Hot Topics - Breast Cancer

Consumer Reports says:

• "Tamoxifen reduces the risk of breast cancer (and possibly fractures) but increases the risk of uterine cancer, blood clots, and cataracts. And its long-term effects are unknown. So it's worth taking tamoxifen only if you're at high risk of breast cancer and at low risk of harm from the drug itself, as described above." [From "Breast cancer: Clearing up the confusion" October 15, 1999].
  
  
• "The benefits of regular screening mammograms, usually starting at age 40, have become clearer than ever. To help ensure an accurate mammogram, follow the steps listed above. But don't rely just on mammograms--include manual exams as well." [From "Breast cancer: Clearing up the confusion" October 15, 1999].
  
  

"Is screening for breast cancer with mammography justifiable?" - Danish researchers report in The Lancet (Jan. 8), "Screening for breast cancer with mammography is unjustified. If the Swedish trials are judged to be unbiased, the data show that for every 1000 women screened biennially throughout 12 years, one breast cancer death is avoided whereas the total number of deaths is increased by six. If the Swedish trials (apart from the Malmo trial) are judged to be biased, there is no reliable evidence that screening decreases breast-cancer mortality. Media coverage: The Guardian | The Independent

"Weighing the Risks and Benefits of Tamoxifen Treatment for Preventing Breast Cancer " - Researchers report in The Journal of the National Cancer Institute (Nov. 3), "The risks and benefits of tamoxifen depend on age and race, as well as on a woman's specific risk factors for breast cancer. In particular, the absolute risks from tamoxifen of endometrial cancer, stroke, pulmonary embolism, and deep vein thrombosis increase with age, and these absolute risks differ between white and black women, as does the protective effect of tamoxifen on fractures. Tables and aids are developed to describe the risks and benefits of tamoxifen and to identify classes of women for whom the benefits outweigh the risks... The quantitative analyses presented can assist health care providers and women in weighing the risks and benefits of tamoxifen for reducing breast cancer risk." The accompanying editorial spotlights the lack of information about the effects of tamoxifen in black women.

"British Study Says U.S. Results On Tamoxifen Are Inconclusive" - The Wall Street Journal reports (July 10, 1998), "A new study calls into question widely publicized U.S. results, released earlier this year, suggesting that the drug tamoxifen prevents breast cancer in women at high risk of developing the disease. British scientists who conducted the longest-running study of tamoxifen have concluded there isn't enough evidence the drug prevents breast cancer, according to research published Friday in the medical Journal Lancet. They said that only longer-term trials would provide information about which women would benefit most, the significance of side effects, the effectiveness of the drug and its impact on death rates."

"Breast cancer drugs hold out hope -- but not certainty" - Steven Milloy writes in the Philadelphia Inquirer (May 23, 1998), "Even if tamoxifen really can prevent breast cancer as touted, this news has little value to the average woman. Let's say out of every 1,000 women, about 30 get breast cancer. Which 30 will get breast cancer? No one knows. Breast cancer can't be predicted with anything close to certainty, even in women with well-established risk factors. Assuming tamoxifen reduces breast cancer incidence by 50 percent, only about 15 women will develop breast cancer. Which 15? Once again, no one knows. So all 1,000 women must remain vigilant. Tamoxifen is not a vaccine."

"Long-term Tamoxifen Acts Like Estrogen, Spurs Tumor Growth" - Biotechnology Watch reports, "Scientists say they have figured out why the breast cancer drug tamoxifen loses its punch after a few years, allowing deadly tumors to start to grow again. They have shown that in time, the drug, an anti-estrogen, starts to act like estrogen, actually spurring the growth of tumors."

"Blinded With Science" - Laura Flanders writes In These Times (August 8, 1999) "There's a battle going on between pharmaceutical giants, eager to hook healthy women on breast cancer "prevention" drugs... To put it mildly, that short study had serious shortcomings. While 45 percent fewer women taking tamoxifen developed invasive breast cancer than those given a placebo, the actual number of cancers -- 154 (2.3 percent) on the placebo and 85 (1.3 percent) on tamoxifen -- were small."

"Wondering About A Wonder Drug" - Susan Love writes the New York Times (August 3, 1999) "Once again, we have been disappointed by what we regarded as the "truth" about cancer. A miracle drug is a miracle for some and not others, and we don't yet know enough to figure out which group is which."

"Scientist finds reason why breast cancer drug stops working" - The Associated Press reports (July 29, 1999), "Tamoxifen, a drug that fights breast cancer by blocking the action of the hormone estrogen, eventually loses its effectiveness and then actually may help the cancer grow, researchers say."

"When Politicians Play Doctor; The Mammogram Debate Shows Why It's Dangerous" - Two physicians comments in the Washington Post (May 4, 1997), "Last January, an expert panel convened by the National Institutes of Health reached the conclusion that scientific evidence was insufficient to endorse screening mammograms for all women between the ages of 40 and 49. The panel instead advised each woman to decide with her doctor, based on her own concerns and risk factors, whether to get the test. "

"Bad Science in the Senate" - Jessica Mathews writes in the Washington Post (February 10, 1997), "The Senate is once again trespassing where it has no business to be. On the basis of some mysteriously acquired epidemiological insight, 98 senators, and presumably the two who missed the vote, recently concluded that women in their forties benefit from routine mammograms. All 100 should be mortified. One thing Congress apparently can do in a bipartisan spirit is to make a fool of itself."

"Women oversold on mammograms" - Mona Charen writes in the Rocky Mountain News (February 6, 1997), "According to the NIH panel, mammograms miss 25% of malignant tumors in women in their 40s, compared with 10% in older women. The younger the woman, the denser the breast. This makes it more difficult to see tumors on X-rays. Moreover, if mammograms are done routinely on women in their 40s, the tests will produce 30% to 40% false-positive results - meaning needless anxiety and possible surgery and other medical interventions that are not without risk. The truth is that we have all been overterrified about breast cancer (heart disease kills more women) and oversold on mammograms. Alas, not every tumor starts small and can be rendered harmless by early detection. Some just explode seemingly overnight. Some are deadly no matter how early they are found. Others will not kill even if left untreated for years. The New York Times explained the risk / benefit balance by quoting Dr. Donald Berry, a Duke University statistician and member of the panel: At best, '98.5% of women in their 40s will get no benefit" from mammograms. "The other 1 1/2% have their lives extended by 200 days.'"

"Mammogram decision by NIH panel took guts" - Elizaberth Auster writes in the Cleveland Plain Dealer (January 28, 1997), "It is, rather, to those experts' credit that they had the courage to acknowledge what they don't yet know."

"Panel won't recommend mammograms for women in 40s" - The Boston Globe reports (Jan. 24, 1997), "'The current data do not support an across-the-board recommendation for screening women in their 40s,' said Dr. Leon J. Gordis, an epidemiologist at Johns Hopkins School of Medicine and chairman of the panel."