After breast cancer: Keeping the devil at bay

October 8, 1999
Web posted at: 2:52 PM EDT (1852 GMT)

In this story: The drugs The doctors The lifestyle RELATEDS

By Kiki Alderon

(WebMD) -- Joan Kerr, a Texan diagnosed with breast cancer eight years ago, enjoys living healthy each day. "Because of breast cancer, I'm a happier person," she says.

Not everyone has such a sunny perspective on breast cancer. Though most women with the disease survive for years after their diagnosis, the demon often returns. So these women must make prevention a part of their daily lives through drugs, doctor visits and a healthy lifestyle.

The drugs

For nearly 20 years, tamoxifen (Nolvadex) has been used to treat patients with advanced breast cancer. Now doctors are prescribing it for people whose breast cancer has been successfully treated as well. One study, published in the May 16, 1998, issue of the journal The Lancet, found that taking tamoxifen for five years reduces recurrence in such women by 42 percent and mortality by 22 percent.

After five years, though, the drug may no longer be effective and may even be detrimental, according to research by Duke University Medical Center and the Novalon Pharmaceutical Corp. in Durham, North Carolina.

Tamoxifen can cause side effects such as hot flashes, early menopause, irregular periods and weight gain, according to the Susan G. Komen Foundation. Women who took tamoxifen also had twice the risk of developing endometrial cancer as women who took a placebo, reports the National Surgical Adjuvant Breast and Bowel Project (NSAPB) in the Breast Cancer Prevention Trial. In addition, these women had an increased risk of developing more serious problems, including blood clots in large veins, blood clots in the lungs and stroke.

Due to these risks, researchers are interested in further study of raloxifene (Evista). Originally used to prevent osteoporosis, raloxifene has more recently been shown to reduce the risk of breast cancer in women who already have undergone treatment, but who have other high-risk factors, such as being over 35, having a mother or sister who had breast cancer before the age of 50 and having started menstruation before the age of 15, according to the NSAPB. The NSAPB says that raloxifene potentially carries fewer side effects than tamoxifen, and won't add to the risk of developing endometrial cancer.

The doctors

Regular visits to the doctor are especially important for women on the lookout for a recurrence of breast cancer. At the Texas Southwestern Center for Breast Cancer, Dr. George Peters, executive director, says women should make appointments on the following strict schedule once cancer treatment is completed:

During the visit, doctors should conduct a physical exam looking for lumps or physical changes, ask patients about other changes they may have noticed, like pain and weight loss, test for liver problems and perform an annual chest X-ray.

For women who have had lumpectomy on one breast, mammograms are performed on that breast every six months. Lumpectomy and mastectomy patients should both have yearly mammograms on the opposite breast. Some physicians may perform bone scans as well. As Peters tells his patients, "You can divorce your husband, but you can't divorce me."

Only once or twice in the last 20 years has Peters performed a mastectomy to prevent the recurrence of breast cancer. Patients considering this option should see their doctor and a psychologist, Peters says. He considers it appropriate only when the worries about cancer are overwhelming. "That should be the last option we consider, but we have to consider the psychological distress of the patient."

The lifestyle

Researchers are still sorting out the role diet and exercise can play in keeping breast cancer at bay. The correlation between fat intake and breast cancer is still hotly debated, Peters says, but undeniably, a healthier diet strengthens the body overall.

Discovering she had the disease prompted Kerr to "get down to basics and what's important." She now dances, walks and does aerobics. She also eats right, focusing on fruits and vegetables while avoiding fat. "My main thing is that I tried to keep the stress level down as much as possible, just realizing if you don't make your bed that day and if you don't wear the appropriate outfit to a party, it's not the end of the world."

Since detecting the cancer early makes it much easier to treat, self-examination is essential for breast cancer survivors. In 80 percent to 90 percent of recurrences, women themselves detect the cancer, reports the Susan G. Komen Foundation. The areas usually affected are the chest, adjacent areas such as the underarm lymph nodes and elsewhere in the body due to metastasizing, with the most common areas being lungs, liver, bones and brain.

Some types of recurrence, like that in a breast previously treated with radiation, the chest wall or a skin recurrence on the mastectomy side, can be treated. But most can be controlled, though not cured. That makes vigilance, attention and knowledge essential to the future of any breast cancer survivor.

RELATEDS AT :

Tamoxifen and prevention

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RELATED SITES:

National Cancer Institute: Breast cancer risks
Susan G. Komen Foundation
American Cancer Society
National Cancer Institute: Cancer Trials

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