Comments on: Tamoxifen decisions

By: neo-neocon

neo-neocon — Thu, 11 Mar 2010 16:38:47 +0000

Michal: This article was about preventative tamoxifen for woman who have never had breast cancer but are judged to be at greater risk for it. I don’t have the stats for recurrence, but I believe the case for tamoxifen is quite a bit more powerful in women who have had breast cancer and are taking it to prevent recurrence. That said, I have no idea what they would be with someone who has had your type of cancer. I wish you the best of luck, however, in making this decision and for your future health.

By: Tom

Tom — Thu, 11 Mar 2010 16:37:18 +0000

Michal-
Medicine is not inherently illogical. You have a problem of conflicting agendas: ACTUAL liver problem v. POTENTIAL breast problem. You are of course correct in your liver v. breast analysis.

TMX causing hepatitis? Your gastro doc must be made to be very sure all other causes have been ruled out. Your oncologist cannot guarantee you the outcome desired in taking TMX for the period prescribed. And the two docs must confer together about you and your care.

By: Michal

Michal — Thu, 11 Mar 2010 08:38:50 +0000

TMX is causing a liver inflammation that my Gastro says I can’t live with for another 3.5 yrs while I finish my treatment.
My oncologist says I have to finish the TMX for at least another year, or I’m at great risk of relapse. I had Duc. Car. Insitu, not even stage I.
Isn’t obvious that I need my liver a lot more than my breast? Can’t they just scan me more often??
Medicine is so illogical. And I’m not in the states, I’m in Israel where I don’t think these medicos are so worried about malpractice.

By: Tom

Tom — Wed, 10 Mar 2010 21:14:58 +0000

There are way more numbers games played in medicine than most of you can imagine. For example, most chemo docs will tell a premenopausal woman who’s had a 9mm cancer excised that the benefits of adjuvant (to prevent recurrence) chemo are marginal, but if it’s one (1) mm larger, adjuvant chemo is indicated.

Now, keep in mind that adjuvant chemo reduces the risk of breast cancer recurrence in Stage I (=less than 2cm= 20mm) very modestly, from 6% to 4%. That means 100 women get chemo in order to save 2. This is, however, today’s standard of care, and docs who don’t observe it will get hammered in a malpractice suit brought by an untreated woman who relapses. Thus, getting paid for treating 100 women to help 2, they all do it.

By: Sergey

Sergey — Wed, 10 Mar 2010 19:55:56 +0000

All this is very strange. A drug with so serious side effects should never be used for preventive treatment of healthy individuals. This violates the first principle of medicine: “Do not inflict harm”.

By: huxley

huxley — Wed, 10 Mar 2010 17:29:52 +0000

If someone invented a pill to cut a cancer risk in half, would you take it?

Who wouldn’t?

Apparently the answer is millions of women…

Tom’s quite right that the NYT is falling for (or playing) a classic statistical illusion, while it is women who are seeing the situation more clearly.

It’s called “denominator neglect” — the tendency of people to focus on the numerator and ignore the denominator. For instance, in studies people prefer a gamble of 9 out of 100 to 1 out of 10.

One can legitimately say that reducing 19 to 10 is ~50% improvement. However, when placed in context of of 1000, it’s only the difference between a 2% risk and a 1% risk.

By: Tom

Tom — Wed, 10 Mar 2010 15:54:19 +0000

Gaaah! I just read the NYT piece. and it proves my point about glibness: starts off by saying the drug cuts cancer risk in half (see my earlier post). And proceeds to marvel, with tedious verbosity, that women “at risk” ain’t bein’ persuaded.

The most flagrant personally experienced glibness about cancer therapy was by an oncologist touting hideously toxic, sometimes fatal, biologic therapy for metastatic melanoma some yrs ago: said it increased median survival 50%….From 2 months to 3 months!

By: Assistant Village Idiot

Assistant Village Idiot — Wed, 10 Mar 2010 14:03:22 +0000

Tom, your point is important enough that you divert me from my intended comment. Individuals vs. populations. Yes, and that accounts for much of the reasoning that objects to ever more condoms being placed on ever more bananas and calling it sex education. The school must think of populations, but parents, churches, and friends must think of the individual.

By: Tom

Tom — Wed, 10 Mar 2010 01:10:48 +0000

El: It is the doctor’s professional responsibility to “sort out” the odds. That’s part of the job! Trouble with playing the odds is the patient just plays once, making a yes or no, go or no go decision. Playing the odds is a strategy for multiple bites at the apple, not one. Works better for the doc than for patient Jane Doe.

There is a profound difference between managing individuals and managing populations.Population outcomes guide individual care but do not predict individual outcomes. It pains me to belabor the obvious; forgive me.

By: Granny Jan

Granny Jan — Wed, 10 Mar 2010 00:54:52 +0000

I was told last week that the death rates are exactly the same for those taking tamixifen or not. It just decreases the rate of reoccurence.

My sister took it and the cancer reoccured anyways.
I didn’t know all the side effects but I’m not taking it for my early stage breast cancer and my doctor said more women are opting out. If he insisted I would have taken it.

I just have to do radiation.
It’s really not a big deal. Just make sure you get digital mammograghy… much better pictures. Also, it is probably true that Jewish women have a higher rate of breast cancer.