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Breast health revisited Tamoxifen fears are questioned

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Breast health revisited: Tamoxifen fears are questioned
by Sylvia Jutila

The October issue of Senior News had a very interesting article about breast health written by Bill Sturgeon. He brought up some issues that deserve thought and study. However, I want to clarify some items. I am especially concerned that women taking tamoxifen to prevent recurrence of their breast cancer might decide to stop taking it as result of the article.

Sturgeon began by questioning the tamoxifen trials that were conducted to see if breast cancer in high risk women could be prevented. Contrary to his assertions, these trials clearly demonstrated that women can reduce their risk of breast cancer by 50 percent.

He also quoted Samuel Epstein, MD, as saying that the risks to healthy women for taking tamoxifen are so great, the trials should have been stopped. This is not the case. While all medications have their side effects and risks, women who have three first degree relatives with breast cancer only had one alternative to preventing breast cancer prior to tamoxifen-and that was bilateral mastectomies. Taking tamoxifen is another alternative now. Hopefully more alternatives will be available soon.

Sturgeon wrote that liver failure and liver cancer result from taking tamoxifen, that liver cancer takes about 10 years to be noticed and that "experts" state there will be a forthcoming epidemic as a result of tamoxifen use. Tamoxifen has been in use for 25 years so we should be in the middle of a tamoxifen-induced liver cancer epidemic-which we are not. Liver failure and liver cancer are no longer listed as risks for tamoxifen. Endometrial (lining of the uterus) cancer is a rare complication and is treatable if caught early.

He proposed soy as a substitute for tamoxifen to prevent breast cancer. No studies have demonstrated soy's effectiveness in preventing breast cancer, although there is a great deal of research being done with soy. There may be side effects to large consumption of soy and the FDA is looking closely at many studies concerning the safety of soy products. Moderate intake of soy is probably beneficial.

Sturgeon also presented some misleading facts about breast cancer detection technologies. In a side article he explained how cancers get started, stating they grow until the tumors are large enough to be palpated or found by X-ray or thermogram. Thermograms have not proven to be reliable for diagnosing breast cancer. At present, mammography is the best technology to detect cancers in the earliest stages when the survival rate is 97 percent.

Also, we cannot, as Sturgeon suggested, prevent breast cancer. There are life-style choices that can reduce our risk such as reducing alcohol consumption, eating a low-fat diet and being physically active. But many other factors contribute to the development of breast cancer including the genetic predisposition conferred by having the BRCA1 and BRCA2 genes. These are factors that we cannot control.

Finally, as for Sturgeon's quoting Epstein in "Conflict of interest," Astra Zeneca certainly has not paid for all of the activities of Breast Cancer Awareness Month. I would like to thank the Humboldt Community Breast Health Project, the local St. Joseph Health System managed Breast Cancer Early Detection Project and Breast and Cervical Cancer Control Project and the American Cancer Society staff and volunteers for their efforts in bringing breast cancer awareness to the community. This was done without Zeneca money or influence.

The best thing a woman can do to protect herself against breast cancer is eat a healthy diet (including soy products), exercise, do regular breast self exams, have a clinical breast exam and if you are 40 or older have an annual mammogram. For further information please contact the American Cancer Society at 707-442-1436 or 1-800-ACS-2345.

Sylvia Jutila is executive director of the Eureka office of the American Cancer Society.

One-time article Copyright 2000 by Humboldt Senior Resource Center .