Opinions welcome-- do I get a fourth opinion on hormonal treatments?

[saleboat]

Thank you RB for always keeping that issue front of mind for us. I've purchased one of the books that you suggested (by Barry Sears) and found it helpful.

Jen

[R.B.]

Smart Fats is MUCH MORE thought provoking AND particularly for women.

If you consider it in its wider context it has pertinece to brain mets.

I found a copy for $5 on the WEB - it is a definate MUST buy and read.

A trial I have posted on this site showed 70% differential in risk of tumours being invasive based on Omega three / DHA content in breast tissue taken at the same time (the third with highest dha content had 69 % lower risk than the bottom third).

For me for the sake of some dietary change figures like that are too big to ignore - why they have not done large scale tests is beyond me except a sneaking sad suspicion that reserachers dont get funds for telling drugs companies how not to make money......

If you have the funds you can get tested for your fat profile which I think would be really useful. The details of some labs are in the book.

Fats in breast tissue change in about three months it is reported. Gluteal tissue it is reported can take years

(I have no interest in the book and no idea who the author is I just have been searching for buying and reading books on the subject as well as lots off the net trials etc. I was particularly impressed by this book......)

Thanks for the response.

RB

[al from Canada]

This is all very good adice. My question, and it has been for years now, the medical tx standard is not to mix ER inhibitors with chemo. The more I read the less sense it makes. Why aren't we adding say, an AI with herceptin AND xeloda or one of the others? My question is limited to metastatic disease. Not doing so is making less sense all the time.


Regards,
Al

[panicked911]

Hi Jen:

Like you I am at Sloan and highly triple positive (er, pr, Her2) interestingly my onc immediately switched me to AI from Tomaxifen which the surgeon had started me on right after my lumpectomy on 10/5.

I know tomaxifen was working - I could feel it - breats were much less dense, ent down a full cup size etc within three weeks of starting it. Amazigly i felt great on it as well - all the achs and pains were gone and my energy level shot up.

Yet once I started herceptain and began lupron shots I was switched to Arimidex - bam - the aches and pains were pack, energy level plumeted . Asked to be switxched back to Tomaxfen and was told not now - neeed to stay withthe arimidex or another AI much less riskier.

So here I am now trudging along - steps are a nightmare b/c of the pai in the knee joints and if i sit to long in one place i "stiffen up" - despite all of this - still believe small price to pay .... I was diagnosised at stage 1 and am determined to remain there .....

[saleboat]

Hi--

Thanks for the message. If I'm not mistaken, you (Panicked911--Ann?) did not have chemo, right? I wonder if that fact makes Sloan's hormonal recommendation a bit different.

I tell you, my mind swirls on this one, because it seems as though the recommendations (in general) are all over the map.

Thanks again,
Jen

[AlaskaAngel]

I don't know about you, Saleboat, but the farther back in time one's diagnosis happened, the less real information there is to work with. Just to start with there is the question of whether one truly is strongly HER2 positive or not, since until recently they didn't know that IHC was less reliable than FISH. My path report is from early 2002 and even though it was done at a central testing facility there is no information about any characteristics other than ER, PR and HER2.

So then I think, well, maybe I should push to have my tumor block re-analyzed for PTEN and other characteristics. I think it just might even make sense to use Onco-Dx to get better information for us, even though we have already had treatment. But it seems like everyday there are more "characteristics" that are showing promise in terms of testing, and there is some logic in waiting because a tumor block isn't something to waste piece by piece.

It just may also be true that chemotherapy simply pushes recurrence out farther on the timeline rather than reducing the actual number of recurrences, and as HER2's we do know they don't have reliable long-term statistics specific to HER2's regardless of ER and PR.

My personal opinion is that with all the uncertainty involving treatment for patients who are HR+, at the very least the breast care guidelines should be revised to stop advising chemo over the alternative of ovarian ablation and hormonal therapy for Stage 1's until the new clinical trial is completed, especially given that 60% of Stage 1's will never even have recurrence with surgery alone as therapy, and that less than 20% of ALL stages who do receive chemotherapy will benefit from it.

AlaskaAngel

[AlaskaAngel]

Association between HER-2/neu and the progesterone receptor in oestrogen-dependent breast cancer is age-related.

Breast Cancer Res Treat. 2005; 91(1):81-7 (ISSN: 0167-6806)




Huang HJ; Neven P; Drijkoningen M; Paridaens R; Wildiers H; Van Limbergen E; Berteloot P; Amant F; Christiaens MR; Vergote I
Division of Gynaecologic Oncology in Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

In oestrogen receptor-positive (ER+) breast cancer, HER-2/neu and the progesterone receptor (PR) are inversely associated. This explains a lower response to anti-oestrogens if ER+ breast cancers are HER-2/neu positive. One randomized study however, showed that premenopausal women with an ER+ breast cancer respond to anti-oestrogens independent of HER-2/neu. We therefore hypothesized an age-related association between HER-2/neu and PR in ER+ breast cancers. Receptors for ER, PR and HER-2/neu were analysed by immunohistochemistry (IHC). A uni- and multivariate analyses was carried out to assess this relationship in 1104 women with an ER+ breast cancer. We observed an inverse association between HER-2/neu and PR only after age 45. There were 173 women of age45 years. In multivariate analysis, only tumour grade (p=0.005) but not PR status was associated with HER-2/neu in women age45 years group, both PR status (p=0.001) and tumour grade (p=0.001) were independently associated with HER-2/neu. In ER+ breast cancers from women age>45, PR was positive in 76.9% if HER-2/neu negative but in 53.4% if HER-2/neu positive (p<0.001) and the median quantitative PR levels are 150 and 75 respectively in HER-2/neu negative and HER-2/neu positive tumours (p=0.002). This age effect of HER-2/neu on the PR status was not seen in women age 45 years but not in women age...

(sorry, this was all I could get of the article...)



A.A.