Should My Friend Choose Anti-Estrogen Therapy to Prevent Recurring Breast Cancer?

By Josh Bloom — Sep 05, 2024

A long-time family friend had to decide whether to undergo five years of antiestrogen therapy following surgery and radiation for her breast cancer. The odds were high that she would be OK without the treatment and only slightly higher with it. Seven years ago, Elle Macpherson had to make the same decision. The right answer? There really isn't one.

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A long-time family friend (I'll call her Beth) received mixed news earlier this year. She was told that she had breast cancer and would need surgery and radiation. Fortunately, following the operation, her surgeon told her that she was cured and would require no chemotherapy, but he suggested a consult with an oncologist anyway.

We all breathed a sigh of relief.

However, the oncologist, a young woman, felt otherwise and strongly suggested that Beth undergo anti-estrogen therapy with anastrozole – a drug that inhibits the synthesis of estrogen by blocking the action of the enzyme aromatase. Was this a reasonable choice for Beth?

Knowing a bit about oncology, I pressed the doctor, asking if it was correct that most women who had my friend's type of cancer (Stage 2A) would be alive in five years following surgery and radiation, whether they took the treatment or not. I also expressed concern about side effects. Anastrozole is not taken just for a few weeks, during which unpleasant effects could be 'toughed out'; it is taken for five years.

It's not clear at this point whether the doctor actually wanted me dead or just looked like she did. Yet, I pressed her for data on Beth's case. Without anastrozole, Beth's odds of five-year survival were 92%. Using the drug raises that number to 96%. The oncologist called this "clinically significant," but is this a wise choice for Beth, who is 69? After all, the drug will help only four women in 100, yet all 100 will suffer the side effects, which the doctor described as "not that bad."

Perhaps this is true from the standpoint of an oncologist; she prescribes far worse drugs than this, but most of the time, it's for people who don't have a predicted 92% five-year survival without treatment. Some patients are desperately trying to survive for an extra six months and will try almost anything to fight back against the cancer.

But for a healthy woman, five years of anastrozole isn't all that pleasant. Here are some of the common and less common side effects:

Source: Susan G. Komen

It turns out that Beth's choice was similar to that of a very famous celebrity seven years ago.

Elle Macpherson goes 'natural'

Months following Beth's decision to forgo therapy, Drs. Vinay Prasad and Adam Cifu discussed the same decision that actress/model Elle Macpherson had to make seven years ago in their Sensible Medicine Substack article:

'Elle Macpherson Made a Reasonable Choice, and Naturopathic Medicine Did Not Help'

And the numbers they quote are almost identical to those for Beth:

Without knowing the precise details, the magnitude of the benefit is typically 2-7%. To give some rough (and plausible numbers), 16 women out of 20 might be cured by surgery alone, but 17 women out of 20 would be cured with surgery and chemotherapy. Put another way, 20 women have to take chemotherapy so that 1 more is cured. And, sadly, 3 will have recurrence no matter what they do.

Prasad and Cifu, Sensible Medicine, Sept. 5, 2024

Macpherson chose to forgo therapy. Although the specific medications that she declined have not been revealed, her doctors recommended radiation, chemotherapy, and anti-estrogen therapy. The details are largely irrelevant because, like Beth, Macpherson's chances of remaining healthy were very good.

Unfortunately, she used her disease to promote her company WelleCo ($10 off your first order!) and alternative medicine; her care team consisted of a primary doctor, a doctor of naturopathy, a holistic dentist, an osteopath, a chiropractor, and two therapists.

While this kind of behavior is to be expected from wealthy celebrities, when you add in the fact that at one time she dated (1) the vile Andrew Wakefield, the story turns from shameless self-promotion to a truly vomit-worthy episode.

Nonetheless, I wish her (and, of course, Beth) well.

Wakefield? Not so much.

NOTE:

(1) MacPherson not only dated Wakefield but also helped him promote his anti-vaccine movie, “1986: The Act.” And she was also part of an anti-vax campaign when COVID-19 hit. Nice.

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Josh Bloom

Director of Chemical and Pharmaceutical Science

Dr. Josh Bloom, the Director of Chemical and Pharmaceutical Science, comes from the world of drug discovery, where he did research for more than 20 years. He holds a Ph.D. in chemistry.