Now here's some good news for Tamoxifen-taking, hot-flash suffering women. A new study finds women who have lots of hot flashes during treatment with the breast cancer drug Tamoxifen have a lower risk of recurrence than women who don't suffer from the annoying waves of heat commonly associated with menopause.

"This study provides the first evidence that hot flashes may be an indicator of a better prognosis in women with early stage breast cancer," said study author John P. Pierce, Ph.D., from the University of California at San Diego. "Our data supports the possibility of a significant association between hot flashes and disease outcome."

More study is necessary to determine whether or not hot flashes -- which may predict better outcomes than severity of cancer, hormone receptor status, and age -- are associated with Tamoxifen and breast cancer progression.

Femara (letrozole) is an aromatase inhibitor that works by suppressing the production of estrogen. In postmenopausal women estrogen is still produced in the body by the adrenal gland. Decreasing this production is a way of decreasing the risk of recurrence.

Tamoxifen on the other hand works by blocking the estrogen receptors on the cancer cell itself resulting in slower growth of the cell or cell death. Tamoxifen can be given to post or premenopausal women but Femara would only be prescribed to women that are postmenopausal. The reason being, is that a premenopausal women will still have estrogen produced by the ovaries. Femara would not be effective in this instance.

A Phase III clinical trial that is ongoing shows preliminary results that Femara is superior than Tamoxifen in women with early stage disease that are postmenopausal. The results of the study were published in the Annals of Oncology.

On Tuesday, researchers announced that a three-drug cocktail may help women with HER2-positive breast cancer better than any other drug used on its own. About one quarter of women with breast cancer make up this HER2 category.

Tests on mice revealed using the three drugs along with breast cancer drug tamoxifen helped wipe out tumors altogether. And the tumors did not come back. This is the first time mice were cured of a very aggressive human breast tumor. Incidentally, when a single drug was used, tumors returned within several weeks.

The three wonder drugs used in this study -- all are monoclonal antibodies that precisely target certain aspects of tumors -- are the experimental drug pertuzumab; trastuzumab, also known as Herceptin; and gefitinib, or Iressa.

Published in the Journal of the National Cancer Institute, this study supports the notion that HER2-positive tumors eventually become resistant to one drug and attacking them on several fronts seems to work better.

Results of two studies, sponsored by the Adjuvant Breast Cancer (ABC) Trials Collaborative Group, conclude that adding chemotherapy to the estrogen-blocking drug tamoxifen improves survival for those with early-stage breast cancer. The same studies reveal preventing the secretion of estrogen from the ovaries does not offer much benefit for most women.

Researchers studied 1991 patients, ages 28 to 81. All had received five years worth of treatment with tamoxifen therapy with or without standard chemotherapy. Some premenopausal women were also treated with ovarian removal (ablation) or suppression, a technique used to stop the glands from secreting hormones.

While early results, appearing in the Journal of the National Cancer Institute, fell short of statistical significance, chemotherapy still reduced the overall risk of death by 17 percent, mostly for women younger than 50 and especially for premenopausal women not treated with ovarian ablation or suppression.

Simply being female puts all women at risk for breast cancer. That and age, race, family history, personal history, genetic make-up, when they had children, when they reach menopause, and a whole host of other possible factors.

Now U.S. doctors are officially calling body mass index, breast density, and alcohol consumption predictors of the disease, says Therese Bevers, medical director of the Cancer Prevention Center, at the University of Texas M.D. Anderson Cancer Center in Houston.

Bevers helped write updated guidelines for the prevention of breast cancer and presented them at the 12th annual National Comprehensive Cancer Network in Hollywood, Florida on Friday.

The guidelines, featuring the revised list of risk factors, also offer treatment options for women -- including bilateral mastectomy for women who have tested positive for the genes BRCA1 and BRCA2 as well as possible medical treatments with drugs such as tamoxifen and raloxifene.

Women sixty five and over with early stage breast cancer who do not have radiation after surgery may have an increased risk of a local recurrence or development of a new primary breast tumor.

Half of the women diagnosed with breast cancer are sixty five and over. Past studies have shown that older women are less likely to be offered chemotherapy, hormonal treatments or radiation. Young women are more likely to receive aggressive treatment for their breast cancer.

This study showed some important things:

1. Women in the study who had a lumpectomy without radiation were found to have an greater risk of a local recurrence.
2. Women in the study who received hormonal therapy and stayed on their treatment for the full five years had less of a recurrence rate than those who prematurely stopped the medication.

If you are over the age of sixty five and have been diagnosed with early-stage breast cancer, talk to your doctor about the risks and benefits of receiving radiation after surgery.

My good friend Deb, a young breast cancer survivor, emailed me this morning. She told me that she just filled her last prescription for Tamoxifen today. In the email she said it was a 'weird feeling'. I myself, will be going off Tamoxifen this October and will have fulfilled my five years on the drug as well.

I asked Deb to tell me more about how she felt and what it means in her life now that she will be discontinuing Tamoxifen for her breast cancer treatment.

"I have truly mixed feelings! It is bittersweet. It can be a scary, anxiety-provoking thought just thinking about ending it. It was my protection and security after chemotherapy for so long. I know that Tamoxifen still has effects in my body for years after stopping. I have three months left and I will stop Tamoxifen in June. Part of me is glad to stop it, to not have to remember to take a pill daily and my breast cancer treatment is now complete."

"Yet there is the other part of having to trust my body again. It failed me once. It means I'll have to modify some things in my life, substitute for taking a pill to fight off cancer. It means taking exercise more seriously, exercise can cut your risk for recurrence up to fifty percent. It means I'll stick to my diet a little better. I may also decide to take a Cox 2 inhibitor, like celebrex, as an anti-inflammatory. When Vioxx was pulled from the market, these similar Cox 2 inhibitors were pulled from clinical trials, now those trials are back open and are showing benefit. I have injuries in my knees, so will be taking it for that as well."

"In a sense I'll be flying on my own again. I remember them saying five years thinking how long that would be, it actually slipped right by. I will get tested to see if I'm in menopause, but seriously doubt that I am. It would be nice to go on an AI, but I really don't want to be in menopause quite yet. So, my prescription is diet and exercise and perhaps a Cox 2 inhibitor as preventative. I will still continue to see my oncologist every six months. I will continue to celebrate life and live it to its fullest and appreciate those things and people that truly make a difference in my life"

Deb Kirkland -- Young Breast Cancer Survivor

Breast cancer drug tamoxifen, designed to cut recurrence in women with estrogen-receptor positive disease, has been shown to continue working long after women stop taking the drug. And two studies suggest it might also offer long-term protection for healthy women with high risk of developing breast cancer.

One such study found the drug decreases risk of hormone-sensitive breast cancer by 39 percent over 20 years. Another shows a 34 percent decrease for up to eight years after the therapy concludes.

Published in the Journal of the National Cancer Institute, one study -- the International Breast Cancer Intervention Study, or IBIS -- looked at 7,145 women at high risk of breast cancer. And for the first time, clear evidence has surfaced in support of the merits of tamoxifen after the completion of treatment.

IBIS study participants took either a daily dose of tamoxifen or a placebo for five years. At the eight-year mark, 87 women who took the actual drug were diagnosed with estrogen-receptor positive breast cancer. And 129 women in the placebo group were diagnosed with the same disease.

In the second study, researchers from the Royal Marsden Hospital in London investigated 20-year data on 2,471 healthy women at high risk of breast cancer who took tamoxifen for six or seven years. Similar results were found.

Despite the benefits of tamoxifen as a preventative treatment, the drug is not currently approved for this use in the UK, where breast cancer is the most common form of female cancer.

International pharmaceutical company AstraZeneca is donating $10 million to the American Cancer Society (ACS). The donation is one of the largest gifts ever received by the ACS and will help provide support for patients in United States hospitals.

Support will come in the form of specially-trained ACS employees who will work in 60 different hospitals and cancer centers and will offer social, emotional, financial, and transportation assistance in medically underserved Atlanta areas.

London-based AstraZeneca, maker of breast cancer drug tamoxifen and other breast and prostate cancer drugs, made $26 billion in sales last year, the same year the company gave $7 million to a Boston Cancer Society for the development of a Hope Lodge.

According to the results of an international study, postmenopausal women who have taken tamoxifen for early stage estrogen-receptor positive breast cancer for two to three years might increase their chances of survival by switching to newer breast cancer drugs called aromatase inhibitors.

Study researchers found this drug switch-up reduced the number of events linked to poor survival by 32 percent -- although no difference has been found in overall survival at this early point in the trial.

"These findings provide some limited evidence to advise all women being administered tamoxifen to switch, even though this approach is not devoid of potentially serious side effects," say experts at the National Cancer Institute.

Side effects appear to be minimal, however, and the up side of treatment with aromatase inhibitors is the fact that they don't seem to carry the risk of death from other causes like with tamoxifen, which can cause stroke or endometrial cancer.

This study is expected to be published in the March 15 issue of the journal Cancer.

It's an unsettling journey -- the pursuit of the five-year cancer survival mark. Some say each year of cancer survival makes the future more of a sure thing. And so surviving five years -- the traditional landmark of real remission -- is a big accomplishment. But then there's the perspective of numbers that for me say I have a 93 percent chance of surviving breast cancer for five years. After that, though, there's no telling what will happen. So I am eagerly awaiting the moment when I cross the five-year finish line as I anxiously realize this very same moment may also signal a more dismal outlook.

The paradox hit me straight in the face yesterday as I was waiting for my radiation oncologist to give me another six-month all clear announcement. I was reading the January/February 2007 issue of Coping magazine while I waited. And as I flipped through the pages, I landed right at these words:

Studies show that half of all breast cancer recurrences occur after completion of five years of standard tamoxifen therapy. Additionally, a third of women with estrogen receptor-positive early breast cancer experience a recurrence, and more of half of these recurrences occur more than five years after surgery.

Now this doesn't apply directly to me. My breast cancer was estrogen receptor-negative which makes me a non-candidate for tamoxifen. And this is what scares me. My tumor was aggressive and while my treatment was also aggressive, I don't get the extra five-year protection from hormone therapy. If women taking this drug can have recurrences after completing the therapy, I wonder what's in store for me having not had it.

Maybe I'm making comparisons that don't amount to any real conclusions. Perhaps my type of disease allows for a more secure future. Or perhaps it places me on shaky ground. I don't know for sure. And I don't think I'll dive any deeper into research than I already have. Instead, I will live for today -- while enjoying the announcement my oncologist shared with me yesterday. All clear!

Results presented at the 2006 annual San Antonio Breast Cancer Symposium, says that it appears Nolvadex (tamoxifen) reduces the risk of developing cancer years following completion of preventative therapy among women who are at high risk of developing breast cancer.

Data from a clinical trial, including 7,145 women who were at high risk for developing breast cancer, was reevaluated at 10 years follow up. They found that breast cancer was reduced by 29 percent among women treated with tamoxifen compared to those taking the placebo. The preventative effect on breast cancer, specifically hormone-positive breast cancer, was actually improved at 10 years compared to the five-year follow-up.

The researchers concluded that women who are at high risk of developing breast cancer continue to benefit from tamoxifen, even five years following completion of treatment.

Talk to you doctor if fall in the high risk group for breast cancer. There are individual risks and benefits for tamoxifen and it may prevent physicians from recommending its use in certain women.

Dr. Len Lichtenfeld, MD, is the deputy chief medical officer for the American Cancer Society. He is also a blogger and authors his very own blog -- called Dr. Len's Cancer Blog.

Dr. Len writes on his blog about all sorts of topics related to cancer. He shares his opinion on the recent drop in breast cancer cases (December 15, 2006), he promotes the Great American Smokeout (November 14, 2006), he sounds off on lung cancer screenings (October 25, 2006), and he urges parents to always slather sunscreen on their children (October 5, 2006). He has so much more to say -- and his blog is a great stop for those wishing for more information on hot cancer topics.

As this year comes to a close, Dr. Len offers a review of what he believes were the hottest cancer topics of 2006.

Dr. Len reflects in his blog about decreased cancer death rates that represent real progress in the fight against cancer. He calls the HPV vaccine a breakthrough and he recaps the STAR trial -- a comparison of raloxifene to tamoxifen to reduce the risk of recurrent breast cancer in post-menopausal women -- with emphasis on how raloxifene proved just as effective as tamoxifen, but with a better safety profile. He calls new targeted therapies a dream -- with a hefty price tag -- sure to garner debate and discussion in 2007.

Dr. Len reviews the Surgeon General's report on second-hand smoke -- it's harmful to non-smokers, the report says -- and he marvels at the capability of science to approach an understanding of what makes a cancer cell a cancer cell. He also remarks on how remarkable it is that chronic myelogenous leukemia is in fact chronic and no longer fatal, thanks to the drug Gleevec.

Of course, there is ample attention given to the declining incidence of breast cancer, reportedly due to less women using hormone replacement therapy, and the risks weighing on those who are overweight and obese, and survivors and supporters who gathered for Celebration on the Hill -- the site of one incredible American Cancer Society event.

Dr. Len closes his review of 2006 with recognition of three celebrities who lost their lives this year to cancer -- Dana Reeve, Ann Richards, and Ed Bradley. And while he recognizes there are other lives and other stories that deserve mention, there is simply not enough time or space for him to do justice to every noteworthy item.

"What we have seen over the past year is an incredible leap forward in cancer research, diagnosis and treatment, and I suspect there are going to be even more exciting developments in the coming year," says Dr. Len who looks forward to 2007 -- a year that is sure to deliver more hope and more progress in the fight against cancer.

A liquid form of the hormonal therapy Tamoxifen is now available for women who have difficultly swallowing pills.

Soltamox, the brand name for liquid Tamoxifen, was approved by the FDA in October. Some women develop dysphagia, difficultly or painful swallowing, during or after chemotherapy and radiation treatments. These women might cut or crush up their pills in order to be able to swallow them. This can impact how the body absorbs the medication and the overall effectiveness of Tamoxifen.

Some women skip doses or avoid taking the pills all together. The new delivery method for Tamoxifen may help you if you suffer from dysphagia and your doctor recommends that you take hormonal therapy.

The medication is sugar free, clear and colorless. It tastes and smells like licorice and aniseed. Liquid and pill form Tamoxifen have the same side effects.

Zometa can help prevent bone loss in premenopausal breast cancer patients says a study published in the Journal of Clinical Oncology.

Young women that have estrogen receptor positive breast cancer can be treated with hormonal therapy. Some of these treatments can cause the loss of bone density. Treatment with drugs called bisphosphonates may be able to prevent this bone loss.

Zometa, a bisphosphonate, was studied to evaluate two different approaches to hormonal therapy. The patients received either Zoladex plus Tamoxifen or Zoladex plus the aromatase inhibitor, Arimidex. Half the women were treated with Zometa.

Women who did not receive the Zometa during hormonal therapy experienced significant loss of bone mineral density. Bone loss was worse for women treated with Zoladex and Arimidex than for women treated with Zoladex plus Tamoxifen. The women who did receive Zometa along with hormonal therapy had stable bone mineral density.

Bisphosphonates, the researcher concluded, should be considered for patients at risk of bone loss due to hormonal therapy.

Previous posts on the topic of bisphosphonates and Zometa:

Halting the spread of breast cancer to the bone

Prostate cancer and bone loss

Novartis cancer drug may cause jaw damage

Breast Cancer: Pain control improved for bone metastasis