Breast Cancer Blog

Submitted by Dr.Kattlove’s Cancer Blog

What if there were a pill that women who had surgery for breast cancer could take that would lower their chances of dying from the cancer? And what if the pill had few side effects and that after 5 years the women could stop taking it? Who wouldn’t go for it?

Guess what? Lots of women won’t take the pill. The pill is a kind of drug called aromatase inhibitor or AI for short. It is given to women who have had breast cancer surgery to prevent the cancer from returning. It is only used in women who are past the menopause and works by blocking the production of the small amounts of estrogen that post-menopausal women normally make.

Because most cancers in post-menopausal women feed on this estrogen, most oncologists prescribe AIs to prevent the cancer’s recurrence. In the past, oncologists recommended tamoxifen, which has probably saved the lives of hundreds of thousands of women with breast cancer. Now studies have shown that AIs are more effective by as much as 25% and have fewer side effects, so they has become the choice of almost all oncologists.

A “no brainer”, right? I think so and that is why I was so startled to read in a recent issue of the Journal of Clinical Oncology that a lot of women aren’t taking the drug even though it has been prescribed.

The researchers looked at pharmacy databases and identified women who were prescribed one of the three different brands of AIs, called anastrazole. By looking at how often a woman refilled her prescription, they could tell if she was taking the drug on schedule or missing doses. By the way, the woman was considered to be taking the drug regularly if she missed no more than 20% of her doses.

In spite of this loose definition, the researchers found that by the end of the first year of treatment, about one-fourth of the women weren’t taking the drug properly. By the end of 3 years, this number grew to 40%. That means that 2 out of every 5 women who were prescribed this potentially life-saving drug weren’t taking it or at best taking less than 80 percent of their prescribed doses.

Why did this happen. The researchers talked about the possibility of side effects, recurrence of the cancer, other diseases, or that women didn’t believe in the value of the drug. I’m not baffled. The other day, I saw a 50 year old man with super high blood pressure who wasn’t taking his pills. Didn’t he know that he is asking for troubles - a heart attack or stroke? I gave him my lecture, including simulating what he might look like if he had a stroke, but I’m not sure I did much good.

It’s the same for these women even though this is CANCER! No woman wants it to come back and this is their best chance to prevent it. But, like my patient with the high blood pressure, people aren’t into prevention. That is why we often eat an unhealthy diet, don’t exercise, don’t buckle are seat belts, and don’t take drugs that might prevent cancer from returning. It is so sad.

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