Firstly; drugs like tamoxifen bring on early menopause and ageing, and are no fun to take for a long time. It is also implicated in some endometrial cancers.
Secondly; giving drugs to the healthy has huge knock-on effects to the future of drug use and efficacy, and it is impossible to prove a benefit. I cite the over-use of antibiotics in humans and animals and the devastating repercussions for their potency against common illness now which is a developing crisis. Also the over-use of wormers which has led to resistance and poisoning.
Thirdly; I suspect that this decision has been partially politically driven as breast cancer has such a huge, rich and militant representation. I question whether - in the long term and taking into account all of the above- it would not be more cost effective to give prophylactic surgeries to those who are at the highest risk, and request it. Call me a cynic; but I also have good reason to believe that many women have expensive and devastating treatments for very early changes in breast tissue, and would not have needed them if monitored.
I am concerned that other cancer patients - not just ovarian- will inevitably find that the availability of their treatments become scarcer as more and more drugs are given to those who might or might not need them.
That's probably opened a hornets nest, but these things are not decided out of science, they largely depend upon very shakey statistical conjecture.
I agree, Isadora. I also wonder what the accumulated financial cost will be. How many 100's of prescriptions of Tamoxifen = a course of Avastin, etc. I also agree with your wondering about whether the decision is taken scientifically or politically. Forgive my cynicism
Love Wendy xx
Hi Isadora,
I haven't much to add but that your concerns make a lot of sense.Less common illnesses never seem to get a fair proportion of research and financial backing.
My understanding is that around 500 000 women, at known genetic risk of developing breast cancer, are to be offered tamoxifen instead of a mastectomy if they request it. In such women tamoxifen can reduce the risk of developing disease by 40%. It seems a reasonable alternative to me.
You are not alone...it is pretty worrying to say the least (but at the bottom of the heap we are)
It is never fair and the points you make I can but only agree ...love x G x
Thanks for raising this Isadora. I'm still on the fence on this as I really don't know enough but from the Welsh perspective I was furious to read in one article the response of the Wales Government is that it, '...said it welcomed the changes and expected health boards to make the drugs "available to patients who meet the clinical criteria'.
Typically weasely words and what's happening about the review of cancer drugs in Wales. There's clearly no backing for this in Wales as the health boards will continue to do what they want with the inadequate funding they receive for drugs and equipment.
xxx Annie
What a strange world we live in. Although Tamoxifen offers treatment to healthy individuals who carry this faulty gene to reduce their risks from 85% to 40% of getting breast and/or ovarian cancer in later life, yet cigarettes are still being sold which carries a reasonable amount of risk to lung cancer in later life. The alternative to Tamoxifen is the more radical surgery of a masectomy followed by boob implants. Those who choose this path also choose to have a full hysterectomy in later life.
The cost of tamoxifen is £120 for a 5 yr course, the masectomy is £10,000.
I personally feel that if there is clinical evidence that something can reduce the risk of cancer in a reasonable proportion of people it should be considered. When I was given tamoxifen as it could prevent reoccurance in 10% of ovarian cancer I welcomed it, so I can hardly object to the 40% of potential breast cancer sufferers being offered the same. I heard tamoxifen being described as "cheap as chips" especially compared to avistan, I hadn't realised how cheap!
Well I for one am glad of the opportunity to have a choice about what to do about my risk. I have BRCA1, had OC last year, and am told I have a high risk of breast cancer. As I am over 50 my risk is reduced somewhat, as most BRCA carriers develop breast cancer before 50. I am informed that if I do develop breast cancer it is likely to be a triple negative type, which is harder to treat.
I completely trust my genetic specialist, who has been involved in a lot of the research into breast cancer and genetics, and if he tells me that the drugs are suitable and will reduce my risk , I believe what he says. The thought of more major surgery to have my breasts removed is daunting to say the least, so the offer of risk reducing drugs offers a reasonable alternative to me, and others like me. The costs, politics etc play no part in my decision making.
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