Tamoxifen

by Sherrill Sellman, GetWell International, 1998

There has been much ado in the press recently about the wonders of the drug tamoxifen. It has been heralded as a major breakthrough in the treatment and possible prevention of breast cancer. Tamoxifen is now recommended for all pre -menopausal women with hormone-positive cancers, as well as for most post menopausal women with breast cancer and a growing number of women with hormone-negative cancers. Recent trials indicate that it may play a part in preventing breast cancer in high risk women. Tamoxifen is currently used by more women with breast cancer than any other drug.

But as is the case with all pharmaceutical drugs, there are serious dangers which seem to be conveniently glossed over. Far from the savior of women's lives, it has potential lethal side-effects.

In 1992 the Lancet published a review of many studies; it concluded that of the patients taking tamoxifen, 74.4 percent survived, as compared with 70.9 percent in the non-tamoxifen group - a less than impressive improvement. The report found that the group helped most consisted of post menopausal women with ER-positive status. The study went on to report that pre menopausal women who were ER-negative had absolutely no benefit from taking tamoxifen. Despite tamoxifen's proven ability to reduce recurrence in post menopausal women, major studies have shown that tamoxifen reduces death from breast cancer only marginally. The majority of women who take tamoxifen live no longer than women who refuse it. Furthermore, some breast cancers learn how to use tamoxifen to stimulate their growth.

Tamoxifen's Dark Side

While the initial findings of tamoxifen's role in breast cancer treatment seemed so promising, as with so many of the synthetic hormone altering drugs, further research presented grave concerns for its widespread use. In fact the MIMS Annual lists 25 adverse reactions to tamoxifen. Some can be fatal.

Menopausal Symptoms

Tamoxifen often induces menopausal symptoms in young women. About half of the women experience hot flashes. Fluid retention and retention and weight gain occur in about 25 percent of women. Vaginal discharge and vaginal atrophy are additional symptoms. Some studies have also found that pre menopausal users are at risk of developing accelerated bone mineral loss and osteoporosis. Menstrual irregularities also occur in pre menopausal women. Amenorrhoea (absence of the menstrual cycle) often results and can be permanent.

Eye Damage

About 6 percent of women taking even low-dose tamoxifen suffer damage to the retina, corneal opacities and decreased visual acuity. Irreversible corneal and retinal changes can occur in those taking 20 mg of tamoxifen twice a day (the usual dose). These changes may have no immediate effect on visual acuity but they may predispose the eyes to later problems including cataracts.

Blood Clots

Tamoxifen irritates the walls of the veins and inflammation (a natural healing response to irritation) follows. The constant irritation and inflammation weakens the veins causing bleeding, clotting, thrombophlebitis and in the worst cases - obstruction of the blood vessels serving the lungs which can be deadly and occur with little warning. The incidence of thrombophlebitis in women using oral contraceptives is generally regarded as significant (1 in 2000) , however, with tamoxifen it's 30 times greater. Several studies, showed that the risk of developing life-threatening blood clots increases about seven times in women taking tamoxifen.

Psychological Symptoms

Depression has reported as a potential side-effect of tamoxifen in 30% of women. Cases have been reported of an inability to concentrate.

Asthma

Tamoxifen can trigger asthma attacks in some sensitive patients.

Vocal Cord Changes

Changes to the vocal cords resulting in impairment of singing and speaking abilities are occasionally caused by tamoxifen.

Tamoxifen - A Known Carcinogen

It wasn't long before laboratory studies showed that tamoxifen acted as a carcinogen. It binds tightly and irreversibly to DNA, the genetic blueprint of a cell causing a cancerous mutation to take place. No amount of tamoxifen is safe when it comes to carcinogenic effects.

Liver Cancer and Liver Disease

Tamoxifen is toxic to the liver and there have been reports of acute hepatitis in patients treated with tamoxifen. The latest human studies show a six-fold increase in liver cancer among women taking tamoxifen for more than 2 years. Liver failure and tamoxifen-induced hepatitis, although rare, have been reported. Even Zeneca, the manufacturer of tamoxifen admits that it is a liver carcinogen while nevertheless aggressively promoting its use.

Uterine (Endometrial) Cancer

Uterine growths such as polyps, tumors, endometrial thickenings and cancers occur in a significant number of women . One study detected abnormal endometrial cells in subjects the day after the first tablet was taken. Precancerous uterine and endometrial changes were seen in 10% of the women taking tamoxifen in a recent study. The higher the dose of tamoxifen and the longer it is taken, the greater the risk of changes. Women taking the standard dose of 20 mg for two years run the risk of uterine cancer that is 2-3 times greater than normal. After five years the risk is 6-8 times greater than normal. In February 1996 a review by the International Agency for Research on Cancer , composed of scientists from various countries, definitely concluded, "that there is sufficient evidence to regard tamoxifen as a human carcinogen that increases a woman's risk of developing ....cancer of the endometrium, the inner lining of the uterus."

When the news came out reporting that breast cancer patients who take tamoxifen for five years or longer - the same regimen that seems to prevent recurrence - might have triple the risk of uterine cancer, Many researcher say that if it is caught early endometrial cancer seldom kills, so "its no big deal". That statement infuriated critics who noted that the treatment for uterine cancer is hysterectomy.

It was recently discovered that breast cancer patients who develop uterine cancer while using tamoxifen are likely to have a fast moving, lethal form of the disease.

It also should be noted that tamoxifen has also been associated with gastrointestinal cancers.

Breast Cancer Protection Revisited

The premise for taking tamoxifen is its supposed role in protecting breast cancer patients from its recurrence. It was further postulated that it prevented breast cancer from occurring in the opposite breast ( contra lateral). However, disturbing findings continue to surface challenging tamoxifen's effectiveness. In 1992 the New England Journal of Medicine showed that tamoxifen may reduce the incidence of contra lateral cancer but only in pre menopausal women and only in three of eight trials. In another 1992 study, tamoxifen not only failed to reduce contra lateral cancers in pre menopausal women, it actually increased their incidence.

Heart Disease and Osteoporosis

The promise of tamoxifen was its supposed protective benefits to the heart and bones. It was theorized that its estrogenic properties would help reduce heart disease and osteoporosis in women but, once again, the theory crumbled under the weight of hard facts. Several trials with tamoxifen failed to show that it has any effect on bone density and thus on prevention of osteoporosis. In three other trials, bone density increased slightly in lower spinal vertebra but not in longer bones or hip bones which are particularly susceptible to fractures and potentially fatal complications. Initial data seemed to indicate that it decreased the incidence of heart attacks. However, in the January 1996, it was reported by the National Cancer Institute that tamoxifen failed to prevent heart disease in breast cancer patients.

Tamoxifen - A Listed Carcinogen

In 1996 the World Health Organization formally designated tamoxifen to be a human carcinogen, grouping it with 70 other chemicals, about one quarter of them pharmaceuticals.

Alternatives to Tamoxifen

While the cancer establishment continues to invest huge amounts of money into research, manufacturing and trialing of harmful drugs for the prevention and hopeful cure of breast cancer, safe and effective options already exist. Estriol, one of the estrogens produced by the ovaries is considered a safe estrogen in that it has been shown to inhibit breast cancer. A recent study showed that 37 percent of those women who received estriol had either a remission or an arrest of their cancer. Might not estriol, a natural, safe hormone with almost no side effects, be able to accomplish what tamoxifen does but without the toxic side-effects?

There is also convincing evidence that natural progesterone has an important role in breast cancer treatment and prevention. A study 1981 revealed that when a group with a low progesterone was compared with a normal progesterone group, the incidence of breast cancer in the low progesterone group was over 80 percent greater than in the normal progesterone group.

In a 1995 researchers found that women using a topical progesterone cream had dramatically reduced cell multiplication rates of breast cell growth compared to women using either a placebo or estrogen, demonstrating that natural progesterone creams impressively decreased breast cell proliferation rates. Lifestyle factors also play a significant role. Everyday exercise, both at work and at leisure, reduces breast cancer risk. Women who exercised at least four hours a week during leisure time were found to have a 37 percent reduction in risk of breast cancer compared with sedentary women.

Herbs and food contain phytoestrogens. Their benefit parallels that of tamoxifen in that phytoestrogens occupy estrogen receptors and are less estrogenic that those made by the body. Since it is now known that reducing caloric intake reduces estrogen levels. Recent studies find 46 percent less breast cancer among women consuming more fruit and vegetables. Women interested in preventing breast cancer could make modest changes in diet and derive better and certainly safer results.

History continues to repeat itself. Time and time again woman have been reassured that the wonder drugs or treatments offered them would be their salvation only to discover they were exposed to harmful carcinogenic chemicals. The disasters of DES, thalidomide, silicone breast implants, Estrogen Replacement Therapy and now tamoxifen continue to demonstrate how readily women's lives have been sacrificed in the pursuit of profits. The warnings were drowned out by the glossy advertising campaigns and the reassurances of "medical experts".

There are solutions to the breast cancer epidemic. However, they will be found more by altering lifestyle, dietary and stress factors and reducing or eliminating exposure to the many known toxic, carcinogenic chemicals that are polluting the environment than by some miraculous drug discovery. Too many women have already been maimed and their lives sacrificed to unproven and unsafe drug treatments.

About the author:
SHERRILL SELLMAN is a psychotherapist, lecturer, and Women's Health Educator. Sherrill writes for health magazines in over 12 different countries and presents public and corporate lectures and trainings in Australia, New Zealand, America, Canada, and England. Sherrill offers a Hormonal Balancing Coaching Program by phone consultation at (918) 437-1058. For further info visit www.ssellman.com or email golight@earthlink.net.