Q I have been prescribed Arimidex for a recurrence of cancer in a lymph node. Tamoxifen failed to stop the growth. Can you give me any information about this drug as I know it is comparatively new? - EL, Dorset
A Originally hailed as a major contribution to breast cancer prevention, tamoxifen has had a bumpy ride since AstraZeneca first launched it more than 15 years ago. Studies have shown that tamoxifen seems to reduce the rate of recurrence and death among women over 50. It may also reduce the risk of cancer in the well breast by 40 per cent. However, you need to take the drug for at least five years, and this may cause a number of other problems, including secondary cancers.
Arimidex (anastrozole) is an aromatase inhibitor that 'substantially' decreases oestrogen concentrations in postmenopausal women, supposedly without the adverse effects seen with tamoxifen.
Antioestrogen therapy reduces the amount of oestrogen produced by the body, so there's less of it available to reach cancer cells and make them grow. When a woman is past menopause, nearly all the oestrogen in her body is made outside the ovaries by a male-like hormone from the adrenal glands, which is converted into oestrogen by the enzyme aromatase. By stopping aromatase activity, aromatase inhibitors decrease available oestrogen.
For this reason, aromatase inhibitors are thought to be effective only in postmenopausal women, whose ovaries no longer produce oestrogen. Premenopausal women have relatively high levels of oestrogen made in the ovaries, so reducing the small amount of oestrogen from other sources would have little effect on them.
In a randomised study of 9366 postmenopausal women with operable breast cancer, the five-year ATAC (Arimidex and Tamoxifen Alone or in Combination) Trialists' Group, compared the effectiveness and safety of anastrozole and tamoxifen alone or in combination with each other. Anastrozole resulted in significantly better disease-free survival after three years and significantly fewer adverse effects than either tamoxifen or the combination. However, tamoxifen was better tolerated for musculoskeletal disorders and fractures (Lancet, 2002; 359: 9324).
The jury is still out on Arimidex (see www.asco.org/prof/pp/html/guidelines/ai.htm). Anastrozole may be associated with more bone fractures, given that it reduces oestrogen. Also, the relative safety of undergoing five years of anastrozole treatment remains uncertain, as drug treatment of this type masks the longer-term effects of the cancer.
Follow a high-fibre, low-fat, low-protein diet rich in dark-green leafy and yellow vegetables (risk of cancer appears to increase, the more protein you eat) (Int J Cancer, 1990; 45: 899-901). Lowering fats may enhance your immune system and increase NK (natural-killer)-cell activity (Am J Clin Nutr, 1989; 50: 861-7). Limit eggs, and avoid fried foods, hydrogenated fats, smoked, salt-cured or pickled foods, sugar and too much salt.
Vegetarian diets may be protective, as are soy products. The Kelley dietary programme, which has 10 types of individually tailored diets, also has some evidence of success (WDDTY, vol 7, no 3).
Supplement with at least 10 g/day of vitamin C, and folic acid, B6 and the other B vitamins, antioxidant vitamins A and E, and digestive enzymes, if faulty. Some therapists recommend thymus extract to boost the immune system. Both omega-3 and omega-6 fatty acids have been found to kill cancer cells. Selenium, magnesium, iodine and zinc can all fight cancer. Germanium, another mineral, appears to enhance the production of our body's own interferon (Tohoku J Exp Med, 1985; 146: 97-104).
A reader of our sister publication PROOF! (vol 10, no 2, Case Studies) was diagnosed with tumour growths in the lymph nodes of her armpit. Her first choice of alternative therapy was subcutaneous injections of Viscum album (mistletoe) berry extract. She also began a wholly organic vegan diet along with relaxation sessions, dry skin-brushing and acupuncture to support her immune system. As the tumours continued to grow, she started a course of injections directly into the tumours. Within six weeks, the tumours began to recede. Eventually, there was no discernible tumour left, and the swollen lymph nodes in her armpit returned to their normal size and softness.