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Bone Drug/Cancer News Highlights Women's Risky Therapy Choices

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Ladies, Pick Your Cancer

Many women receiving menopausal treatments today are too young to remember the old American folk tune, There Was An Old Lady Who Swallowed A Fly even though the song could be written about them.

The old lady swallows a spider to catch the fly-then a bird to catch the spider, then a cat to catch the bird ad infinitum-until she is a walking Noah's Ark and iatrogenic casualty.

For forty years women obligingly swallowed the "fly" of Premarin, a horse urine menopause drug manufactured by Wyeth (now Pfizer) until it was revealed to increase endometrial cancer in the 1970s.

But not to worry. Wyeth had a better drug, the notorious Prempro ("spider") which, by adding a progestin to the estrogen, reduced endometrial cancer while increasing the risk of breast, ovarian and lung cancers. Oops. Nor did the original endometrial cancer risk completely go away.

bone

As Prempro was found to cause cancer and greater difficulty in reading mammograms that would detect same, Selective Estrogen Receptor Modulators or SERMs were sometimes added (the "bird."). SERMS like tamoxifen and Evista could help mammogram readability and even prevent and/or treat breast cancer...except they increased the risk of endometrial and ovarian cancer. Anyone see where this is going?

No wonder when the news broke last week that bisphosphonate bone drugs like Fosamax and Boniva could reduce the incidence of breast cancer, women reacted with another American folkism: "Fool Me Twice, Shame on Me."

Sure the re-analysis of Women's Health Initiative data (WHI) by original author Rowan Chlebowski, MD, found women taking the bone drugs had 31 percent less invasive breast cancer after seven years. But the women on bisphosphonates, in the paper presented at the Annual San Antonio Breast Cancer Symposium, were also more likely to get noninvasive breast cancer called ductal carcinoma in situ (DCIS). Thanks for that!

This is not the only example of the choice given to women of "trading" one cancer for another-some termed "good cancer"- thanks to Wall Street wonder drugs that put profits before women's health. Within hours of the news, "Study Shows Merck's Fosamax May Fight Breast Cancer," appeared on Portfolio.com.

Hormone therapy's slight ability to reduce the risk of colon cancer is still marketed by Prempro makers, despite its increasing the risk of breast cancer, heart attacks, stroke and blood clots and contributing to asthma, lupus, scleroderma, non-Hodgkin's lymphoma, urinary incontinence, hearing loss, malignant melanoma and dementia according to journal articles.

In fact, a Wyeth-funded article in the current issue of the Journal of Women's Health discovers, when speculating about the cost of colon cancer that hormone patients might not incur, that hormone therapy is "cost effective." Wyeth authors don't discuss how long women need to take hormones since the colon effect doesn't remain after discontinuation and women are supposed to take hormones for the shortest amount of time and at the lowest dose possible.

Gad Rennert, MD of the Technion-Israel Institute of Technology in Haifa, Israel, a second presenter in San Antonio last week about bisphosphonate reduced breast cancer, also touts hormone therapy's colon cancer benefit in the September 20, 2009 issue of the Journal of Clinical Oncology.

And speaking of trade-offs, bisphosphonates, which stop bone loss by turning off the body's bone "remodeling," are associated with esophageal ulcers, bleeding and blockage. (Which is why women need to remain upright when taking them.)

Women taking bisphosphonates have twice the incidence of chronically irregular heartbeat according to journals and can develop incapacitating musculoskeletal pain that leaves them bedridden or using wheelchairs according to the Los Angeles Times. In Fosamax' first seven years of use, 118 Serious Adverse Event reports were filed including death, hospitalizations and life-threatening events.

Bisphosphonate caused osteonecrosis of the jaw (ONJ) or jaw bone death has surfaced as a new dental nightmare inspiring oral and maxillofacial surgical groups to recommend abstinence from the bone drugs before women undergo procedures and dentists to only work after signed waivers.

Worse, like hormone therapy itself, scientists increasingly believe bisphosphonates can actually cause the fractures they were designed to prevent because the non-renewed bone becomes brittle. Atypical skeletal fragility, subtrochanteric stress fractures and delayed healing of fractures are frequently seen.

And then there's cancer.

Twenty-three cases of esophageal cancer in bisphosphonate patients in the US since 1995 were reported earlier this year in the New England Journal of Medicine. Eight were fatal. In Europe and Japan, 31 cases were reported, six of them fatal.

Clearly, like the Old Woman, each new therapy is worse than the one before-and no one remembers why she even swallowed the fly.
Martha Rosenberg is a columnist and cartoonist, who writes about public health

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