Banishing Breast Cancer?

Banishing Breast Cancer?
I was treated for breast cancer five years ago and have been taking Tamoxifen ever since. I'm supposed to stop now. What can I do to prevent a recurrence?

Tamoxifen is an oral drug that blocks the effects of estrogen, the hormone that promotes growth of some breast cancer cells. It can help prevent recurrences of estrogen-receptor-positive breast tumors and is usually prescribed for five years after the primary treatment. Oncologists see no benefit to taking Tamoxifen for more than five years, both because patients are then past the time of highest risk for recurrence and because Tamoxifen can become less effective after an extended period of use, and yet half of breast cancer recurrences occur five or more years after diagnosis.

Results of a clinical trial involving 5,187 women in the United States, Canada and Europe show that another drug, letrozole (trade name FemaraTM), can nearly halve the risk of breast cancer recurrence among postmenopausal women with estrogen-receptor-positive tumors. The results were so dramatic that investigators halted the trial so that they could offer letrozole to women taking a placebo. The study results were announced on October 9, 2003 and published in the November 6, 2003 issue of The New England Journal of Medicine.

Letrozole works by blocking an enzyme (aromatase) that converts hormones from the adrenal gland to estrogen. The effect is to reduce blood levels of estrogen by more than 95 percent. Side effects include hot flashes, night sweats, sore muscles and an increased risk of osteoporosis. A separate sub-study is trying to determine the exact long-term effects of Femara on bone density. There is also concern that this drug might raise cholesterol levels over time.

Cancer experts still don't know how long women should take letrozole and whether doctors should recommend it to all women who have been on Tamoxifen. The current consensus seems to be that women just finishing their five years on Tamoxifen should consider taking letrozole.
You also can try to lower your estrogen levels, and thus your risk of breast cancer recurrence, by losing excess fat if you're overweight, getting regular exercise, reducing or eliminating consumption of alcohol, and eating only hormone-free beef and dairy products (if you eat those foods). Adding soy foods to your diet can also help. Make sure you eat plenty of fresh fruits and vegetables and fish or flaxseed to get omega-3 fatty acids, and consider supplementing with CoQ10, which may be beneficial.

Andrew Weil, M.D.

Depression May Help Spur Mental Decline

(HealthDay News) -- Depression may speed age-linked cognitive decline, researchers report.

Researchers at the San Francisco VA Medical Center and the University of California, San Francisco found that depressed seniors are more likely to develop mild cognitive impairment within six years than those who are depression-free.

The more severe the depression, the greater the risk of the mental decline, according to the study, which appears in the March issue of the journal Archives of General Psychiatry.

The study included 2,220 people 65 and older. At the start of this study, participants were checked for symptoms of depression. Six years later, they were assessed for cognitive impairment.

The researchers found that close to 20 percent of those with moderate to high depression at the start of the study had developed cognitive impairment after six years, compared to just over 13 percent of those who had mild depressive symptoms and 10 percent of those who had no symptoms of depression.

"This is important, because mild cognitive impairment often precedes dementia," study lead author Deborah Barnes, a mental health researcher at SFVAMC, said in a prepared statement.
She said family members and health providers should pay attention when an older adult shows signs of depression.

"Even if they don't have cognitive impairment at that time, our study suggests that you probably want to keep an eye on them. Depression might be an early sign of neurodegeneration -- in fact, it might be the first symptom that a family member notices," Barnes said.

The study also found no correlation between depression and vascular disease. The authors said this was a significant finding because other researchers have suggested that vascular disease may cause inadequate blood flow to different areas of the brain, resulting in depression and cognitive impairment.

"We found no evidence to support that hypothesis," Barnes said.

More information
The American College of Physicians has more about Depression.

Younger Women Prone to Depression After Heart Attack

(HealthDay News) -- While an episode of depression after a heart attack is fairly common, new research shows that women aged 60 and younger are far more likely to suffer from it than others.

The finding is important because people who struggle with depression after a heart attack are more likely to be hospitalized and die from cardiac problems, and have higher health-care costs, compared with heart-attack patients who don't become depressed. Identifying depressed heart patients might help doctors better treat them, the researchers said.

"Depression is common among patients with heart attacks," said study author Dr. Susmita Mallik, an assistant professor of medicine at Emory University School of Medicine. "About 22 percent of all heart-attack patients are depressed."

However, younger women are more likely to be depressed than older patients, Mallik said. "Younger women were at the highest risk of depression. The prevalence of depression was 40 percent in women 60 years and younger," she said.

The findings appear in the April 24 issue of the Archives of Internal Medicine.

For the study, Mallik and her colleagues looked at depression in 2,498 men and women who had suffered a heart attack between January 2003 and June 2004.

"We found that the prevalence of depression was 40 percent in women age 60 years or younger, 21 percent in women older than 60, 22 percent in men 60 or younger and 15 percent in men older than 60," Mallik said.

What's more, when the researchers looked at other factors, including race, medical history and coronary heart disease risk, the odds of depression were 3.1 times higher for women age 60 and younger than for men older than 60.

It's not clear why younger women are at such a high risk for depression after a heart attack, Mallik said.

"Not all patients become depressed after having a heart attack," Mallik said. "Depression should not be considered a normal reaction after a heart attack. Clinicians and patients should be aware that depression is an important risk factor for adverse outcomes after a heart attack."

Mallik believes doctors should be looking for depression among heart attack patients, particularly younger women. "They should be aware that younger women are at the highest risk for depression, and screening for depression should be particularly aggressive in these women," she said.

Dr. Nieca Goldberg, chief of women's cardiac care at Lenox Hill Hospital in New York City, thinks women need to be more open with their doctor about their emotions after a heart attack.
"This paper is important, because it underscores the importance of evaluating the psychological issues that often accompany a heart attack," she said.

Goldberg thinks younger women are more susceptible to depression because a heart attack is such a major event, especially at a younger age. "It's a life-changing, stressful event," she said. "It's a shocking experience. There are concerns among women whether they are going to be able to get back and take care of their families and return to their usual life."

Goldberg also noted the well-documented connection between the mind and the heart. "Clearly, depression does influence recurrent heart disease and is related to someone's social support," she said.

It's important for women to have a good support network after suffering a heart attack, Goldberg said. "Women need to be able to share their emotional feelings after a heart attack," she said. "Doctors have to be more careful to pick up depression."

More information
The American Academy of Family Physicians can tell you more about depression after a heart attack.