Breast Cancer Archive

A large international trial of exemestane (Aromasin), a drug that reduces the risk of breast cancer recurrence, has found that it can also help prevent breast cancer from developing in the first place. That makes exemestane a third option for preventing breast cancer in postmenopausal women who are at elevated risk for the disease. Two other drugs, tamoxifen (Nolvadex, generic) and raloxifene (Evista), are already approved for prevention, but few women take them for that purpose because they can have serious (although rare) side effects such as stroke and blood clots. Exemestane appears to have less frightening side effects — for example, hot flashes, joint pain, and loss of bone density.

All three of these drugs target estrogen, which fuels the growth of most breast cancers, but exemestane works by a different mechanism than the other two. Tamoxifen and raloxifene are selective estrogen-receptor modulators, which bind to estrogen receptors in the breast and block their interaction with estrogen. Exemestane belongs to a different class of drugs, called aromatase inhibitors, which work by blocking the body's production of estrogen. Previous studies have shown that aromatase inhibitors are more effective than tamoxifen in preventing breast cancer from recurring. The study, funded by the drug's maker, Pfizer, and conducted under the auspices of the National Cancer Institute's clinical trials unit, looked at whether exemestane could reduce the likelihood of a first occurrence of breast cancer. Results were presented at the American Society of Clinical Oncology meeting in Chicago on June 4, 2011, and simultaneously published online in The New England Journal of Medicine.

Q. When you talk about breast cancer screening, why don't you mention thermography? I've been using it for several years instead of mammography, which uses radiation.

A. The short answer is, we don't have good evidence that thermography is useful, and it definitely is not a substitute for mammography.

Prospective studies show no increased risk of recurrence.

At one time, soy seemed to be just the ticket for women: heart-healthy, good for bones, and helpful for hot flashes. And then there was the low rate of breast cancer in soy-consuming countries. But as so often with "miracle foods," closer study has dampened some of the enthusiasm.

Early research indicated that soy protein could lower LDL (bad) cholesterol, but later studies were so unimpressive that the American Heart Association asked that food companies no longer be allowed to label soy products as helpful in preventing heart disease. It's still unclear whether soy does much for bones or hot flashes. And although some studies suggest that it may protect against breast cancer, other research has found that isoflavones (a component of soy that binds to estrogen receptors) can spur the growth of breast cancer cells in test tubes and animals. There's also some concern that soy's estrogenic activity may interfere with tamoxifen, a drug used to prevent recurrence in women with estrogen-sensitive breast cancer. As a result, some clinicians advise patients with breast cancer to limit their consumption of soy or avoid it altogether.

Many postmenopausal women and their clinicians are avoiding hormone therapy (HT) because of the health risks, but there's been some hope that it might be safer in younger women near or at menopause. In the case of breast cancer, at least, that isn't so, according to results from the Million Women Study in the United Kingdom. In this study, taking HT in early menopause was actually associated with a higher than average risk of breast cancer. Also important — for the many women wondering about the impact of their past HT use — results showed that soon after quitting HT, a woman's breast cancer risk was no greater than that of a woman who never had HT. Finally, the study found little or no increased breast cancer risk among women taking estrogen-only HT who waited at least five years after menopause to start taking hormones. Results were published online Jan. 28, 2011 in the Journal of the National Cancer Institute.

Other research has consistently found higher rates of breast cancer in women taking HT — in particular, combined estrogen and progestin. But few studies have investigated the timing of HT and how that influences breast cancer risk. The Million Women Study is the first to look specifically at the relationship between breast cancer incidence and when women started HT.

New government statistics show that there are nearly 12 million cancer survivors in the United States. In many ways this is terrific news, and a testament to improved diagnosis and treatment options. But there’s a flip side to surviving cancer, and many survivors are never totally “free” of the disease. The ongoing psychological and emotional issues can be almost as much a challenge as cancer treatment was. Harvard Health editor Ann MacDonald explores the ongoing fear of recurrence, survivor guilt, the “Damocles syndrome,” and more.

Health problems, or treatments for them, sometimes thwart sexual desire and sexual function. There may not be a quick fix for health-related sexual problems, but there are things you can do to enjoy your love life while taking care of the rest of your health.

CT scans may break the impasse over lung cancer screening, although many questions remain.

Screening people for lung cancer ought to work. Lung cancer is common, relative to other cancers, so you're not looking for a needle in a haystack. If it's caught at a very early stage, it often can be treated effectively with surgery and even cured. Current and former smokers are easy to identify, so focusing on a high-risk group is pretty straightforward. And the technological means to spot suspicious growths and lesions in the lungs has existed for decades.

Calcium can accumulate in our bodies where it doesn't belong. Is too much calcium intake to blame?

Calcium is the most plentiful mineral in the human body. Almost all of it — 99% — is stored in the skeleton, where it serves to maintain healthy bones and teeth. But that's not all it does. Calcium is also essential for the normal functioning of muscles, blood vessels, and nerves. Tiny amounts are dissolved in the fluid inside and outside every cell in the body. Too much or too little calcium can be deadly to those cells, so the body carefully controls its blood levels.