Health Advocate Wanted

In the area of preventive medicine I have found another concept deviation:

My breast cancer ordeal, mentioned earlier, did not end in 2007. The next year mammogram discovered suspicious calcifications in my other breast. I had another biopsy and, thank God, they were non-cancerous!

For me it meant that while the initial tests were lacking precision (well, this is the path of progress) I, in fact, was healthy.

Feeling encouraged, pretty much as the lady on the picture above, I came to my surgeon for a follow up. He recommended me to start taking Tamoxifen as a preventive measure:

- It is proven to reduce the risk of breast cancer up to 40%.

I realized that apparently, in his eyes I was a patient who had twice  required a second test – i.e., a representative of the elevated-risk statistic group. 

As usual I made a research and learned that Tamoxifen is a drug that interferes with the activity of the female hormone - estrogen. The majority of trustworthy Internet sites promote Tamoxifen’s benefits as cancer treatment. Its side-effects are commonly evaluated as minor, such as: blood clots, strokes and cataracts, hot flashes, vaginal dryness or discharge, joint pain, leg cramps, depression, fatigue, difficulty in breathing, nausea and weight loss, etc.

Not a big deal, right?

The array of menopausal symptoms made me wonder if the aging body itself regulates estrogen in a similar fashion and what happens to this natural mechanism when the hormonal substitute is introduced: do they join forces or neutralize each other? 

Another website offered the following information:

If you have had breast cancer, you have an increased risk of endometrial cancer. Tamoxifen makes the risk of endometrial cancer a bit higher. The longer you take Tamoxifen, the higher your risk of developing a Tamoxifen-related endometrial cancer.

            http://www.breastcancer.org/treatment/hormonal/side_effects/tamoxifen.jsp

It made me think for a while, which cancer I should prefer.

But all in all the most respectable sources, such as the National Cancer Institute (www.Cancer.gov) agreed that

“The benefits of Tamoxifen as a treatment for breast cancer are firmly established and far outweigh the potential risks.”

I made a decision not to take the drug mostly because hormonal intervention was not coherent with my idea of preventive medicine.  The information I quote below was found months later. It just confirmed the validity of my uneducated concerns and proved that we must question such things:

In 1992 the Lancet published a review of a number of studies in which a total of 30,000 breast cancer patients were randomly assigned either to take Tamoxifen or not.

Virtually all women who take it become resistant within five years. A recent randomized controlled study showed that Tamoxifen reached its maximum protective effect on breast tissue with women who took it for five years. Taking it for five more years didn't offer any more protection, and may actually have caused more cancers. In other words, after a while the breast cells become resistant to Tamoxifen and actually start to be fed by it. (Love MD, Susan, Dr. Susan Love's Hormone Book, Random House, New York, 1997, page 264)

Tamoxifen A Major Medical Mistake? by Sherrill Sellman, Extracted from Nexus Magazine, Volume 5, #4 (June - July 1998) ://www.all-natural.com/tamox.html

It looks like the only constructive conclusion to a story like this must be “become a pro-active, responsible patient, do your research, do not rely passively on the wisdom of others…”

In fact, taking control of your health is a strong trend nowadays  promoted even on one of the Oprah’s shows:

The famous   Dr. Oz had demonstrated the long list of questions one should always ask a doctor.  In serious cases he suggested getting a health advocate – i.e. a special person, better with medical and legal (!?) background who could accompany patient on important doctor’s visits. Such companion would be better equipped to convey these questions than an overwhelmed and emotional patient.

Though trying to be pro-active myself, I feel neither smart, no lucky. The Dr. Oz’s advice makes me sad.

How many people can afford a quality health advocate, and how many more helpers a patient will eventually need to communicate with advancing medicine?