struggling with my AI's(i hate them)

[R.B.]

^ Good find Alaska Angel (-:

The converse of women with greater fats levels needing higher dosages would be that aromatase inhibitors will have a greater effect in lean women, which may mean women with low body fats are at risk of more pronounced side effects,

[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

[R.B.]

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).

These are valid questions AA.

How do you balance risk of long term 'damage' in terms of 'ageing' / alteration of body cell function, v short term benefits? How does chemo impact on lifespan, QOL etc?

What are the long term effects of chemo on cell function, energy production capacity etc?

How are different age groups affected comparatively etc?

[fauxgypsy]

After trying Tamoxifen, Femara, and Arimidex, I have decided to try to lower my risks with diet and exercise (once my hip pain allows it again). My doctor asked me to try Aromasin, but I read over the possible side effects and I just don't see the point. Since I quit taking the Arimidex, many of the side effects have begun to get better. Until recently I didn't realize that there could possibly be cognitive effects as well. I am feeling much better, the joint pain seems to be improving. I am sleeping better as well.

I may be misunderstanding the data in the papers at the following two links, but what I get out of it is that is lowers the chance of recurrence, but does not change mortality rates. I want to be able to live the life I have now. What if I give up feeling healthy for the next few years and it still comes back. I may regret this decision. I just don't know.

http://jco.ascopubs.org/content/28/3/509.abstract
http://jco.ascopubs.org/content/28/20/e346.full

There are also other issues. Bone loss. Weight gain for some women.

http://www.healthcentral.com/breast-...76/potentially

I guess I just have some reservations about the long term effects of this therapy.

Leslie

[sarah]

hello,
the idea of lean versus fat women taking AIs is interesting. I was lean before chemo but became fat however I would never have considered not taking the AIs whatever the side effects. I do wonder why AIs are not adjusted for weight.
Personally the worse side effects for me (and I had hot flashes, arthritic wrist, foot etc pain) were: bone loss for which I was given Clastoban which did indeed help rebuild bone and abrupt, menopausal type mood swings for which I was given Paroxetene.
I do think that the side effects need to be considered since so many women are having problems staying on them despite the fear of recurrence.
love sarah