Dont’s for Breast Cancer Risk/Diagnosis

May God rest their souls
To our personal friends:
Amanda Khethiwe Fesseh, March 15, 2012 (33 years)
Tanya Hill Causey, October 25, 2011 (49 years)
We must keep fighting for a cure!

Are you a breast cancer survivor?

Do you know of any woman who has been or is being treated for breast cancer,or do you have any family members that have breast cancer? Then please read this and share some pearls. It can make a difference between living and dying.

The new clinical guidelines on the management of female conditions/issues in such women have been released by the American College of Obstetricians and Gynecologists (ACOG)

The Birth Control Pill:

Do not use the “pill” if your mother or sister or aunt has/had breast cancer (defintely do not use them personally if you have survived breast cancer). If your doctors do not ask you, tell them of your choices that are appropriate to you which are barrier methods (condoms), the copper intrauterine device, and sterilization. Hormonal methods are contraindicated in women with breast cancer and are considered a risk even for women who have been cancer free for 5 or more years.The hormones can increase your risk of developing breast cancer

Pregnancy:

Are you able to become pregnant following breast cancer treatment,relax don’t worry; you can do so without increasing the risk of disease recurrence, according to the college.

Pregnancy following breast cancer treatment has not been shown to increase the risk of recurrence or mortality (that is of you dying of the condition), according to a recent large study that is cited in the guideline. But chemotherapy can compromise fertility, and 5-year use of tamoxifen (this is a hormone that prevents/blocks the actions of estrogen and is used to treat and prevent some types of breast cancer) may diminish a woman’s ovarian reserve before she may safely conceive

The new guideline, which cites evidence from 166 published sources, covers such diverse issues as hot flashes (vasomotor symptoms); vaginal dryness( atrophy); contraception and fertility; uterine evaluation; and the treatment and prevention of bone loss in the context of current treatment regimens, which may include chemotherapy, hormonal treatments, radiation, and surgery.

Going through the “Change”..

For treatment of hot flashes,stop any hormone (estogen) pills you might have been on. Hormonal therapy is generally contraindicated in women with hormone-positive breast cancer.
ACOG advises that medications like Zolft,Paxil,Prozac,Celexa and Luvox which belong to the class of drugs-selective serotonin reuptake inhibitors,( SSRIs ) can safely be used to treat hot flashes in some women with breast cancer.
If you are on tamoxifen, Effexor,an SNRI class of medication (serotonin norepinephrine reuptake inhibitor),is a better choice than an SSRI, because it avoids a potential interaction;or gabapentin can be used instead
Note however that even though none of these medications is licensed in the United States for the treatment of hot flashes,they are very commonly and safely used for these indications.

“More and more women are living with breast cancer,” Dr. Mindy E. Goldman, lead author of the guideline, said in an interview. But its treatments, particularly the hormonal therapies, have gynecologic side effects. “Ob.gyns. need to be aware of how these drugs work,” said Dr. Goldman, who is director of women’s cancer care at the University of California, San Francisco.

We,the team members of the ObGynPatientNews.com want the patients of these Ob/GYNs to be well informed too, as we remember fondly our dear friends, Amanda and Tanya.

Bone fracture effects:

Because medications used in chemotherapy cause suppress the ovaries(which produce hormones that promote bone health), and some of the medications like aromatase inhibitors contribute to bone loss and increase fracture risk, the guideline recommends that treatment with medications like Fosamax and Etidronate be considered though raloxifene is effective also but can cause hot flashes.

The guideline also recommends annual monitoring of women whose risks of bone loss significantly change as a result of treatment. And vitamin D levels should be checked in women with breast cancer.

Sex becomes difficult:

Up to 40% of women with breast cancer have severe vaginal dryness, and the vaginal (topical) hormonal creams, suppositories, and vaginal rings commonly used to treat it have not been shown to be safe in women with breast cancer, so do not use these if you fall in this risk category. Preference should be given to nonhormonal vaginal moisturizers, like Astroglide available at Walmart for example; with hormonal treatments used on a very short-term basis (with the patient’s full awareness of risks and benefits; and their autonomous informed consent) when nonhormonal options have failed and is absolutely necessary.

Testosterone (male hormone)supplementation, in patches or creams, remains without enough breast safety data to support it; so to be safe avoid these.

Can I preserve my eggs for later use?

In vitro fertilization (IVF) with embryo cryopreservation (preserving the embryo/baby) is seen as a strong option for preserving the potential to have a child; however, there is concern that ovarian stimulation in IVF could cause proliferation of breast cancer cells, leading some practitioners to recommend natural cycle (nonstimulated -with any hormones at all) IVF.

It is not clear whether ovarian suppression during cancer treatment preserves fertility, according to the guideline. Tamoxifen as an ovarian stimulant has been investigated and has shown promise in treating women whose fertility has been compromised as a result of breast cancer treatment. Although one of the chemotherapeutic agents:the aromatase inhibitor letrozole cannot be used in premenopausal women as a breast cancer treatment, it may be used in combination with gonadotropins (these are protein hormones secreted in the brain but act to stimulate the ovaries) as a fertility agent following treatment.

What if I have irregular menses or bleeding while on treatment for breast cancer:

If you bleed irregularly while on treatment for breast cancer you will need to be checked for cancer of the uterus

This is done in the office setting by taking a sample of the lining of your uterus-an endometrial biopsy

Routine endometrial biopsy and uterine ultrasound are not recommended for postmenopausal women taking tamoxifen without evidence of vaginal bleeding, as ultrasound has been associated with a significant false-positive rate leading to unnecessary invasive diagnostic procedures.

However, for women on tamoxifen who experience vaginal bleeding, an endometrial evaluation – including biopsy and follow-up of possible uterine structural anomalies – is essential, the guideline states.

The members of the Committee on Practice Bulletins–Gynecology who wrote the guideline reported no relevant conflicts of interest.

Extracted from obgyn news JENNIE SMITH article

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