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Aromatase inhibitors 'significantly reduce breast cancer deaths'


A new study claims a class of hormonal drugs called aromatase inhibitors may significantly reduce the risk of death among postmenopausal women with estrogen receptor-positive breast cancer - the most common form of the disease.

Lead study author Prof. Mitch Dowsett, of The Institute for Cancer Research (ICR) in the UK, and colleagues publish their findings in The Lancet.

It is estimated that around 231,840 women will be diagnosed with invasive breast cancer this year, and more than 40,000 will die from the condition.

Estrogen receptor-positive (ER-positive) breast cancer accounts for around 70% of all cases, in which breast cancer cells contain receptors that attach to the hormone estrogen. When the hormone binds to these receptors, this can encourage the growth of breast cancer tumors.

At present, women with ER-positive breast cancer may be treated with tamoxifen - a drug that prevents estrogen from binding to receptors in breast cancer cells. The drug is primarily prescribed for women with early-stage breast cancer who have undergone surgery, radiation and/or chemotherapy in order to prevent recurrence.

According to Prof. Dowsett and colleagues, taking tamoxifen for 5 years is associated with a 30% reduction in breast cancer death. But their study suggests another class of hormonal drugs - called aromatase inhibitors - may be more effective.

Aromatase inhibitors lower estrogen levels by preventing the enzyme aromatase - found in fat tissue - from changing other hormones into estrogen. As such, there is less estrogen to bind to receptors in breast cancer cells.

In the US, aromatase inhibitors are currently used to treat early-stage breast cancer in postmenopausal women who have been treated with tamoxifen for around 2-3 years.

Previous research suggests aromatase inhibitors are more effective for reducing breast cancer recurrence than tamoxifen, though how they impact survival has been unclear.

Aromatase inhibitors reduced breast cancer mortality by 40%

For their study, the team analyzed the data of nine clinical trials involving 31,920 postmenopausal women with early-stage ER-positive breast cancer. The women in the trials had either received no hormonal therapy or had used aromatase inhibitors or tamoxifen for at least 5 years.

Compared with women who had not received hormone therapy, those who received aromatase inhibitors were 40% less likely to die from breast cancer in the 10 years after treatment initiation. Women who took tamoxifen were at around 30% lower risk of breast cancer death.

"Our global collaboration has revealed that the risk of postmenopausal women with the most common form of breast cancer dying of their disease is reduced by 40% by taking 5 years of an aromatase inhibitor - a significantly greater protection than that offered by tamoxifen. 

Aromatase inhibitors remove only the tiny amount of estrogen that remains in the circulation of women after the menopause - but that's enough to have a substantial impact on a wide range of ER-positive tumors, despite their extraordinary differences at the molecular level."

However, the researchers note that treatment with aromatase inhibitors may present a number of side effects. These can include shortness of breath, chest pain, hot flashes, muscle or joint pain and depression.

"It's important to ensure that women with significant side effects are supported to try to continue to take treatment and fully benefit from it," notes Prof. Dowsett.

Earlier this month, Medical News Today reported on a study published in Nature suggesting half of breast cancers could be slowed if the hormone progesterone was added to treatment.

Source: Medical News Today

Endometriosis

Endometriosis is the abnormal growth of cells (endometrial cells) similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometriosis is most commonly found on other organs of the pelvis.

Who is affected by endometriosis?

Endometriosis affects women in their reproductive years. The exact prevalence of endometriosis is not known, since many women may have the condition and have no symptoms. Endometriosis is estimated to affect over one million women (estimates range from 3% to 18% of women) in the United States. It is one of the leading causes of pelvic pain and reasons for laparoscopic surgery and hysterectomy in this country. Estimates suggest that 20% to 50% of women being treated for infertility have endometriosis, and up to 80% of women with chronic pelvic pain may be affected.

What causes endometriosis? 

The cause of endometriosis is unknown. One theory is that the endometrial tissue is deposited in unusual locations by the backing up of menstrual flow into the Fallopian tubes and the pelvic and abdominal cavity during menstruation (termed retrograde menstruation). The cause of retrograde menstruation is not clearly understood. But retrograde menstruation cannot be the sole cause of endometriosis. Many women have retrograde menstruation in varying degrees, yet not all of them develop endometriosis.

Another possibility is that areas lining the pelvic organs possess primitive cells that are able to grow into other forms of tissue, such as endometrial cells. (This process is termed coelomic metaplasia.)

What are endometriosis symptoms? 

Most women who have endometriosis, in fact, do not have symptoms. Of those who do experience symptoms, the common symptoms are:

  • Pain (usually pelvic) that usually occurs just before menstruation and lessens after menstruation
  • Painful sexual intercourse
  • Cramping during intercourse
  • Cramping or pain during bowel movements or urination
  • Infertility
  • Painful pelvic exam

Other symptoms that can be related to endometriosis include:

  • lower abdominal pain,
  • diarrhea and/or constipation,
  • low back pain,
  • chronic fatigue
  • irregular or heavy menstrual bleeding,
  • painful urination, or blood in the urine

12 Types of Birth Control


Combination pill

What it's called: Estrostep Fe, LoEstrin 1/20, Ortho-Novum 7/7/7, Ortho Tri-Cyclen Lo, Yasmin, Yaz.

What it does: This birth control mainstay is still 99% effective against pregnancy when taken around the same time every day. It's also known for easing hot flashes and restoring regular periods.

Who should avoid it: Smokers and those 35 or older. The estrogen may cause dangerous blood clots. If you suffer from migraines, you should also pass because it may trigger the painful headaches.

Progestin-only pill

What it's called: Micronor, Nora-BE, Nor-QD, Ovrette.

What it does: Known as the mini pill, progestin-only meds don't contain estrogen. They're safer for smokers, diabetics, and heart disease patients, as well as those at risk for blood clots. They also won't reduce the milk supply for women who are breast-feeding.

Who should avoid it: If you have trouble remembering to take your pill at the same time every day, progestin-only pills might not be your best bet. They need to be taken at exactly the same time every day; if you're more than three hours late, plan on using a backup method.

Extended-cycle pill

What it's called: Lybrel, Seasonale, Seasonique.

What it does: These pills prevent pregnancy and allow you to have a period only every three months. (Note: Lybrel stops your period for a year, but you must take a pill every day, year-round.)

Who should avoid it: There's no evidence proving it's dangerous not to have periods, but there is still no long-term research to show that it is safe.

Vaginal ring

What it's called: NuvaRing.

What it does: The ring is made of flexible plastic and delivers estrogen and progestin, just like the combination pill. You place the ring in your vagina for three weeks, and then remove it for one week so that you have a regular period.

Who should avoid it: Women who smoke, or have blood clots or certain cancers, should not use the NuvaRing.

Diaphragm

What it's called: Milex Wide Seal, Ortho All-Flex, Semina, SILCS.

What it does: Made of rubber and shaped like a dome, a diaphragm prevents sperm from fertilizing an egg. It covers the cervix and must always be used with a spermicide. Women must be fitted for a diaphragm in their doctor's office.

Who should avoid it: If your weight tends to fluctuate by more than 10 pounds at a time, the diaphragm may not work. If you gain or lose weight, you'll need to be refitted. Prone to bladder infections? You might want to consider another option. If you've had toxic shock syndrome, you shouldn't use a diaphragm.

IUD

What it's called: Mirena, ParaGard.

What it does: ParaGard is a surgically implanted copper device that prevents sperm from reaching the egg. Mirena, also surgically implanted, works by releasing hormones. Intrauterine devices (IUDs) are more than 99% effective and good for 10 years.

Who should avoid it: Some doctors recommend the device only for women who have given birth. When the device is implanted, your uterus is expanded, and this might cause pain in women who have not had children. If you're planning on having children in a year or two, look at other options. The IUD can be removed, but the high cost—up to $500—might not be worth it for short-term use.

Female condom

What it's called: Femy, Protectiv, Reality.

What it does: The female condom is made of polyurethane, or soft plastic, and protects against STDs. It is inserted deep into the vagina, over the cervix, much like a diaphragm. Unlike the male condom, the female condom can be put into place up to eight hours before sex.

Who should avoid it: Male condoms offer more protection—both against STDs and pregnancy—than female condoms, so if you and your male partner aren't in a long-term, monogamous relationship, female condoms are not a perfect substitute.

Male condom

What it's called: Durex, LifeStyles, Trojan.

What it does: Male condoms protect against pregnancy and STDs, including HIV. Worn properly, condoms prevent sperm from entering the uterus. Go with latex or polyurethane condoms; lambskins do not shield you against all STDs.

Who should avoid it: If your mate is allergic to latex or polyurethane, you'll have to find another option. And if you tend to use a lubricant that contains oil, such as hand lotion or baby oil, you'll need to switch to an oil-free option like K-Y Jelly, which, unlike oil-based lubricants, doesn't degrade latex.

Patch

What it's called: Ortho Evra.

What it does: You can place the hormone-releasing patch on your arm, buttock, or abdomen, and rest easy for one week.

Who should avoid it: If you're particularly at risk for blood clots, you might want to find a different method. The patch delivers 60% more estrogen than a low-dose pill, so you're at an increased risk for dangerous blood clots.

Implant

What it's called: Implanon, Norplant.

What it does: About the size of a matchstick, the implant is placed under the skin on your upper arm. Implants last for three years and can cost up to $800. They are nearly 100% effective.

Who should avoid it: Implanon may not work as well for women taking St. John's wort, or women who are overweight.

Sterilization

What it's called: Essure, tubal ligation, vasectomy.

What it does: Women can undergo either tubal ligation, a surgical procedure that blocks the fallopian tubes from carrying eggs to the uterus, or tubal implants (Essure), a nonsurgical technique in which a small coil is inserted into the fallopian tubes. The sterilization process is less risky for men: A vasectomy is a minor surgery in which the tubes that carry sperm from the testicles are cut.

Who should avoid it: If you plan to have children, sterilization is not an option—it's not designed to be reversible.

Emergency contraception

What it's called: Copper T IUD, Next Choice, Plan B, Plan B One-Step.

What it does: Emergency contraception is a backup for regular birth control. Plan B contains a higher dose of the same synthetic hormones found in the combination pill. It works best if taken within 72 hours of unprotected sex, but may work up to five days later. There's also the copper T IUD, which a doctor can insert into your uterus five to seven days after unprotected sex.

Who should avoid it: Plan B, known as the morning-after pill, is available over-the-counter at most pharmacies, but only to women 18 years and older. Minors need a prescription. Copper T IUDs can be very expensive—up to $500. Plus, they last for up to 10 years, so if you hope to get pregnant in the future, this isn't for you.

Source: health.com