Friday, April 11, 2008

Did I use aromatase inhibitors to treat my breast cancer?

Recently I received a very thoughtful question about my use of the type of estrogen-blocking drugs called aromatase inhibitors. Here is the inquiry followed by my brief response:

Dear Diana,

Please include me in your newsletter list. I used to get news from your web-site but haven't for quite a while. I read your wonderful book shortly after my diagnosis of breast cancer back in 2002 and enjoyed it tremendously - and found so much very valuable.

I know that your focus is primarily about the relationship between diet and cancer, but since you are so involved in research of various kinds and such a friendly, kind voice, I thought I would ask if you happen to have any thoughts about aromatase inhibitors (AI's). I've spoken to oncologists who recommend the AIs after tamoxifen, but I know from web-sites and personal acquaintances that the side-effects can be horrific. Right now, I'm weighing cost (side effects) vs. benefits (less recurrence of tumors and metastasis.) Since I've completed 5 years on tamoxifen, I'm debating whether or not to take Femara.

Of course, I realize that you don't give "advice" on treatment, but I just wondered if you have any thoughts, experience or resources dealing with AIs.

With warm regards and all good wishes, xxxxxxxxxxxx

My response:

Thanks for your very kind comments. I no longer send out an Email newsletter but you can keep up with me on my blog. Copies of all my newsletters are archived on my web site.

I did not take AI's, in fact they were not offered to me after my 5 years of Tamoxifen, primarily because I already have osteoporosis. However, it has been now 13 years without a recurrence of my breast cancer diagnosis in 1995, with which I had many positive axillary and inner mammary lymph nodes putting me at very high risk of recurrence.

You are right, I cannot give you direct advice on a medical issue that is outside my professional scope of practice, but hopefully your oncologist can give you some very specific reasons why she/he thinks you would benefit from initiating AI's at this point.

You can do a quick search of abstracts at PubMed, using the search terms "aromatase inhibitors benefits" or something like that. You will see from a cursory read in articles published as recently as late 2007 that there are no established protocols based on long-term randomized clinical trials in early stage breast cancer patients, which take molecular phenotyping of the different types of tumors into account. These studies are urgently needed so researchers can really sort out who will benefit from this drug and who will not (i.e., who was already cured by surgery and/or other adjuvant therapy?) along with long-term safety and quality of life concerns. Some discussion of side effects can be found at

Ultimately the decision will be yours and after enough questioning and thoughtful consideration, you will find your comfort level and peace with your decision.

Continued best wishes for health, healing, and hope!

Diana Dyer, MS, RD


This question and the myriad of questions that fall into this same category of treatment options and/or self-care after cancer can overwhelm and even paralyze a cancer survivor into inaction and depression. However, this person sounds to me like she has a good view and grounding of healthy survivorship, asking lots of questions from lots of people sorting through science and personal experiences to ultimately come to an informed decision rather than a purely emotional decision. This is what I like to call "Active Hope", and I predict that no matter what course of action she chooses, our reader will do very well.

I send you all best wishes for health, healing, and hope!

Diana Dyer, MS, RD

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