TAMOXIFEN USE IN CANCER PREVENTION TOO EXPENSIVE
Breast cancer research is probably underfunded. However I believe that our (the taxpayer's) money could be spent much more intelligently than on trials of tamoxifen for the prevention of breast cancer.
The National Surgical Adjuvant Breast and Bowel Project recently announced that there was a 45% reduction in invasive breast cancers in a group of women at high risk for developing breast cancer who took the drug tamoxifen (Nolvadex) daily for an average of 4 years. Reports on the television and on the front pages of several major newspapers indicated that the results were so impressive that the trial was stopped because they didn't want to jeopardize the women taking the placebo. What doesn't sound near as impressive but is a better reflection of the truth, is that there was a reduction from a 2.3% incidence to a 1.2# incidence in the treatment group; a 1% reduction in incidence.
However, I'm writing about how our money is being ill-spent, so let's examine the price tag of this wonder drug. In my city, the lowest cost of a month's supply of tamoxifen was $86.64 (lowest price of three pharmacies). Using that figure, the cost of only the tamoxifen for the 6,681 women in the treatment group was $27,784,408. Given that there were 96 fewer cases of breast cancer (invasive and non-invasive) in the treatment group than would be expected, the cost of preventing one case of breast cancer was $289,421. When you consider there were 19 more than expected cases of endometrial cancer in the treated group, the number of cancer cases spared because of treatment was reduced from 96 to 77. The per case cancer prevention cost was therefore $360,836. Since the treated group also had a higher incidence of vascular disease (blood clots) (99 vs. 70), the number is higher when you calculate life-threatening disease-free costs. The cost per patient who did not get cancer or vascular disease in the treated group rings in at a staggering $578,842. These costs do not include physician fees or sonography which has been recommended due to the increased risk of endometrial cancer.
The last time I checked, $60 million taxpayer dollars (placebos cost money too!) were given to this tamoxifen study (source: US Representative T. Tiahrt's office). Using that figure, $1.25 million of our money was spent for each woman who did not get cancer or vascular disease on the study. Since Zeneca Pharmaceuticals is the manufacturer of Nolvadex, and the only potential financial beneficiary in sight, shouldn't they have paid for the trial? Shouldn't they still pay for the trial and give us our money back? Or, better yet, shouldn't they give us our cut of their profits from the increased use of the drug because of our study - which could easily be hundreds of millions of dollars per year?
Raloxifene, a medication that works similarly to tamoxifen is now being touted at scientific conferences as a breast cancer preventive agent without the increased incidence of endometrial cancer. All the hoopla is based on 8 cases of cancer. Raloxifene is made by Eli Lilly. According to the "Washington Post," "Lilly and the National Cancer Institute are planning a large, multi-year clinical trial that will compare tamoxifen with raloxifene directly." What? We're doing it again! how much will it cost to prevent one case of cancer in this trial, $2 million? Who will pay for the NCI's participation in the trial? Why should we pay for a drug company to prove their drug is useful when they are vying for a 1 billion dollar per year market? Our government (we) should not be in the business of supporting pharmaceutical companies.
There are other potential breast cancer prevention strategies that we should support. There are extensive data showing the beneficial effects of nutrients on preventing cancer. One study that comes to mind, showed that only 12% of rats given a combination of antioxidant nutrients developed chemically-induced breast cancer compared to 100% of the placebo animals. These results were in the same tumor model used to justify the study of tamoxifen for the prevention of breast cancer. The monthly cost of a combination of these nutrients for use in humans is less than five dollars. These nutrients are cheap, non- toxic, and have a great potential to prevent breast cancer.
I submit that we should spend our money researching inexpensive, potentially effective nutrients that will otherwise be ignored by the pharmaceutical industry, not on marginally effective, extraordinarily expensive medications which primarily only benefit their manufacturer. If we do this, I believe far more women will ultimately be spared from this disease. - by: Neil H. Riordan, PA-C, 9910 Jamesburg Street, Wichita, KS 67212 (316) 773- 5773
(Reprint, Townsend Letter for Doctors & Patients, December 1998 edition)
SUMMARY: Although tamoxifen initially showed the tendency to counter breast cancer recurrence, it would soon be revealed that it also promoted particularly aggressive uterine and liver cancers,caused fatal blood clots and interfered with many other functions...
".There is sufficient evidence to regard tamoxifen as ahuman carcinogen that increases a woman's risk of developing cancer of the endometrium,the lining of the uterus." International Agency for Research on Cancer
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...Indeed Now is the time for all of us to choose to go to Health..
Copyright © 1996. The Light Party.
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