regular breast cancer screening is very important for survivors.

To find out if doctors were recommending breast cancer screening to survivors, researchers surveyed British physicians who care for women diagnosed with breast cancer. The researchers also reviewed the results of eight studies on the benefits of ongoing breast cancer screening for survivors.

The results:

  • Doctors didn’t consistently recommend ongoing, long-term breast cancer screening for survivors.
  • Ongoing, long-term screening for survivors is lifesaving: women who were screened consistently for 10 years or more were 72% less likely to die from recurrent or new breast cancer compared to women who didn’t get consistent, long-term screening.
  • The risk of a recurrence or a new, second breast cancer was about the same during each of the 10 years after diagnosis. Most people think that if breast cancer is going to come back or a new cancer to develop, it will be in the first 2 or 3 years after diagnosis — this study found that isn’t the case.

The results were published in the September 2011 issue of Health Technology Assessment.

These results underscore the importance of long-term, regular screening mammograms for survivors. Still, other research has shown that mammograms alone can be less effective at detecting breast cancer in women with a personal history of breast cancer. Survivors may benefit from other screening tests — such as breast MRI or breast ultrasound — in addition to screening mammograms. Some experts think that screening with 3-D mammograms also may be especially useful for survivors. The FDA has approved a 3-D mammogram system, but the technology may not be widely available.

If you’ve been diagnosed with breast cancer, you and your doctor should develop a screening plan tailored to your unique situation. If the plan includes only regular mammograms, you may want to ask your doctor if breast MRI or ultrasound along with mammograms might make sense for you. No matter what your screening plan includes, be sure to stick with it over the long term, not just in the first few years after you’ve finished treatment.

Long Term Mammography Needed for Breast Cancer Survivors

(MedPage Today) –Regular surveillance mammography after breast cancer boosts survival and should be continued for at least a decade, a systematic review suggested.

Second cancers in the same or opposite breast occurred at a fairly constant rate over the first 10 years instead of being largely in the first two or three years as often thought, Clare Robertson, MSc, of the University of Aberdeen, Scotland, and colleagues found.

Mammographic follow-up to detect these tumors was associated with reduced all-cause mortality and breast cancer-specific mortality in the studies reviewed.

Because the analysis also presented favorable data regarding cost-effectiveness, the group argued online in Health Technology Assessment for routine surveillance mammography out to at least 10 years.

Action Points


  • Yearly surveillance mammography after breast cancer boosts survival and should be continued for at least a decade.
  • Note that surveillance mammography for breast cancer survivors appeared to be cost-effective.

Annual surveillance after breast cancer surgery is recommended in guidelines from the American Society of Clinical Oncology, and is common practice in both Britain and the United States.

The researchers surveyed 183 surgeons and radiologists at 105 British centers and found that most stopped following women with surveillance mammography (74%). Slightly over half said they stop at 10 years, though discontinuation at five years was also common at 35%.

Though surveillance schedules varied widely, follow-up mammography usually started at 12 months (87%), repeated annually (72%), and was coordinated using a symptomatic breast service (96%).

Most clinicians surveyed also reported discharging women from clinical follow-up (82%), typically at five years after breast cancer surgery (65%).

The researchers cautioned that their response rate was low (17% of 1,048 surveys sent out) but noted that the responses correlated fairly well with prior surveys on the topic and were likely representative.

The review also looked at the eight cohort studies that have reported on the mortality impact of surveillance mammography among breast cancer survivors.

All suggested a benefit of routine follow-up, though methods differed sufficiently to preclude pooled analysis.

All-cause mortality was 34% lower with yearly surveillance mammography than without it (age-adjusted odds ratio 0.66, 95% confidence interval 0.51 to 0.86) in one study.

Breast cancer-specific mortality was 72% lower with surveillance mammography (multivariate adjusted hazard ratio 0.28, 95% CI 0.22 to 0.37) in another study.

The smaller tumors that could only be found with imaging were associated with better survival odds than larger tumors among these women as well, the group reported.

Tumors larger than 20 mm in diameter — which represent about 80% of those detected with mammography done every three years — independently raised the relative risk of death 2.26-fold compared to those under 10 mm in diameter (95% CI 1.58 to 3.24).

Tumors with missing size data, which likely were those of women who did not have surgery, were associated with 3.19-fold higher risk of death (95% CI 2.24 to 4.53).

“While we have no information as to how these events were detected in clinical practice, the implication is that surveillance mammography may be of value,” Robertson’s group wrote, since it suggests, “that surveillance mammography could be used to reduce the size at which ipsilateral breast tumor recurrence or [second contralateral] cancers are detected.”

Yearly mammography alone, without additional clinical examination, appeared to be the regimen with the biggest net benefit and most likely to be considered cost-effective in the group’s economic analysis.

The incremental cost of yearly surveillance mammography was $7,364 (£4,727) per quality-adjusted life-year compared with no surveillance, falling well below the traditional British regulatory threshold of £30,000 for cost-effectiveness.

But for lower risk women, such as the 70-year-old in the scenario modelled, “it may be more cost-effective for surveillance to be performed less often (every two or three years) with mammography alone or another similarly less intensive and less costly test or combination of tests,” the group wrote.

They acknowledged the paucity of data available to go into the economic models, making it an exploratory analysis that should be interpreted cautiously.

By Crystal Phend, Senior Staff Writer, MedPage Today
Published: October 02, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner