Milk the issue

[Rich66]

http://www.latimes.com/news/health/la-he-milk-20100712-2,0,3862887.story

[karen z]

Interesting article. Thanks for posting.

The advice I have typically gotten from nutritionists (and follow) has been to stick to low fat and organic if I am consuming dairy products.

[1rarebird]

Dealing with breast cancer involves making a lot of choices. Some are based on irrefutable science--others on a just a feeling in your "gut". Right now, avoiding dairy is a gut feeling choice that I have made in an effort to bypass any bovine estrogen and IGF that may come with it.

Since I have always had at least a glass of milk every day of my 60-some-odd years, giving up milk was a significant change for me. Lucky for me I discovered that almond milk is a good tasting substitute for milk that can be obtained organic. It does contain some phytoestrogens, but I believe in low enough amounts that let's me feel more comfortable about pouring on some with my bowl of granola in the mornings.

bird

[Rich66]

Bird,
Are you referring to the Vitamin E in almond milk?

[TanyaRD]

Very interesting article. Thank you for posting.

[foxery]

nice article . . . !!!
almond milk helps lower LDL cholesterol and protect the heart. High levels of vitamin E ensure powerful antioxidants . . . !!!

[Jackie07]

Bird,

Do take something else to prevent osteoporosis as the five year Tamoxifen did cause some bone damages in my neck area.

[Rich66]

I was just bringing up Vitamin E since to much may interfere with Tamoxifen.

Also, from what I've been able to gather, Tamoxifen is more likely to strengthen bones..compared to aromatase inhibitors that deplete them.

[Jackie07]

No, Rich, Tamoxifen is just the lesser of the evil... (I read somewhere that)Tamoxifen targets Estrogen more around the breast area while Aromatease Inhibitor such as Arimadex targets all Estrogen in the entire body. They both cause osteoporosis.

[Jackie07]

Clin Breast Cancer. (http://javascript<b></b>:AL_get(this, 'jour', 'Clin Breast Cancer.');) 2008 Dec;8(6):527-32.
The effect of tamoxifen or exemestane on bone mineral density during the first 2 years of adjuvant treatment of postmenopausal women with early breast cancer.

Jones S (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Jones%20S%22%5BAuthor%5D), Stokoe C (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Stokoe%20C%22%5BAuthor%5D), Sborov M (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Sborov%20M%22%5BAuthor%5D), Braun M (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Braun%20M%22%5BAuthor%5D), Ethirajan S (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ethirajan%20S%22%5BAuthor%5D), Kutteh L (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Kutteh%20L%22%5BAuthor%5D), Pippen J (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Pippen%20J%22%5BAuthor%5D), Patel M (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Patel%20M%22%5BAuthor%5D), Paul D (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Paul%20D%22%5BAuthor%5D), Blum JL (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Blum%20JL%22%5BAuthor%5D), Holmes FA (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Holmes%20FA%22%5BAuthor%5D), Myron MC (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Myron%20MC%22%5BAuthor%5D), Cantrell J (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Cantrell%20J%22%5BAuthor%5D), Hartung NL (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hartung%20NL%22%5BAuthor%5D), Look RM (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Look%20RM%22%5BAuthor%5D), Di Salle E (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Di%20Salle%20E%22%5BAuthor%5D), Davis JC (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Davis%20JC%22%5BAuthor%5D), Ilegbodu D (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ilegbodu%20D%22%5BAuthor%5D), Asmar L (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Asmar%20L%22%5BAuthor%5D).
US Oncology Research, Inc., Houston, TX, USA. steve.jones@usoncology.com
Abstract

BACKGROUND: Adjuvant therapy with aromatase inhibitors is associated with increased bone loss in postmenopausal women with breast cancer. We assessed changes in bone mineral density (BMD) from baseline to 24 months in patients receiving either tamoxifen (T) or exemestane (E).

PATIENTS AND METHODS: A total of 578 women randomly assigned to T 20 mg per day orally or E 25 mg/day orally enrolled in this substudy; baseline, 12-month, and 24-month BMD measurements of the femur and lumbar spine by dual-energy x-ray absorptiometry were planned. Women receiving bone antiresorptive agents were excluded. Mean BMD changes from baseline to 12 and 24 months were tested between the treatment groups using 2-sample t tests and both g/cm2 (as percent changes) and T scores (as differences from baseline).

RESULTS: A total of 167 women with all 3 imaging studies were evaluable and form the basis of this report (T=89, E=78). Using T scores, the mean difference from baseline was significant between the 2 groups at 12 months at both the spine (P=.0002) and the hip (P=.0004), and at 24 months only at the hip (P=.02). CONCLUSION: More bone loss occurred during the first 12 months of treatment with E compared with T, but by 2 years the differences were less apparent and bone loss with E had slowed.


PMID: 19073509 [PubMed - indexed for MEDLINE]

[Jackie07]

Also, the summary on page 14 in this report:

http://www.managedcaremag.com/supplements/0512_earlybreastcancer/MC_earlybreastcancer_suppl.pdf


contains similar information listed in the Arimidex Webpage http://www.astrazenecaoncology.com/arimidex-information.aspx:

ARIMIDEX is only for postmenopausal women. ARIMIDEX can cause fetal harm when administered to a pregnant woman. Before starting treatment with ARIMIDEX, pregnancy must be excluded (see CONTRAINDICATIONS section of full Prescribing Information).

In women with preexisting ischemic heart disease 465/6186 (7.5%), an increased incidence of ischemic cardiovascular events occurred with ARIMIDEX (17%) vs tamoxifen (10%). In this patient population, angina pectoris was reported in 25/216 (11.6%) vs 13/249 (5.2%) and myocardial infarction was reported in 2/216 (0.9%) vs 8/249 (3.2%) patients receiving ARIMIDEX and tamoxifen, respectively.

Compared to baseline, ARIMIDEX showed a mean decrease in both lumbar spine and total hip bone mineral density. Tamoxifen showed a mean increase in these measurements. Nine percent of patients receiving ARIMIDEX had an elevated serum cholesterol vs 3.5% of patients receiving tamoxifen.

Common side effects seen with ARIMIDEX vs tamoxifen in the early breast cancer trial after 5 years of treatment include hot flashes (36% vs 41%), joint disorders (including arthritis, arthrosis, arthralgia) (36% vs 29%), asthenia (19% vs 18%), mood disturbances (19% vs 18%), pain (17% vs 16%), pharyngitis (14% vs 14%), nausea and vomiting (13% vs 12%), rash (11% vs 13%), depression (13% vs 12%), hypertension (13% vs 11%), osteoporosis (11% vs 7%), peripheral edema (10% vs 11%), lymphedema (10% vs 11%), back pain (10% vs 10%), insomnia (10% vs 9%), and headache (10% vs 8%). Fractures, including fractures of the spine, hip, and wrist, occurred more often with ARIMIDEX vs tamoxifen (10% vs 7%).

In the advanced breast cancer studies, the most common (occurring with an incidence of >10%) side effects occurring in women taking ARIMIDEX included hot flashes, nausea, asthenia, pain, headache, back pain, bone pain, increased cough, dyspnea, pharyngitis, and peripheral edema. Joint pain/stiffness has been reported in association with the use of ARIMIDEX.

Clinical and pharmacokinetic results suggest that tamoxifen should not be administered with ARIMIDEX. Estrogen-containing therapies should not be used with ARIMIDEX as they may diminish its pharmacologic action.
Read full Prescribing Information for ARIMIDEX (http://www.astrazeneca-us.com/cgi-bin/az_pi.cgi?product=arimidex&country=us&popup=no)http://www.astrazenecaoncology.com/Portals/0/icon_pdf2.gif (PDF – 786 KB

[Rich66]

I guess it depends on menopausal status...not sure how that relates to male BC.

http://www.breastcancer.org/tips/menopausal/longterm_conc/bone_strength.jsp

The aging process has a greater effect on bone loss than the presence or absence of estrogen. Smoking, prolonged bed rest or inactivity, being underweight, and certain medications can increase bone loss. Weight-bearing exercise increases bone mass. Tamoxifen tends to stabilize bone strength, but for the first year of taking it, pre-menopausal women may experience bone loss; post-menopausal women may have some bone fortification.


J Clin Oncol. (http://javascript%3Cb%3E%3C/b%3E:AL_get%28this,%20%27jour%27,%20%27J%20Clin%20 Oncol.%27%29;) 1996 Jan;14(1):78-84.
Effect of tamoxifen on bone mineral density measured by dual-energy x-ray absorptiometry in healthy premenopausal and postmenopausal women.

Powles TJ (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Powles%20TJ%22%5BAuthor%5D), Hickish T (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hickish%20T%22%5BAuthor%5D), Kanis JA (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Kanis%20JA%22%5BAuthor%5D), Tidy A (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Tidy%20A%22%5BAuthor%5D), Ashley S (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ashley%20S%22%5BAuthor%5D).
Royal Marsden Hospital, Surrey, United Kingdom.
Abstract

PURPOSE: Tamoxifen is an effective treatment for metastatic and primary breast cancer and is now being evaluated as a chemoprevention agent in healthy women. Any long-term effects on estrogen-sensitive tissues such as bone may have important therapeutic implications. METHODS: We measured bone mineral density (BMD) in the lumbar spine and hip using dual-energy x-ray absorptiometry (DXA) in premenopausal and postmenopausal healthy women who participated in our placebo-controlled tamoxifen chemoprevention of breast cancer trial. RESULTS: BMD data are now available from 179 women for this analysis. In premenopausal women, BMD decreased progressively in the lumbar spine (P < .001) and in the hip (P < .05) for women on tamoxifen, but not those on placebo. The mean annual loss in lumbar BMD per year over the 3-year study period in tamoxifen-treated compliant women who remained premenopausal throughout the study period was 1.44% (1.88% calculated on an intent-to-treat basis) compared with a small gain of 0.24% per annum for women on placebo (P < .001). Tamoxifen had the opposite effect in postmenopausal women. The mean annual increase in BMD for women on tamoxifen was 1.17% in the spine (P < .005) and 1.71% in the hip (P < .001) compared with a noninsignificant loss for women on placebo. CONCLUSION: These results indicate that tamoxifen treatment is associated with a significant loss of BMD in premenopausal women, whereas it prevents bone loss in postmenopausal women. These adverse and beneficial effects of tamoxifen should be considered in the assessment of the therapeutic benefits for both the adjuvant treatment and the chemoprevention of breast cancer.

PMID: 8558225 [PubMed - indexed for MEDLINE]



Med Sci Monit. (javascript:AL_get(this,%20'jour',%20'Med%20Sci%20 Monit.');) 2008 Sep;14(9):RA144-8.
The multiple applications of tamoxifen: an example pointing to SERM modulation being the aspirin of the 21st century.

Singh MN (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Singh%20MN%22%5BAuthor%5D), Martin-Hirsch PL (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Martin-Hirsch%20PL%22%5BAuthor%5D), Martin FL (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Martin%20FL%22%5BAuthor%5D).
Lancashire Teaching Hospitals NHS Trust, Fulwood, Preston, UK.
Abstract

Tamoxifen is a selective oestrogen receptor modulator (SERM) with an established role in the treatment and chemoprevention of hormone-related breast cancer. It is also cardioprotective and increases bone mineral density. However, due to pleiotrophic ligand-receptor properties, its role in a variety of seemingly unrelated disorders, including multiple sclerosis, Parkinson's disease, Alzheimer's disease, systemic lupus erythematosus and urological cancers, has been investigated in many studies. The non-patented drug tamoxifen confers a significant advantage over newer drugs in being inexpensive and well-tolerated with a known side-effect profile. This review highlights the interaction of tamoxifen on oestrogen receptors (ERs) and assesses whether this agent continues to have future applications in a variety of clinical settings, both as a therapy in early and established disease and usage as a prophylactic in those at risk of debilitating conditions. Indeed, it may have as-yet-unknown benefit(s) in a variety of conditions, both as a prophylactic in those at high-risk and also as in novel therapeutic strategies in established disease. Future clinical studies may seek to establish the exact future role and efficacy for SERMs both in men and women. Perhaps a multi-functional SERM such as tamoxifen may be the aspirin of the 21(st) century.

PMID: 18758431 [PubMed - indexed for MEDLINE]






I'm aware testosterone suppression in prostate cancer induces bone loss..but testosterone supplementation might not a good idea in male breast cancer:


Endocr Pract. (http://javascript%3Cb%3E%3C/b%3E:AL_get%28this,%20%27jour%27,%20%27Endocr%20Pr act.%27%29;) 2008 Mar;14(2):201-3.
Invasive breast cancer after initiation of testosterone replacement therapy in a man--a warning to endocrinologists.

Thomas SR (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Thomas%20SR%22%5BAuthor%5D), Evans PJ (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Evans%20PJ%22%5BAuthor%5D), Holland PA (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Holland%20PA%22%5BAuthor%5D), Biswas M (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Biswas%20M%22%5BAuthor%5D).
Department of Diabetes and Endocrinology, Royal Gwent Hospital, Newport, Gwent, United Kingdom.
Abstract

OBJECTIVE: To alert fellow endocrinologists of a rare side effect of testosterone therapy, for which men with hypogonadism must receive appropriate counseling and monitoring. METHODS: We present clinical features, laboratory data, and histopathologic findings in a man with hypogonadism who received testosterone replacement therapy. RESULTS: A 61-year-old man was referred to an endocrinologist after presenting to his general practitioner with erectile dysfunction and low libido. He had no history of hypothalamic, pituitary, or testicular disorders. There were no other illnesses or medications to account for low testosterone levels. Physical examination was unremarkable. There was no family history of malignant disease. Biochemical investigations confirmed the presence of primary hypogonadism, for which no cause (including Klinefelter syndrome) was identified. Testosterone therapy was initiated to improve sexual function and preserve bone density. Five weeks later, the patient returned to his general practitioner, complaining of a gradually enlarging lump in his right breast. When biopsy showed breast cancer, testosterone therapy was discontinued. Right mastectomy and axillary node clearance were performed. Further histologic examination revealed estrogen receptor-positive, invasive carcinoma, without nodal involvement. The patient remains on tamoxifen therapy and is undergoing follow-up in the breast clinic. After 6 months of treatment, estradiol levels were undetectable, and testosterone levels remained low. CONCLUSION: Although breast cancer has been described in men with hypogonadism receiving long-term testosterone replacement therapy, to our knowledge this is the first report of breast cancer becoming clinically manifest after a short duration (5 weeks) of testosterone treatment. This case should remind clinicians that men receiving testosterone therapy should be warned of the risk of not only prostate cancer but also breast cancer. Patient self-monitoring and breast examinations by the attending physician are recommended.

PMID: 18308658 [PubMed - indexed for MEDLINE]

[TanyaRD]

Bird,
These are excellent points and it would be wise to include at least 1000mg calcium daily and also have your Vit. D levels checked if you haven't already followed by appropriate supplementation of D3.

[1rarebird]

Rich, Jackie and Tanya--thank you all for your comments and recommendations. Please note that I am taking once a month bisphoshonate, Boniva, along with 1200 mg per day calcium. My vitamin D blood serum level was check 5 months ago and found to be 44 ng/ml but I am supplementing 2000 IUs a day just in case I need more. I power walk 3 miles a day so I hope my femurs at least are getting the exercise they need. I will ask for follow up bone density testing one year for the last one. Maybe all of this effort will keep my bone loss under control in the future as I continue with the tamoxifen.

And Rich, I found most interesting the abstract on the one case of male breast cancer in a patient having just started testosterone treatment for sexual dysfunction. I have a 65-year old friend who has started that same regimen and who is also is a two-times cancer survivor: prancreatic and colon. I will forward him the abstract so he can discuss his situation with his doctor.

Thanks again everyone---

bird