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Ironically, the concluding part of Jacqui Wise’s article (1) was positioned electronically on the same page as the BMJ’s advertisement for its ‘Too Much Medicine’ campaign. Scotland has now followed England and Wales in recommending tamoxifen and raloxifene as ‘preventive’ drugs for those with a family history of breast cancer. Whether or not the ‘side effects’ of these drugs outweigh the benefits depends on the individual lives and priorities of each woman.
The arguments against using tamoxifen to ‘prevent’ breast cancer were well rehearsed twenty years ago. (2) Jacqui Wise’s article does not mention serious life-threatening adverse events that may result from tamoxifen prescription, such as thrombo-embolism and endometrial cancer. DeGregorio and Wiebe wrote in 1994: ‘new evidence suggests that the types of tumors that develop while a woman is taking tamoxifen are extremely aggressive. Women who develop uterine cancers induced by tamoxifen therapy may be more likely to die from uterine cancer than those who spontaneously develop this form of cancer.’ (3) One important adverse event is still not even listed in the most recent edition of the British National Formulary: some women experience voice changes, which would be disastrous for a professional singer.
Happily, women are now tested for oestrogen receptors before being prescribed tamoxifen. Twenty-six years ago I was not tested, and found out later that I was prescribed tamoxifen inappropriately. All I had was the side effects (though I only took it for two years): endometrial polyps and the loss of the top octave of my singing voice. But with a poor prognosis, and a family history of breast cancer, I have survived without recurrences, largely I think because of radical changes to my diet and lifestyle.
In Scotland, as well as an increasing incidence of breast cancer, we also have a diabetes epidemic (4). Obesity is a risk factor for breast cancer as well as diabetes, and prevention may well include lifestyle and dietary changes, including avoidance of oral contraceptives and HRT. Women with the breast cancer genes have difficult choices to make, and surgery may be one of them, but before taking tamoxifen they need to consider the risks carefully, as well as alternative strategies, which may have many other benefits.
Heather Goodare
1 Wise, Jacqui. NICE recommends preventive drugs for breast cancer. BMJ 2013; 346: 141 16.
2 Goodare, Heather. Tamoxifen trial in healthy women at risk of breast cancer (letter). The Lancet 1993; 342: 444.
3 DeGregorio M.W., Wiebe V.J. Tamoxifen and breast cancer (Yale University Press, New Haven and London, 1994, p. 5).
4 The Times 25 June 2013, p. 1.
Re: NICE recommends preventive drugs for breast cancer
Ironically, the concluding part of Jacqui Wise’s article (1) was positioned electronically on the same page as the BMJ’s advertisement for its ‘Too Much Medicine’ campaign. Scotland has now followed England and Wales in recommending tamoxifen and raloxifene as ‘preventive’ drugs for those with a family history of breast cancer. Whether or not the ‘side effects’ of these drugs outweigh the benefits depends on the individual lives and priorities of each woman.
The arguments against using tamoxifen to ‘prevent’ breast cancer were well rehearsed twenty years ago. (2) Jacqui Wise’s article does not mention serious life-threatening adverse events that may result from tamoxifen prescription, such as thrombo-embolism and endometrial cancer. DeGregorio and Wiebe wrote in 1994: ‘new evidence suggests that the types of tumors that develop while a woman is taking tamoxifen are extremely aggressive. Women who develop uterine cancers induced by tamoxifen therapy may be more likely to die from uterine cancer than those who spontaneously develop this form of cancer.’ (3) One important adverse event is still not even listed in the most recent edition of the British National Formulary: some women experience voice changes, which would be disastrous for a professional singer.
Happily, women are now tested for oestrogen receptors before being prescribed tamoxifen. Twenty-six years ago I was not tested, and found out later that I was prescribed tamoxifen inappropriately. All I had was the side effects (though I only took it for two years): endometrial polyps and the loss of the top octave of my singing voice. But with a poor prognosis, and a family history of breast cancer, I have survived without recurrences, largely I think because of radical changes to my diet and lifestyle.
In Scotland, as well as an increasing incidence of breast cancer, we also have a diabetes epidemic (4). Obesity is a risk factor for breast cancer as well as diabetes, and prevention may well include lifestyle and dietary changes, including avoidance of oral contraceptives and HRT. Women with the breast cancer genes have difficult choices to make, and surgery may be one of them, but before taking tamoxifen they need to consider the risks carefully, as well as alternative strategies, which may have many other benefits.
Heather Goodare
1 Wise, Jacqui. NICE recommends preventive drugs for breast cancer. BMJ 2013; 346: 141 16.
2 Goodare, Heather. Tamoxifen trial in healthy women at risk of breast cancer (letter). The Lancet 1993; 342: 444.
3 DeGregorio M.W., Wiebe V.J. Tamoxifen and breast cancer (Yale University Press, New Haven and London, 1994, p. 5).
4 The Times 25 June 2013, p. 1.
Competing interests: No competing interests