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Posts Tagged ‘Tamoxifen’

Many women who were on Tamoxifen were only on it for the suggested 5 years and then it was time to celebrate the 5 tear survival marker. But the truth is that women are living longer after diagnosis but that there are higher risks for relapse. A study released in June 2013 looks at women staying on Tamoxifen for 10 years rather than the 5 years, as there is better protection for recurrence and dying from the disease.

The study looked at 7000 women and it showed that those who took the Tamoxifen for 10 years had 25 % less recurrences and 23% fewer died. Not numbers to to be ignored.

The concern is that Tamoxifen is not metabolized by everyone is still a concern and is a $60 blood test to see what type of metabolizer you are, but is not offered in Canada. This is where Canadian women need to be vocal as the recommended time to take Tamoxifen increases as consumers we need to be armed with knowledge to make better decisions.

Tamoxifen needs to be metabolized before it can be fully effective to treat breast cancer.  An enzyme in your body called CYP2D6 is important to convert the Tamoxifen to Endoxifen, which then can block estrogen. There are four levels of metabolizers: ultra rapid metabolizer, normal metabolizer, intermediate metabolizer and poor metabolizer. The poor metabolizer notes that your body is unlikely to convert Tamoxifen to the useable form and that a different cancer treatment should be reviewed with your physician.

The CYP2D6 blood test is one factor in determining treatment.

Obtaining the CYP2D6 blood test is not available in Canada despite the fact that Tamoxifen is the most prescribed form of treatment for pre-menopausal breast cancer. At the Mayo Clinic Clinic, USA this blood test costs approximately $60. In certain circumstances patients in Canada maybe able to be tested, but at a cost of approximately $500 with blood work sent over the border. This would have to be arranged by your oncologist. While Tamoxifen is the most widely prescribed cancer medication in the world generating revenues of US $265 million in 1992 and in 1995, worldwide sales reached $400 million there is no information or access to a blood test that is essential for its effectiveness. It is unclear why this blood test is not standard procedure for women prescribed Tamoxifen or even mentioned on their literature.

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https://www.change.org/en-CA/petitions/canadian-government-to-cover-cyp2d6-blood-test-for-women-on-tamoxifen-for-breast-cancer-mandatory-cyp2d6-blood-test-for-women-on-tamoxifen-to-prevent-further-recurrences
tamoxifen

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Poison or not Poison, as individuals who are taking Tamoxifen need to understand all the risks including factors that impact on its effectiveness. Note there are no warnings or contraindications on the packaging.

Research has shown up to 50% of breast cancer survivors are depressed. Can you imagine taking medication that is suppose to prevent recurrence of breast cancer being ineffective because of antidepressant medication? So by taking your antidepressant this may in fact increase your risk for recurrence. Tamoxifen is the standard treatment for anti-estrogen pharmacological treatment for hormone receptor positive breast cancer in pre-menopausal women. Some breast cancer cells require estrogen to grow and Tamoxifen binds to the estrogen receptor preventing it from activating and breast cancer growth is blocked.

Some women may develop a mood disorder such as Major Depression and require pharmacological treatment. Also, Tamoxifen has a  potential side-effect of causing depression in 30 per cent of women. The treatment with Tamoxifen with certain psychiatric medications are contraindicated in that they decrease the effectiveness of the Tamoxifen. This makes the Tamoxifen less effective and give rise to increasing the recurrence of cancer. These medications listed are Pimozide (Orap), Fluoxetine (Prozac), Paroxetine (Paxil), Perphenazine (Trilafon), Thioridazine (Mellaril), Chlorpromazine, Citralopram, Clomipramine, Doxepin, Escitalopram, Haloperidol, and Sertraline.

In 1992 the Lancet published a review of a number of studies reported that pre-menopausal women who are ER-negative had absolutely no benefit from taking Tamoxifen, the majority of women who take Tamoxifen live no longer than women who do not take it,Tamoxifen reached its maximum protective effect on breast tissue with women who took it for five years and noted some breast cancers learned how to use tamoxifen to stimulate their growth.

A study presented at the American Society of Clinical Oncology’s annual meeting in 2009 found that after two years, 7.5 percent of women who took only Tamoxifen had a recurrence, compared with 16 percent who took either Paroxetine, Fluoxetine or Sertraline. The British Medical Journal, February 2010 found women who took Paroxetine and Tamoxifen notes that Paroxetin interferes with the way Tamoxifen works.

In numbers this means patients treated with both Paroxetine and Tamoxifen have a 67% increased risk of death from breast cancer. Quite scary for women who are on antidepressants and breast cancer treatment caught between treating breast cancer or a mood disorder probably precipitated by a cancer diagnosis. Knowing this information first hand, and picking the appropriate treatment with your physician can decrease your stress levels.

There is another controversy on whether one should have blood work to check on one’s metabolization that affects the overall effectiveness of Tamoxifen. As, Tamoxifen needs to be metabolized before it can be fully effective to treat breast cancer.  An enzyme in your body called CYP2D6 is important to convert the Tamoxifen to Endoxifen, which then can block estrogen. There are four levels of metabolizers: ultra rapid metabolizer, normal metabolizer, intermediate metabolizer and poor metabolizer. The poor metabolizer notes that your body is unlikely to convert Tamoxifen to the useable form and that a different cancer treatment should be reviewed with your physician.

The CYP2D6 blood test
is one factor in determining treatment. Even if test is normal there maybe other unknown factors impacting on the result. There are other drugs that can interfere such as using over the counter medication like Diphenhydramine, which is in Claritin. Checking with your pharmacist is one of the key steps in being your own advocate.
This information is often not well known among family physicians, oncologists and even pharmacists.
Bloggers are online discussing pros and cons and where to get testing .

Obtaining the CYP2D6 blood test is not available in Canada despite the fact that Tamoxifen is the most prescribed form of treatment for pre-menopausal breast cancer. At the Mayo Clinic Clinic, USA this blood test costs approximately $60. In certain circumstances patients in Canada maybe able to be tested, but at a cost of approximately $500 with blood work sent over the border. This would have to be arranged by your oncologist. While Tamoxifen is the most widely prescribed cancer medication in the world generating revenues of US $265 million in 1992 and in 1995, worldwide sales reached $400 million there is no information or access to a blood test that is essential for its effectiveness. It is unclear why this blood test is not standard procedure for women prescribed Tamoxifen or even mentioned on their literature. This could be a question for the Canadian Health Minister The Honourable Leona Aglukkaq, P.C., M.P. and should be addressed in writing so further action can be taken on behalf of women being treated with Tamoxifen.

Knowledge is emPOWERment as it provides options in treatment and control of outcomes.

So, women can discuss with her physician if her mood disorder can be treated with another medication or another treatment modality such as cognitive behaviour therapy, daily exercise regime or mindfulness. Therefore not compromising her risk of recurrence of cancer, while on Tamoxifen or not.

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