[AlaskaAngel]

Hi RB!

I wish I were better at understanding the numbers. I am not so clear on exactly what it all means. In looking at it from different perspectives (usually including quite a lot of my own personal viewpoint *grin*), I have to wonder if there may be something else going on here... and just raise another question to consider.

I am quite concerned about the problem of weight gain in breast cancer patients because of the increased risk for recurrence for those who are overweight. My concern is 2-fold, really. I am unsure how much of the added weight is a problem purely because of the weight itself, and how much of the problem is due to inflammation from accumulated eating over time of an imbalance of fats, or "eating too much of the wrong kinds of fats, and not enough of the right kinds of fats".

From my personal (and thus somewhat limited) experience with the gradually continuing slowdown in metabolism that comes with aging and increasing menopause plus chemopause, as I see it, chemotherapy itself provides the most benefit to those who are younger in slowing down the metabolism to some degree and yet because it their metabolism is not as slow as it is for complete menopause they have the benefit of less tendency for weight gain and quicker weight loss after completion of treatment (with diet and exercise).

But the majority of breast cancer patients are over age 55 and more likely to become overweight with the combination of steroid use during treatment plus the slowdown in metabolism. (Bear with me, I'm getting to the aromatase issue!) I think the use of aromatase inhibitors are the way that oncology has tried to compensate for the greater likelihood for older (more menopausal) patients' weight gain.

But I think the problem of eating the wrong balance of types of fats still might defeat at least some of the benefit of using AI's. I think the oncologists tend to lean too much on depending on the AI's to solve the problem of added risk from weight gain due to steroid use with treatment plus slowing metabolism from menopause.

I also think that it is quite possible that in counting the people in different age groups to measure "success" from use of AI's, they might be over-estimating the value of AI's in thin women. Are the AI's actually reducing the recurrence for them as compared to overweight patients, or are those women doing better because their bodily fat is reduced and less inflammatory to them to begin with? Is the use of AI's a waste of effort for thin women? I think there probably is a breaking point where the use of AI's is helpful, but I can't tell where it would be.

I continue to be concerned about the breaking point also in terms of net benefit of chemotherapy application to breast cancer patients over time because of the metabolic differences between younger patients and older ones. It is just too easy to "want" chemotherapy to work "just in case" in a group of primarily older early stage breast cancer patients when it may instead increase their net risk due to their greater tendency for weight gain with steroids and menopause (and also, the imbalance in types of fats consumed as part of that process).

I know my questions go beyond the topic of AI use alone, but I ask them because sometimes the focus on parts of the big picture leave out other important questions.

I wish I knew the answers.

AlaskaAngel