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Easing Tamoxifen, Aromatase Inhibitors’ Side Effects for Breast Cancer Treatment




Many people who’ve had breast cancer take medications – tamoxifen or aromatase inhibitors – to help prevent the cancer from coming back. Doctors prescribe them for people with “hormone positive” tumors, which accounts for about 2 out of 3 breast cancers.

This approach saves lives. “It is extremely effective in reducing the risk of cancer recurrence anywhere in the body,” says Erica Mayer, MD, MPH, director of breast cancer clinical research at the Dana-Farber Cancer Institute in Boston.

For most people who take hormone therapy medications, there aren’t major issues. “In general, very few patients will have side effects that are severe or interfere with daily life,” Mayer says.

But there can be smaller side effects. And because people typically take hormone therapy for at least 5 years, and potentially up to 7-10 years, it’s important to know which side effects can happen. If they do, tell your doctor. They’ll recommend what to do so you can keep taking these medications as prescribed.

Tamoxifen, Aromatase Inhibitors

Hormone-positive tumors are fueled by the hormones estrogen and progesterone.

Tamoxifen blocks estrogen from attaching to the breast cancer cell, so the estrogen can’t fuel it. It’s like blocking the gas tank on a car, so the fuel can’t get into it.Aromatase inhibitors lower estrogen levels throughout the body. This means there’s less estrogen available to fuel the cancer. These medications include anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara).

Doctors typically prescribe tamoxifen for women who haven’t been through menopause and aromatase inhibitors for women after menopause. Men with breast cancer who are given aromatase inhibitors also need to take a type of medicine called a GnRH agonist.

Although both tamoxifen and aromatase inhibitors target estrogen, they do so in different ways. And their side effects are slightly different.

Hot Flashes and Night Sweats

Hot flashes and night sweats happen to a lot of women during menopause. They’re also side effects of both tamoxifen and aromatase inhibitors.

“For tamoxifen, younger premenopausal women whose ovaries are still working tend not to have symptoms that are as severe,” says Patricia Ganz, MD, director of the Center for Cancer Prevention & Control Research at UCLA’s Jonsson Comprehensive Cancer Center. “As you get nearer to the age of natural menopause, in your 40s and 50s, these symptoms can get worse.”

What helps: To manage hot flashes and night sweats, Mayer recommends starting with environmental approaches, like keeping your bedroom cool at night, dressing in layers, and keeping a fan on.

You can also keep a bottle of cold water by your bed or keep an ice pack under your pillow. Acupuncture may also help with many side effects linked to aromatase inhibitors, including hot flashes, Mayer says.

But if these approaches don’t help and hot flashes and night sweats are interfering with your daily life, medication might be helpful.

What helps: “Certain medicines that are used to treat anxiety or depression also actually can treat hot flashes,” says Jessica Jones, MD. She’s an assistant professor in the oncology division of The University of Texas Health Science Center McGovern Medical School in Houston.

Jones is talking about medications such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and gabapentin.

“But certain antidepressants can decrease the effectiveness of your breast cancer medications,” Jones says. “So you need to make a well-thought out plan with your doctor about which one to use and why.”

Jones adds that a drug prescribed to treat overactive bladder, oxybutynin, may also mean fewer, less severe hot flashes.

Hormone replacement therapy (HRT), which is sometimes used to treat hot flashes, night sweats, and other menopausal symptoms, is not recommended in people with breast cancer, particularly hormone-positive breast cancer.

“In general, we try to avoid systemic estrogen therapies when someone is being treated for breast cancer,” Mayer says.

“Systemic” means that something affects your whole body. So if your breast cancer is fueled in part by estrogen, it’s not good to take estrogen through hormone replacement therapy.

Vaginal Dryness

Vaginal dryness is another problem that’s common in menopause – and as a side effect of both tamoxifen and aromatase inhibitors. It happens because the meds dim your levels of estrogen.

What helps: “There are over-the-counter vaginal lubricants and moisturizers that can help,” Mayer says. “But if those don’t help with the symptoms, we might offer a topical estrogen cream delivered only to the vaginal tissues. It isn’t absorbed by the body.” (“Topical” means that it goes on your skin.)

Using vaginal estrogen hasn’t been shown to raise the risk of cancer recurring. “But you should have a conversation with your doctor about the risks and benefits,” Mayer says.

Again, HRT is not recommended to help manage this side effect.

Mood Swings, Depression, and Sleep Disturbances

These side effects sometimes happen with both tamoxifen and aromatase inhibitors. If they do, tell your doctor.

What helps: If you have depression, there are treatments that can help, including medications and therapy. Other approaches that may help with mood swings, depression, and sleep disturbances include cognitive behavioral therapy (CBT), tai chi, and meditation.

Remember, depression is a medical condition. It’s more than having the “blues” or the normal range of emotions we all have. Don’t hesitate to tell your doctor or therapist.

Joint Discomfort and Pain

Joint symptoms related to hormone therapy for breast cancer do not tend to improve with the use of medications that you might take for typical arthritis, like acetaminophen or ibuprofen, Mayer says.

What helps: Acupuncture and activity both show promise. “We do have evidence that acupuncture can be helpful for joint pain,” Mayer says. “Regular exercise can also help reduce joint pain as well as helping you sleep better at night.”

Bone Loss

Bone loss is a side effect that can happen with aromatase inhibitors because they reduce estrogen throughout the body.

“While taking them, you can experience a gradual loss of bone density, which in some cases can reach the level of osteoporosis,” Mayer says.

What helps: “To reduce the risk of bone loss, you should take a vitamin D supplement and get regular weight-bearing exercise,” Mayer says. “You should also be getting regular bone scans.”

If those bone scans start to show early loss of bone mass called osteopenia, your doctor may prescribe medication to slow bone loss, such as bisphosphonates or denosumab.

Blood Clot Risk

Blood clots are a very rare but serious side effect of tamoxifen.

“For most people, the risk of having a clot while taking tamoxifen is extremely low,” Jones says. “But if you have a history of blood clots, you should not take tamoxifen, and if you have a family history of clots, you should also talk to your doctor about whether it is safe for you to take this medication.”

Uterine Cancer

Tamoxifen can also raise the odds of developing uterine cancer in women who’ve been through menopause. “In general, aromatase inhibitors are usually preferred for these patients,” Jones says.

If the side effects you’re noticing with one hormone therapy are very severe, talk to your doctor about what you’re going through.

“Sometimes, switching from one drug to another can help,” Ganz says. For instance, she points out that there are three different aromatase inhibitors that have subtle differences. “Sometimes people find one drug is a better fit than another,” Ganz says.

Whatever you do, don’t stop taking your medication without talking to your doctor first.

“We have strategies in the breast cancer clinic that we have developed over time to help you manage these side effects,” Mayer says. “If you stop your hormone therapy early without telling your doctor, that may lead to a bad outcome like the cancer coming back.”

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Congress Under Pressure: Colorado Officials Push for Cannabis Banking Reform




With the end of Congress’ session just around the corner, marijuana advocates, stakeholders and lawmakers continue to push for marijuana banking policy change.

This time, Colorado Gov. Jared Polis (D) joined forces with Lt. Gov. Dianne Primavera (D), Attorney General Phil Weiser (D), Treasurer Dave Young (D) and Department of Public Safety (DPS) Executive Director Stan Hilkey in urging congressional leaders to revisit the issue, reported Marijuana Moment.

In a letter sent on Monday to both House and Senate leaders, Colorado officials focused on the impact which a bipartisan marijuana banking bill will have in terms of public safety and industry equity,

“The lack of safe banking and financial services for the cannabis industry in the State of Colorado has become a dire public safety issue for highly regulated cannabis businesses operating in compliance with state …

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New Data Shows Weed Legalization a Boon for Real Estate, New Jobs and Tax Revenue




A new report from the Federal Reserve Bank shed light on the economic impact marijuana legalization has had in recent years, reported Marijuana Moment. Policy changes on the state level have resulted in increased commercial real estate demand, as well as a surge in tax revenues while creating more jobs.

According to an analysis from the Kansas City arm of the Central Bank, which collected data from several states under its jurisdiction, the Tenth Federal Reserve District, the cannabis industry has become one of the main economic sectors positioned to grow substantially in the coming period.

“Overall, the marijuana industry has had a significant effect on the economies of Tenth District states in the initial years after legalization,” the report said. “The emergence of the industry has …

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Will Missouri Legalize Cannabis? Amendment 3 Suffers Another Attack This Time by State NAACP




Cannabis legalization efforts in Missouri are under attack once again, this time by The Missouri State Conference of the NAACP.

What Happened

The Missouri NAACP, breaking with chapters in the St. Louis area is urging its members to vote against Amendment 3 on the Nov. 8 ballot, reported the Saint Louis Post-Dispatch.

The group announced Thursday that it believes recreational marijuana legalization, as it is proposed under Amendment 3, would prevent minorities from entering the cannabis industry. 

“Marijuana possession should not be a constitutional crime. Additionally, for years now, Black people, other minorities, and people who have been criminalized by marijuana laws in the past have been unable to enter the medical marijuana market,” the Missouri NAACP wrote. “That is not right. In an effort to prevent the permanent exclusion of minorities from the cannabis industry in the state of Missouri, the NAACP calls upon every voter to reject the criminalization of marijuana possession, de facto racist regulation of the cannabis market, and the wool being pulled over our eyes by the supporters of Amendment 3.”

Under Amendment 3, the first “comprehensive” cannabis business licenses would be provided to existing medical marijuana companies. 

The state’s chapter highlighted that the amendment “does not increase the number of available full market licenses” and claims that giving “micro” business licenses to disadvantaged groups makes a “very limited” program. 

According to Nimrod “Rod” Chapel Jr., president of the Missouri NAACP, members agreed last week …

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