One in five postmenopausal women with estrogen-positive breast cancer do not take the newer chemoprevention hormone therapy aromatase inhibitor drugs to prevent recurrence as prescribed, according Dana-Farber Cancer Institute and AstraZeneca Pharmaceuticals researchers who conducted a study to determine drug usage.

Aromatase inhibitors, such as Anastrozole, have been shown to be an effective means of blocking estrogen that fuels cancer for women diagnosed with estrogen-positive breast cancer, and Dana Farber's Dr. Ann Partridge warns that, "Women may be compromising their care, and ultimately their survival, if they do not take these medications as recommended."

Despite warnings, a significant number of women are choosing to discontinue use and the researchers of this survey can only speculate as to the reasons why. Some of the reasons they believe play a role in the women's decision not to comply with recommended treatment are: fear of side effects, actual experience of side effects, cost of treatment, and negative health beliefs that treatment will not help.

From a personal insight, the most common reason I know of as to why women are not taking this medication, or discontinue usage, is the fact that these drugs do not have a long history of use, and one can only guess what the possible, and presently unknown, long-term side effects will end up being. While Dr. Partridge states without a shadow of a doubt that these new aromatase inhibitor drugs are effective in breast cancer recurrence, only time itself will remedy the hesitation and non-compliance.

Some of the aromatase inhibitors include Anastrozole (Arimidex), Letrozole (Femara), Exemestane (Aromasin) and Formestane (Lentaron). To learn more about aromatase inhibitors, visit the National Cancer Institute's aromatase inhibitors digest.

MarketWatch is reporting that a panel of experts has recommended that the drug labeling for Tamoxifen be changed to include warnings some women with estrogen-positive breast cancer might be at greater risk for breast cancer recurrence. The recommendation comes as a result of studies that show the drug is not as effective for women with estrogen-positive breast cancer if they also carry an enzyme, called CYP2D6, that does not actively metabolize tamoxifen as it should to make the drug work in preventing breast cancer.

According to the report, the panel's decision isn't official and doesn't indicate the Food and Drug Administration (FDA) will seek a change on the drug's label.

However, one of the panel members suggested that while testing women to see if they are at greater risk, due to poor activity of CYP2D6, should not be mandatory, women need to be made aware of the risks and that testing of this enzyme is available.

This might be an especially important consideration for pre-menopausal women, as Tamoxifen is the only estrogen-blocking drug available to them right now for the prevention of estrogen-positive breast cancer recurrence.

The Cancer Research UK conducted a survey of breast cancer survivors and found more than half admit they have missed taking the scheduled doses of chemoprevention medication. The three most common reasons the women gave for not taking the medicine were: tablets hard to swallow, difficulty in coping with side-effects and the fact that drugs were a constant reminder of illness. In addition, some women simply forgot to take the prescribed medication in a timely manner.

Experts believe a lack of communication with women in regard to handling the side effects of drugs and the importance of staying with treatment the entire length of time prescribed to prevent recurrence, might be lacking. They also feel that more needs to be done to understand why women would willingly chose to discontinue or interrupt long-term chemoprevention drug treatment.

The study was a small one involving 131 women who were at least two years past initial breast cancer diagnosis, but I am certain that given a larger study researchers might realize the same findings. In my opinion, after breast cancer diagnosis -- surgery, chemotherapy, radiation -- or a combination of all three treatments -- is not only a physical challenge but an emotional one. Once past active treatment, the resources and support for breast cancer survivors can fall off dramatically while the difficult issues of being a breast cancer survivor remain.

Drugs appear to be quite a slippery slope for bodybuilders, taking a second drug to offset the unwanted side effects of the first drug. According to University of Glamorgan researchers, 22 percent of bodybuilders use Tamoxifen because steroid use causes breast growth.

Tamoxifen has a few potentially serious life-threatening side-effects such as deep vein blood clotting and the increased risk for the development of new tumors.

Women breast cancer survivors often struggle over whether the benefit of taking Tamoxifen overweigh the risks. In the case of breast cancer prevention, most women go ahead and take the drug, but not without hesitation. That anyone would chose to take such a powerful drug without an absolute need is beyond logic and reason. My suggestion? Stop using steroids. Don't take the first drug -- won't need the second one.

A study done to compare the benefits and risks of two different drugs used to treat invasive breast cancer found both effective, but with slightly differing side effects. Researchers conducted a trial at nearly 200 clinical centers across the country. The women chosen for the trial were at an increased risk for breast cancer. The 19,747 postmenopausal women in the study were either given tamoxifen or raloxifene for five years. At the end of the study, tamoxifen and raloxifene seem to offer the same level of benefit in breast cancer prevention. The group of women on tamoxifen had slightly more uterine cancer diagnosis and lung or deep vein blood clots than the group of women on raloxifene, but not in significant numbers.

However, tamoxifen is seen by primary care physicians as a toxic chemoprevention drug, where raloxifene is seen as a fairly safe drug. Raloxifene is currently prescribed for the prevention and treatment of osteoporosis in postmenopausal women. According to the researchers, "This trial confirms the previously reported benefit of raloxifene in reducing the risk of invasive breast cancer and indicates that raloxifene is as active as tamoxifen in this regard. If raloxifene is approved by the Food and Drug Administration for the prevention of breast cancer, primary care physicians may be more willing, given their experience with raloxifene, to prescribe it for breast cancer chemoprevention than they have been to prescribe tamoxifen."

For over twenty years, the gold standard in long-term chemoprevention for women with estrogen-positive breast cancer was Tamoxifen. It seemed to work well in preventing recurrence of breast cancer for a certain percentage of women taking it for five years. Tamoxifen had its drawbacks though, as it was known to increase the risk for uterine cancer, blood clots and strokes. But there was nothing else that worked as well at preventing breast cancer from coming back, so women took it and hoped for the best.

A few months ago, researchers found that raloxifene, known by most as Evista, worked just as well as Tamoxifen with fewer of the potentially life-threatening side-effects of Tamoxifen. Seemed like good news at the time. But as I like to point out on a semi-regular basis, I feel there is a rush to swallow the latest newest pill before taking a long look at the potential dangers. Every pill comes with dangers. It is a matter of calculated risks when deciding to take a drug that might save your life only to cause a whole new set of medical problems.

And now Eli Lilly, Evista's drug maker, has come out with a new warning that its drug, previously thought to be safer than Tamoxifen, increases the risk for stroke. According to Eli Lilly, the finding was made during a study designed to see if raloxifene reduced the risk of heart disease and breast cancer in postmenopausal women who had heart disease or were considered at high risk.