What breastcancer.org says....about bc patients face leukemia risk

[Jean]

Older breast cancer patients face leukemia risk

Chemotherapy affects normal, healthy cells as well as breast cancer cells. This is why chemotherapy can cause hair loss, anemia, and diarrhea. In rare cases, exposing normal cells to cancer treatments such as chemotherapy and radiation therapy can cause a new, different type of cancer to develop many years after treatment.
The large study reviewed here found that women who received chemotherapy for breast cancer were more likely to develop a specific type of leukemia called acute myeloid leukemia (AML) within 10 years of treatment than women who didn't get chemo for breast cancer.
It's VERY IMPORTANT to know that while the risk for AML was higher for women who got chemotherapy, the risk of AML is still very small. Women who got chemotherapy for breast cancer had a 1.8% risk of developing AML within 10 years of treatment. Women who didn't get chemotherapy had a 1.2% risk.

I think it is safe to say that while any medication can cause other health issues or severe side effects it is important to understand the risks with or without treatment. There is risk in just breathing the air or crossing the street. While no one wishes to increase their risk of any disease - when faced with a dx. of bc one has to consider all the risks and how high are the percentages.

[AlaskaAngel]

Recognizing what one's risk is for AML under present circumstances also means taking into consideration the knowledge that chemotherapy has not been a standard recommendation for adjuvant treatment until roughly the last decade.

Most people diagnosed with breast cancer are older people. Aging increases the incidence of erroneous sequencing of genetic information.

In addition, until very recently, chemotherapy has not been used for younger and younger women as adjuvant treatment.

We really don't have the ability to determine yet how this very recent and very massive change and increase in the use of chemotherapy will change the incidence of AML.

In addition, there is now the added suggestion for increasing the use of chemotherapy among those with micromets. That is yet another group that has not previously been included in the numbers used to calculate risk for AML.

AlaskaAngel

[Jean]

Women have been receiving adjuvent treatment since the 1970's and one study was done from 1970 to 1986 with over 3,000 women from France. The percentage of women who advanced with AML was a small percentage.
Yes, it is accurate that this last decade newer drugs were introduced. Very rarely, certain chemotherapy drugs can permanently damage the bone marrow, leading to acute myeloid leukemia, a life-threatening cancer of white blood cells. When this happens it is usually within 10 years after treatment. In most women, chemotherapy's benefits in preventing breast cancer from coming back or in extending life are likely to far exceed the risk of this serious but rare complication.
I think it sound to say that there will always been a percentage of patients who have serious side effects.
Her2 stats have changed and what once was a bad prognosis has made a huge turn. I believe on this board while we will always practice due diligence in our information it is true to say the benefits out weigh the risks. The risk of the Her2 spreading and destroying our life is far greater than the risk and the odds of AML and that is just a fact. There will always be patients who will experience other side effects from chemo treatment in all types of cancer. It is to be noted that the small percentage that did advance with AML did so in the first five years...and that after 10 yrs. the risk has dropped.
While we must weigh the choices in treatment along with risk, the risk of AML is low - and for the most part I think most women are more concerned with the HER2 spreading. As always it is an individual choice each women must decide for herself. I just don't believe that AML is more frightening than the HER2...while certainly no one wants to open the door to yet another cancer...the percentage against us in the HER2 spreading is far greater than getting AML.

[Hopeful]

Women have been receiving adjuvent treatment since the 1970's and one study was done from 1970 to 1986 with over 3,000 women from France.

The drugs most commonly assoicated with late AML are anthracyclines, "third generation chemotherapies," which were not used as adjuvant breast cancer treatment during that time period. With breast cancer suvivors making up the largest group of cancer survivors, the true risk of this side effect will not become apparent for quite some time, until the cohorts who received the drug live 10 to 15 years post treatment.


Hopeful

[Jean]

Yes, it is accurate that this last decade newer drugs were introduced. Very rarely, certain chemotherapy drugs can permanently damage the bone marrow, leading to acute myeloid leukemia, a life-threatening cancer of white blood cells. When this happens it is usually within 10 years after treatment. In most women, chemotherapy's benefits in preventing breast cancer from coming back or in extending life are likely to far exceed the risk of this serious but rare complication.

Like everything else we do not have all the answers we seek today or even in the near future. But women have to face making choices today with as much knowledge that is available at the present. It has always been my position that we as bc patients need to empower ourselves so that we make decsions based on knowledge and not fear. The disease in and of itself is very frightening to most who are dx. (esp. newly dx. as they are on a severe learning curve. ) So hearing they may or may not need treatment - and then hearing that you can later be dx. with AML ...while it is true, this could happen, it is not the high numbers that a broad statment of we could get AML would have a women think. The rate that has been tested from 1970 up to 2006 with those current treatments are what we have today to glean. Newer treatment results will be forth coming and that is all we have at this time. So many come to this site to gain information about the disease that is shocking for most to absorb - I would like to keep a realistic balance to the knowledge of choices and risks. Becky put it quite
nicley about the fact that we could also get hit by a bus. This disease takes so much - maybe it is better to not also give it strength in the fear of the unknown.
We don't have the numbers at this time of the newer treatments but we do have the percentage of the previous study to work with.

[AlaskaAngel]

It is common knowledge that in the 1970's, 1980's, and 1990's, the procedures for early detection were not as widely performed as they are now. Because of that, fewer people were diagnosed with early stage breast cancer in that period of time. More were diagnosed with later stages of breast cancer. Mammography was also less distinct and harder to read correctly. There were fewer early stage breast cancer patients to receive adjuvant treatment with chemotherapy to be counted and analyzed for effects of adjuvant chemotherapy over time. During that period more of them instead still received the procedure that is much less common now -- radical mastectomy -- they did not receive adjuvant chemotherapy. Over that long period of time that gradually changed. So while it is possible to consider a few studies done back then, when most patients were still being diagnosed with later stage bc, everyone can use their own judgement about how sophisticated or authoritative those studies would have been.

Chemotherapy has been used in some instances as adjuvant therapy for some patients for the last 30 years, but as I clearly stated, chemotherapy was NOT standard recommended adjuvant therapy until about the last 10 years. (Please review my earlier post, which makes that distinction.) The number of patients receiving it as adjuvant therapy increased dramatically over the last decade. This makes it more difficult to analyze and consider the percentage of risk for AML or other chemotherapy-related illnesses to be unchanging over a shorter period of time in spite of the increase during that fairly brief period of time of use of chemotherapy as standard recommended adjuvant therapy.

This site is a good place to explore the history and analysis of treatment for breast cancer with each other to try to identify meaningful information in making decisions about treatment. It is a priceless place for safe and honest discussion. There are a variety of people here, from those who were diagnosed as recently as 2005 and afterward with the common use of trastzumab and chemotherapy and who may have a very different general impression of the history of treatment than those who were diagnosed earlier, when chemotherapy was not the standard recommendation for adjuvant use for early stage breast cancer. Without keeping a general awareness of the history of treatment, it is easier to distort the reality of it and draw different conclusions based on a shorter and more recent period of time.

People feel very passionately about wanting to help and save as many breast cancer patients as possible, regardless of how they view treatment, and there is no question about the desire of those sharing opinions and hopes as well as facts to be as helpful as possible.

AlaskaAngel

[Jean]

First of all the first post I made about the study was from breastcancer.org and the source was from the Journelof Oncology...2007.
The findings stem from an analysis of data for women diagnosed with breast cancer from 1992 to 2002 and entered in a Medicare-linked database. So it is not based on 70's 80's and 90's. When I posted those yrs. it was only to state about another study which was done in France during those dates.

So therefore the percentages that were first stated in the first post are newer studies, I only replied to Hopefully that studies were being done as far back as those years.

The important issue is that in the studies from 1992 to 2002 decisions regarding adjuvant chemotherapy in older women must incorporate both short- and long-term risks of chemotherapy as well as potential benefits, so that patients can make informed decisions.

The study for the period of 1992-2002 did not mention the stage of cancer or for that matter who was HER2.
The time line from 1992 - 2002 I would think would be a greater issue for those dx with HER2 before use of
hercpetin was protocal. (I believe you had to be stage IV to have herceptin as a treatment).

While the study does NOT demonstrate how many were dx. with HER2 it is still prudent to say that HER2 at any stage is a serious threat. So - with that in mind I repeat again that when being dx. HER2 each woman has to make their own choices about risk of treatment.
The study of 1996-2002 deomonstrates that the risk
holds a slight difference from those who received chemo/and those who did not.

[Jean]

http://seer.cancer.gov/publications/mpmono/Ch07_Breast.pdf

Another interesting study...there are many factors which contribute to secondary cancers of all kinds.
Yet still the rates are not outstanding....or extremely high. There will ALWAYS be negative effects as drugs are used - but patients have to weight the odds and make informed decisions.

[suzan w]

Thank you for this! I have always, in the back of my mind (the part not affected by chemo!!!), about the leukemia risk. It is something my surgeon discussed with me. Not my oncologist. Unfortunately my surgeon passed away 3 months after my first 'anniv.' of the surgery. As I did A/C...I am in the category that thinks about leukemia!!

[Jean]

Hi Suzan,
There is no escape for any of us who have had chemo treatment or taking AI's etc. At least the studies that have been published thus far are not showing the risks to be extreme (yes there is risk). :( no one wants to expose their bodies to drugs but given the choices with HER2 I decided to have chemo and weighed my odds.
You are doing fine thus far and I pray for all of us to continue doing so.

Jean

[AlaskaAngel]

Hi - It is an interesting discussion because it involves not only the numbers but the way we think of them and how we compare them in terms of benefit versus risk. The risk for AML has been considered low but that was when not as many patients were being given chemo (because it wasn't standard to give it so broadly before it was standard for adjuvant treatment). So the question is, does the risk rise once it comes a part of standard adjuvant care? And does it rise even further once it becomes part of treating those with micromets, etc. for whom it has not been standard treatment thus far?

Logic says the risk rises. But it takes time for that to happen because AML occurrence happens "down the road".

Personal perspective enters into the picture. To me, since oncologists have never done their homework for early stage breast cancer patients in terms of finding out whether trastuzumab ALONE (without any chemotherapy) works just fine for early stage bc, then why would oncologists wish to put these humans through chemotherapy that adds the already known risk for some degree of AML, as their way of "saving" more breast cancer patients?

How many patients with micromets go on to develop bc? Is that number greater or smaller than the number that go on to develop AML? How much does putting humans through the difficulties involved in chemotherapy and the longterm problems involved with that, and then for them to go through AML in addition "count" to these humans? How long on average does it take for micromets to result in additional breast cancer without chemotherapy, IF they do? Longer or shorter than it takes to develop AML?

I am 9 years out but because my treatment included doxorubicin and radiation I will always be at additional risk for AML. I do think that a healthy lifestyle makes a difference in the long run, but I don't know that for sure. I do know for certain that despite having no comorbidities and living a healthy lifestyle, my immune system response is much more minimal than it was prior to chemotherapy treatment. A tiny sore takes days if not weeks to heal, whereas prior to chemotherapy and radiation it would heal in a day or two.

Without knowing for sure who is right or wrong, some of us see more hope in treatment with toxic substances, and some of us see more hope in more limited application of the treatment. We can't find out until those who would do trastuzumab alone are given that opportunity with clinical trials using trastuzumab alone for early stage bc.

A.A.

[Jean]

The rates may rise or they may not we just don't know the full thrust of the newer treatments. We do know that women with HER2 are surviving the disease whereas just a short 10 yrs. ago that was not the case. Women advanced and the overall death rate was high. Not the case anymore. We must never forget medicine is an art along with a science. While we want all the answers and a cure today - we may not see this for years to come. The what if's are many - we do need to maintain a balance of risk against odds. As medicine has advanced in this century we have benefited greatly and also paid a dear price.
As my Grandfather used to say, "there is no free lunch" there will always be a cost to be faced.

[Jean]

Lani, just posted this on another thread.
This is a perfect example of what I have been saying, we are exposed in so many ways not just chemo treatments....there is food, other meds, the air, toxic chemicals all around our world. In science, where there is action there will always be reaction - Jean

Heart drug linked to higher breast cancer risk





NEW YORK (Reuters Health) – Women taking the heart drug digoxin have an increased risk of breast cancer, according to a study of more than 2 million Danes.
Digoxin, marketed as Lanoxin and Digitek, is used by people with heart failure or with abnormal heart beats. But it can also act like the female hormone estrogen in the body, leading researchers to wonder if it might up cancer risk the same way estrogen treatment does in older women.
About two percent of the women who took digoxin at any point during the new study eventually developed breast cancer.
Former users had the same risk as those who had never taken the drug, while those currently on it were about 40 percent more likely to get breast cancer.
That extra risk is "worth noting," said Dr. Timothy Lash of Aarhus University Hospital in Denmark, a breast cancer expert who was not involved in the study. But he added that it's less impressive when you consider how few women actually developed the disease.
In the U.S., about one in eight women develop breast cancer at some point, according to the American Cancer Society.
For the new study, researchers led by Dr. Robert Biggar of Statens Serum Institut in Copenhagen, Denmark, tapped into two different country-wide databases - one that includes all prescriptions filled in Denmark and another that contains all cancer cases.
About 100,000 women age 20 and older took digoxin at some point during the course of the study, which tracked women for an average of 12 years.
The chance of getting breast cancer was highest in women who were in their first year of taking digoxin. Then it dropped off, but slowly crept up again after 3 years or more on the drug.
Digoxin is often added on top of other heart drugs, such as beta blockers and statins. There was no extra breast cancer risk linked to those drugs, however.
GlaxoSmithKline, which markets digoxin, was not available for immediate comment on the study.
The study can't prove that digoxin, also known as digitalis, actually causes breast cancer in some women. And even if it does, the heart benefits might still outweigh that risk, the researchers write in the Journal of Clinical Oncology.
So the findings don't mean women should avoid taking digoxin, Lash told Reuters Health. Those who are on the drug "are receiving digoxin because they already have a fairly serious chronic disease," he said.
"It might be worth talking with their doctor about the tradeoff, (but) maintaining heart health is an important consideration," he said.