Sunday, November 29, 2015

Nasty Anastrozole

In February I'll pass a milestone - five cancer-free years from the end of breast cancer treatment.  I understand there's nothing scientifically special about the five-year mark except that it's when most studies call a person "cured", however it's still encouraging to stop and notice how healthy I am now.

Here's me in the fall of 2010 as my hair was falling out.  I like it better now!

When I first completed all my treatment, which was a lumpectomy followed by chemotherapy followed by radiation, my oncologist recommended I take a drug called anastrozole for five years.  It is an aromatase inhibitor that significantly reduces the total amount of estrogen in a post-menopausal woman whose ovaries no longer produce estrogen.  For women whose cancer is hormone receptor positive, reducing estrogen in the body can help reduce the chance of the cancer coming back.

Side-effects of anastrozole are bone weakness which can lead to fractures and osteoporosis, joint pain and heart problems, along with the usual effects of reduced estrogen like hot flashes and memory issues.  I was aware of that, and had already been reading online conversations in which women complained of debilitating pain from the drug.  Naturally, I wasn't keen on starting it myself.  I talked it over with my naturopath who urged me to follow my oncologist's advice, but also mentioned that if I chose not to take anastrozole, there is a mixture of Chinese herbs, called Myomin, that does the same thing without the side effects.  Hmm, it didn't seem like a tough decision to me!  I read the literature about Myomin and at the time it was all about reducing estrogen in the body for the purpose of body-building.  The literature (and I use that term loosely - it was mostly ads by places selling Myomin) made no mention of fighting cancer - apparently they can't advertise it for that purpose since the FDA has not cleared it for that purpose.  However, it made it very clear that Myomin works by inhibiting the enzyme aromatase, just like anastrozole.  Recent literature mentions it being used for treatment of endometriosis, ovarian cycsts and uterine fibroids, and also for protection of people taking bioidentical hormones.

So I said no thanks to the anastrozole and took Myomin for six months.  On each visit to my oncologist, she urged me to reconsider, citing studies that showed a better outcome for cancer patients who follow up with anastrozole.  (Of course, there are no such studies on using Myomin, since no drug company would be motivated to pay for them.)  She wore me down, and finally I ordered the prescription.  When the pills arrived they were tiny - maybe 1/8 inch in diameter - and I thought how could something that small, taken in the middle of a meal, possibly hurt me?  I was also thinking of how I'd feel if the cancer came back and I hadn't taken the pills.  I wanted to feel I'd done everything possible never to go through that again.

So, around August of 2011, I started taking anastrozole. As you know, I've had a lot of hip pain over the last several years, and I wondered if anastrozole was making it worse.  I knew it wasn't completely due to the drug because I already had hip pain before that, and I didn't have pain in other joints.  Seattle Cancer Care Alliance gives me a dexa scan bone density test every year to check for osteoporosis and the result, while not perfect, is "appropriate for my age". 

Now, after having had physical therapy and chiropractic and my year of health, I have no more hip pain!  I think learning to tighten my "core" and use my butt muscles has made the greatest difference.  I've been pretty faithful taking the pills, stopping only for a month before and during our trip to Italy in 2013, when I wanted to be as pain-free as possible for walking around, and I didn't notice any great difference from stopping at that time.  I do have hot flashes - not desperately strong ones as when I first started menopause, but just an inability to keep my body temperature steady - I'm always putting on a sweater then throwing it off again.  And I definitely have memory issues.  I blame my age and years of killing brain cells by drinking wine, but it's possible the drug is making it worse.

At my last appointment, my oncologist reminded me that in August I will have been taking anastrozole for five years.  She is okay with my stopping, but recommended continuing as long as it's not bothering me much.  We talked about my taking time off from the drug, and she said six months would be a good length of time to see whether I notice any difference.  That sounds good to me.  I'll wait until summer, maybe for my 69th birthday in July (yikes!) and then take a six-month vacation from anastrozole.  It will be interesting to see if I feel any different.  If by some miracle my memory returns or I start sleeping soundly, that would be a good reason to quit for good, but I might also look into Myomin again.

That was a pretty dense read, but an important topic.  Life is such an adventure, don't we all want to stay healthy and active to enjoy it as long as we can?!  Our Thanksgiving holiday was another reminder of how fortunate I am.  Melanie, Ben, Ben's brother Jason, and doggie cousins Wilbur and Banjo joined us for fun at the coast.

A serious game of UpWords after dinner.  I was playing with real experts - didn't stand a chance.

A great photo of Melanie and Wilbur.  He was so good to stop running around long enough to pose for the camera.

It was a great day!


  1. Congrats on 5 years, Mom! We love you! -T