Arimidex, Aromasin, Femara — Aromatase Inhibitors and Breast Cancer

I’ve been asked by several people to write about this topic.  Women who had Estrogen Positive Breast Cancer and are post-menopausal, are given Aromatase Inhibitors after active cancer treatment for 5 years, and new studies are being done to see if 10 years is beneficial.     Breastcancer.org describes it as follows:

Aromatase inhibitors stop the production of estrogen in postmenopausal women. Aromatase inhibitors work by blocking the enzyme aromatase, which turns the hormone androgen into small amounts of estrogen in the body. This means that less estrogen is available to stimulate the growth of hormone-receptor-positive breast cancer cells.

Aromatase inhibitors can’t stop the ovaries from making estrogen, so aromatase inhibitors only work in postmenopausal women.

There are three aromatase inhibitors:

  • Arimidex (chemical name: anastrozole)
  • Aromasin (chemical name: exemestane)
  • Femara (chemical name: letrozole)

Each is a pill, usually taken once a day. Arimidex and Femara are available as generic medicines.

I take Arimidex (generic Anastrozole).   I was pre-menopausal before Chemotherapy even though I am in my mid-50s.  My Oncologist was debating whether to prescribe Tamoxifen which is given to pre-menopausal women or an Aromatase Inhibitor.  He asked me to research it and give him my input, which I appreciated.  I strongly felt the Aromatase Inhibitor was a better fit for me.   He agreed, but said it would be necessary to closely monitor my hormones to make sure I stayed post-menopausal.  I had blood tests every week for quite some time, but fortunately, I stayed post-menopausal.

I’ve been on Arimidex for 5 months.  I tried not to read too much about side effects because I didn’t want to influence my mind.  However, I do have side effects.   The absolute worst is severe joint pain.  In the mornings it is debilitating.  It is extremely difficult for me to even get down my staircase.  It is way beyond “every bone in your body hurts” feeling.  And when I stand up from a chair, for the first few minutes I can hardly move.  I’ve learned to stay standing for 30 seconds before I walk.  That helps. As the day progresses, it gets much better.  I suffer through it because Breastcancer.org also says joint pain is a good sign:

Joint pain from taking an aromatase inhibitor can be troubling. But a 2008 British study suggests that women who experienced joint pain while taking hormonal therapy medicine were less likely to have the breast cancer come back (recur). Knowing that this side effect might indicate a reduced risk of the cancer coming back may help some people stick with treatment despite the side effects.

Other side effects I experienced was dizziness after taking the pill.  My Physician’s Assistant told me to take it before bed so if I get dizzy, I won’t know it.  That worked!   Hot flahses are also a biggie.  In the first few months of taking Arimidex, I was awakened at least 5 to 6 times per night with hot flashes.  It has gotten better.  Weight gain is the other significant side effect especially in belly fat.  I’ve always struggled with my weight.  The weight I lost during Chemo came flying back the minute I started taking Arimidex.  I try to exercise on my Gazelle as often as possible to help both the joints and the weight gain.

Bone loss is another huge factor.  Patients on Aromatase Inhibitors are monitored with Dexa Scans to determine if there is bone loss.

Cost is another matter.   Aromatase Inhibitors are very expensive even in generic.  Make sure you shop around!   For Anastrozole, the generic for Arimidex, was $300.00 at Walmart for 3 months, $180.00 at a local pharmacy, and $48.00 at Costco for 3 month supply!  You do not have to be a member of Costco to use their pharmacy.

When I asked my Physician’s Assistant, “How do I know this is working?”  she simply stated that the side effects tell the story.  So, I know the drug is working for me.  And I console myself with that fact as I struggle along.

If you are taking an Aromatase Inhibitor, please post and let us know your side effects and how you are coping!  Thanks so much….PS:  I have had a major breakthrough in joint pain by taking an organic apple cider vinegar .  It is miraculous in the 5 weeks I’ve been taking it.  I use Bragg’s Organic (bought at health food store) and mix with water or juice.  I use 2 teaspoons three times per day – mid – morning, mid – afternoon, and mid – evening.  If I forget it, I notice the difference.  I asked my Nurse Practitioner if it was okay to take it and she said, “Absolutely!”

Lessons of Cancer…Quit Judging Others

As a practicing Roman Catholic, I cannot remember a Lent in recent history when I didn’t want to work on “quit being judgmental.”   I recognized that tendency in myself, because often I was quick to judge the behavior of others, mostly strangers.    I always cut myself some slack on judging others because some of it was a learned behavior.  Having worked in the court system for 15 years as Clerk of Court and Assistant to the Judge, part of my job was judging others.

This year as I pondered the onset of Lent and the coming of Easter, I realized that after enduring Cancer, judging others is a whole lot farther from me than it used to be.   It certainly was one of those “aha, be careful what you pray for” kind of moments as I stumbled upon that reality!

Suffering does indeed transform you.   And I’ve always been an experiential learner.   Because I felt judged many times as a Cancer Patient and Cancer Survivor, it awakened my awareness that judging others hurts them and you.

I feel judged each time this happens.  Interestingly enough, it usually doesn’t come from friends and family but from people who don’t know me well or who are strangers:

1)  Subtly someone suggests if you had only taken this vitamin, eaten this food, done this exercise, slept on the right side of the bed, like I have done, you would have never gotten cancer.

2)  If you follow my rules, you will never have cancer return.

3)  When my hair was growing out, my sexuality was judged.  When I took my friend, Sandy, to the hospital because her husband had to work, it was assumed we were a same-sex couple because of my very short hair.

4)  I felt judged as poor because I didn’t have the top-of-the-line insurance, had higher deductibles, and had to pay my own prescriptions.  And I realized that poor could have been only one missed health insurance payment, and I would have been responsible for hundreds of thousands of dollars of medical bills.

Often I have read of the pain of lung cancer patients who always hear the inevitable question:  “Did you smoke?”   Really, it isn’t any of my business if they smoked or if they did not.  Many non-smokers get lung cancer.

Cheryl is one of my blog readers, is a Cancer Survivor and writes a cancer blog of her own–http://notdownorout.wordpress.com/

Cheryl wrote this to me which clearly summarizes these thoughts:  “… your post is a great reminder that we shouldn’t be addressing another’s suffering by blaming the person for experiencing it.”

Obesity and Breast Cancer, A Rant

I get really annoyed every time I read yet another article saying obesity causes breast cancer.  I do not believe it.

I have been considered chubby, overweight, obese, plus size and any other word you want to call it my entire life. Okay, in my case if you want to blame obesity for my breast cancer, go ahead.  But what about the hundreds of thousands of other women diagnosed with breast cancer who haven’t had a day of overweight in their lives?

All of the women in my breast cancer support group are “normal” weight and most were in extremely great physical shape before breast cancer.  The women I see at the extremely busy breast cancer clinic at University of Michigan are “normal” weight or on the thin side of normal.   A high volume of women I met while in the chemo chair were athletes and going through chemotherapy.  Have you ever read an article that said “being athletic causes breast cancer?”   I think not.  I meet a lot of breast cancer survivors and very few would be considered overweight.   I hear from hundreds of women from my Blog and great numbers of them are petite and less than normal weight, many vegetarians, and women who others would consider “did everything right” and still got breast cancer.

Blaming obesity for breast cancer numbs normal weight women into a false sense of security each time they read yet another article blaming obesity for breast cancer.

That’s my rant!

Managing Anxiety before Cancer Checkups

Please vote if you are a Cancer Survivor!

I will have cancer checkups in various forms every 3 months for at least 2 years, then every 6 months indefinitely.   In the course of one week, I had my Radiology Oncologist check-up and my Medical Oncologist checkup.    On the day of my Radiology Oncologist appointment, which was first on the list, I was so anxiety stricken I almost called and cancelled the appointment.  I came close to having panic attacks which I previously have never had in my life.  On my drive to the hospital, I could barely concentrate.  All of the past kept running through my head and the”what ifs” kept drumming in my head.   When I got into the Cancer Center, I told my favorite nurse how I was reacting.  She assured me that I was not alone in my feelings.  She shared that almost all her cancer survivors tell her the same story, and she has had several vomit and others faint just when walking into the place.

That made me feel better that I wasn’t alone in my terrified feelings.    These kind of feelings are new to me.  I’ve always been able to handle stress in my past. Not this time. This is a new kind of stress.

Today I had my Medical Oncologist appointment at a different hospital where I had most of my active treatment.  I did things differently and prepared for it now that I know how difficult my anxiety is.   I made sure I ate a healthy breakfast with a lot of protein, and I allowed myself just the right amount of time to get there so I would not be too early or too late.  Going alone seems better for me, although many people do better with a family member or friend.    Also, I was the first appointment after lunch, so my wait time was minimal.

I kept repeating a mantra to myself that I did not have to go for Chemo, this was a different time, and all was well.  The visit today was much better, and I have another 3 months until I have to face it again.

I found this great advice from the Victoria, Australia Cancer website:

Managing anxiety before check-ups

Many cancer survivors say they feel anxious before routine check-ups. Sleeping problems, poor appetite, mood swings and feeling more aches and pains are common in the lead-up to the appointment.

You may feel anxious before check-ups because:

  • you fear that you’ll be told the cancer has come back
  • going back to hospital brings back bad memories
  • it makes you feel vulnerable and fearful just when you were feeling more in control
  • other people (friends or family) make comments that upset you.

Finding ways to cope with your worries before check-ups may help. Once you have had a few and all is okay, you may feel less concerned.

Tips

  • Take a close friend or relative with you to your check-ups. Sharing your fears may help you cope better, and people close to you may want to help.
  • Make the day something to look forward to. Plan to do something special after your appointment – go out for a meal or buy yourself a treat.
  • Try to see your check-ups as a preventive measure. Regular check-ups may increase the chance of any problems being picked up early when they may be easier to treat.
  • If you find it overwhelming to go to a cancer treatment center, ask if it’s possible to visit the doctor elsewhere.
  • Do deep breathing or relaxation exercises to manage your anxiety when waiting for your appointment.
  • Book the first appointment of the day or plan another activity beforehand so you’re busy and don’t have time to dwell on the appointment.
  • Stay informed about any new treatments for the type of cancer you had. This may help you cope better.

For more helpful information, visit:

http://www.cancervic.org.au/about-cancer/survivors/follow-up-care