New breast cancer drug offers long protection with fewer side-effects

Get it while you can. Good drugs often get taken off the market because of very rare apparent adverse side-effects. A drug with no side-effects will have no main effects

A new drug for breast cancer is better than the treatments that are already widely available and can prevent the disease returning for up to eight years, researchers say. Anastrozole, marketed as Arimidex, is thought to have set a new bench-mark for treating early stage breast cancer in postmenopausal women whose disease is fuelled by oestrogen.

The latest study confirms that the drug produces better results than tamoxifen, which has been a preferred treatment for more than 20 years. The study, published in The Lancet Oncology medical journal, suggests that the drug continues to work even after a patient stops taking it, with a greater chance that tumours will not return or spread.

Although tamoxifen is credited with saving the lives of 20,000 women since the 1980s, it is estimated that 23,000 new breast cancer patients a year could benefit from anastrozole and related drugs, known as aromatase inhibitors.

Anastrozole was approved for use on the NHS in August and has been prescribed to patients with breast cancer since November. Continuing trials are also investigating whether the treatment should be offered as a preventive therapy to women whose genes put them at particular risk of developing the disease. About four in five of the 41,000 women found to have breast cancer each year have passed the menopause and 70 per cent of these have cancers that are exacerbated by oestrogen.

Anastrozole acts by cutting the level of oestrogen circulating in the blood-stream, reducing the cancer risk in so-called receptor-positive cancers. The study looked at the safety and effectiveness of anastrozole compared with tamoxifen, which is sold as Nolvadex, Istubal and Valodex. Researchers followed the progress over five years of postmenopausal women with hormone-sensitive early breast cancer who were randomly assigned to either treatment or a combination of the two.

In a previous study, the chances of surviving for more than 68 months (5½ years) were 15 per cent greater for those on anastrozole than for those taking tamoxifen. In addition, the amount of time that passed before the breast cancer recurred rose by 25 per cent, and there was less cancer spread.

In the latest update on the trial after 100 months (just over eight years), researchers noted that the benefits of anastrozole were maintained even after the treatment was completed. Furthermore, the differences between the two groups in the time it took for the cancer to recur, if it did, increased. The study also suggested that there was no significant difference in the threat of heart disease between the treatment groups – an area of previous concern. Although anastrozole can cause loss of bone density and increase the risk of fractures in women taking the drug, a common osteoporosis drug can help to prevent this side-effect, experts say.

The authors concluded: “The findings of this report extend the previously reported superior efficacy of anastrozole over tamoxifen at 68 months of follow-up to 100 months. We also show a carry-over benefit for recurrence in the hormone-receptor-positive population which is larger than that shown for tamoxifen.”

Margaret Coulton, 61, a retired office worker from Hesketh Bank, near Preston, had surgery to remove a tumour in September 2003 and has been taking anastrozole for nearly four years as part of a clinical trial after initially taking tamoxifen. Switching to anastrozole banished the symptoms she was getting, such as hot flushes, tiredness and nausea, and allowed her to stop taking drugs for depression, another side-effect of tamoxifen, she said.

Cancer charities welcomed the latest results. Emma Pennery, a nurse consultant at Breast Cancer Care, said: “From our contact with hundreds of people living with breast cancer we know that many will be delighted to see this latest evidence of success.”

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Official "obesity" deception

'One in four Australian children and one in two adults are already overweight or obese," the Minister for Health, Nicola Roxon, told a conference of obesity experts this week. Where are they, minister? In the past fortnight, I've been in the centres of Sydney and Melbourne, in Newcastle and Katoomba, and in Sydney suburbs including Maroubra, Gladesville and Parramatta. I've seen plenty of fat adults but nothing like one in two. I've seen thousands of children, but were a quarter of them fat? No way. So we have to ask again, where are they? Either Australia's fat people are hiding, too scared to come out and incur the wrath of the Health Minister, or else something fishy is going on. As fishy as Roxon's other claim, that obesity is costing the economy $21 billion a year.

The claims were made this week to justify the Government's absurd plan to have every four-year-old weighed before they go to school, starting next year. This will add a quarter of a million extra tasks to the workload of our general practitioners and health clinics. This is ridiculous.

"It's totally inappropriate," says Professor Jan Wright from the University of Wollongong's faculty of education. Wright, a co-author with Michael Gard of the book Obesity Epidemic: Science, Ideology And Morality, says there are "many pieces of work in research literature regarding the horrendous experiences" of children who have gone through this sort of thing. "The fact the child is weighed and assessed and there's a report to the parents, it's a kind of surveillance expected of parents that is horrendous."

We have to fight back. If this is the first step in the introduction of a Rudd Labor nanny state, it is necessary to make a stand now. The obesity epidemic is a myth created by the pharmaceutical and health industries, and we don't have to accept their nonsense. There are three main points to be made about fat. First, it is not nearly as extensive as claimed. Second, being a bit overweight is not as bad as most people believe. And third, there's not much you can do about it anyway.

The first step in this is to separate the terms "overweight" and "obese", which are hugely different but are always lumped together to increase the size of the alleged problem. When we do this we will find that the weight of the general population has not increased dramatically in recent decades.

Patrick Basham is a co-author, with John Luik, of Diet Nation, a sceptical look at weight issues around the First World. He says: "The average person is not getting significantly fatter. Where there has been significant weight gain, it is not amongst most people but among people who were already obese."

A study of 8500 Australian children was reported by Adele Horin in the Herald in October. Jenny O'Dea, an associate professor of nutrition and health education at the University of Sydney, said the study found obesity in children was concentrated in poor families and certain ethnic groups. She said the suggestion that all children were at risk of obesity had "been blown out of the water by this research". O'Dea said: "We want to avoid stigmatising already socially marginalised groups", so Labor's plan to weigh every child starting school, which had already been declared, would be a "disaster".

Basham says 1 or 2 per cent of the population of a country such as Australia has a real obesity problem and needs to be helped. But pretending everyone is at risk of obesity and should be monitored and even assisted is a misuse of resources.

Even if one believes the general population is fatter than it once was, we should be cautious about assuming this is a bad thing. A recent major study published in The Journal Of The American Medical Association found that overweight people have a lower death rate than people who are normal weight, underweight or obese. The study was carried out by Katherine Flegal and other federal government researchers at the US Centres for Disease Control and Prevention. Being up to nearly 14 kilograms overweight reduces by 40 per cent your chance of dying from a range of common diseases and risks, not least because it improves your chances of recovering from surgery, injury and infections.

The findings have outraged many health experts, and in response they have made some good points. These include the fact that being overweight does increase the chance of death from some illnesses, even if it reduces the chance of death from many others. It has also been pointed out that health is about more than whether you die.

But it is important to note that worrying about being overweight is rarely useful. Dale Atrens, a reader emeritus in psychobiology at the University of Sydney, has made an extensive study of scientific literature in this area. He says, "The injunction to lose a little weight is probably the most common medical prescription. It is given to untold millions each day through both official and unofficial channels. Globally, the weight loss industry is approaching a trillion-dollar turnover. This is astonishing in light of the fact that there is no systematic evidence that any of the weight loss schemes (except surgery) have any more than transient effects." The next time someone, even a health minister, tries to make you feel guilty about carrying a few extra kilos, just say no.

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Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

Even statistical correlations far stronger than anything found in medical research may disappear if more data is used. A remarkable example from Sociology:

"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correla-tion coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic condi-tions and lynchings in Raper's data. Raper had the misfortune of stopping his anal-ysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic conditions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."

So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.

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