Does Femara change red wine's effect on estrogen in the body?

I posed this question to my boss, a pharmacist, and an intern, at work one day. They graciously did research for me and also contacted the University of Montana Drug Information Service.

You see, I love a glass or two of red wine before dinner but the current advice from the American Cancer Society is to avoid alcohol altogether if you want to not raise the risk of breast cancer. I have estrogen-driven cancer so they are talking to me.

Now I have posted before about a study on mice that showned that a phytochemical in red wine has an anti-cancer effect. But does that finding cross over to humans? And could Femara counteract the increase estrogen circulating in the blood stream that happens when I drink a glass of wine?

Here is the answer from the Drug Information Service:

Thank you for your question regarding Femara (letrozole) and its ability to decrease red wine's effect on estrogen in the body.

Estrogen plays a large role in the human body, especially in female patients who have experienced breast cancer or other hormone sensitive cancer. The substances in red wine believed to have possible effects on estrogen and cancer are phytochemicals. Resveratrol is the phytochemical that has been studied the most. Letrozole is an aromatase inhibitor that is used to treat breast cancer, because it inhibits conversion of androgens to estrogens. Currently there are no published reports of a food-drug interaction between Letrozole and red wine or red wine extract.

Red wine is thought to be cardioprotective. However the data on its effects on breast cancer are conflicting, with some studies showing an increased risk and others showing a decreased risk. There have been no studies conducted with both red wine and letrozole, but there have been several studies conducted with red wine extract in animals. Studies in mice with over-expression of aromatase found that red and white wine have both in vivo and in vitro aromatase inhibitor activity. The studies used samples of several types of wine, including pinot noir, merlot, zinfandel, hardonnay and carbernet. Another study found that red and white wines only have estrogenic activity in mammalian cells, since the extracts had no effect on a yeast estrogen screen assay. These studies included all active components of wine, not just resveratol. Red wine has more aromatase inhibitor activity that white wine because the grape skin, where phytochemicals are primarily found, is removed when making white wine.

There is currently a study being conducted in healthy premenopausal women examining the effect of red and white wine on estrogen and progesterone levels. The results of this study will most likely not be published until late 2008 or early 2009.

The data regarding red wine, estrogen and Letrozole is limited at this time. The studies provide insufficient data to prove red wine's effectiveness as a chemoprotective agent. It is possible that the aromatase inhibitor activity of both agents could be additive; however there are no published reports of an interaction between Letrozole and red wine.

There you have it. No conclusive answer available and no study in process that is looking at Femara's ability to counteract the rise in estrogen level caused by drinking alcohol. Maybe some day we'll have the answer. I haven't quit drinking red wine but think twice about it each time I have a sip.

First Day Of My Life

Can you let go of the stupid shit that distracts you from the important ones in your life for 3 minutes? I hope so. Put on your headphones and listen to Bright Eyes.

Level Out

Will this post resonate with you? For some it will. For some it won't. It's written in sympathy for the people in the first group.

I no longer feel as though I'm dying. I BELIEVE I am well today. I didn't convince myself. I've never been able to force myself, through sheer will, to believe something. After I was diagnosed, well meaning assurances that I would be okay only magnified my doubt about my prognosis. Those assurances, however, played an important role in my journey. They caused me to explore why someone telling me to "be positive" made me feel inadequate and weak. Hearing "you'll be fine" felt like the kiss of death. I heard these things from people who I am not very close to and they meant well.

I believe that I came to center, leveled out, by spending alot of time in mourning. Exploring what death means. Understanding how we die. Really coming to terms with the truth that our society shushes. Becoming comfortable with going to sleep forever.

For those who are suffering from cancer and debilitating fatigue, depression and fear, I hope you allow yourself to grieve your losses. Allow yourself to feel terrified. Allow yourself to mourn for you and your family. While being strong and staying positive is important because it will help those around you, its okay to go off on your own and get angry and cry until you sleep.

This song is for you.





When panic grips your body and your heart is a hummingbird
Raven thoughts blacken your mind until you're breathing in reverse
All your friends and sedatives mean well but make it worse
Every reassurance just magnifies the doubt
Better find yourself a place to level out

Got a cricket for a conscience always looks the other way
A cocaine soul starts seeming like an empty cabaret
Hey, where have all the dancers gone? Now the music doesn't play
Tried to listen to the river but you couldn't shut your mouth
Better take a little time to level out

I never thought of running
My feet just led the way

Mixed up Signals
Bullet Train
Cars are switched out in the crazy rain
I could meet you any place
If the Brakeman turns my way

All this automatic writing I have tried to understand
From a psychedelic angel who was tugging on my hand
It's an infinite coincidence but it doesn't form a plan
So I'm headed for New England or the Paris of the South
Gonna find myself somewhere to level out

Are your brothels full, Oh Babylon, with merry Middlemen?
Never peer out of their periscopes from those deep opium dens
All this death must need a counterweight always someone born again
First a mother bathes her child then the other way around
The Scales always find a way to level out

I tried to pass for nothing
But my dreams gave me away

Mixed up Signals
Bullet Train
People snuffed out in the brutal rain
I could live to any age
If the Brakeman turns my way

It is an old world it's hard to remember
Like a dime store mystery
I'm a repeat first time offender
Who has rewritten history

Mixed up tea leaves
Phantom Pain
Fuzzy logic in the crazy rain
Getting better every day
If the Brakeman turns my way
Mixed up Signals
Bullet Train
Cars are switched out in the blinding rain
He'll be smiling as he seals my fate
When the Brakeman turns my way

I Passed!

Guardian Oncology called this morning while I was at work. I'm well. I'm really better than well, I'm fantastic!

The tumor marker tests CA 27-29, CEA and CA 15-3 all came back good. The CA 27-29 number is slightly raised from 3 months ago but not a significant amount. I had a worrysome result from the CA 27-29 during chemo.

The CA 125, for ovarian cancer came back below 1. They had never seen a result this low before so they had it retested. There was no mistake. Its really that low. Its really that good.

An arthritis test also came back negative. My vitamin levels are good. Slightly anemic but not too bad.

Nothing but good news. I have no need to worry. I'm healthy as I can be. Could I be 'cured'?

3 Month Checkup

What do you do when you are nearing panic and your 3 month cancer checkup runs two and a half hours late? You go shopping thats what.

There's just nothing like shopping to refocus your thoughts. And when the mall is having clearance sales on summer stuff like swim suits, shorts, cute dresses you can make off like a bandit. Spent close to $200 shopping today and really only need to pack brand spanking new clothes for my trip to Michigan tomorrow and it was worth every cent to me.

Having my sister with me in the waiting room, torture room (where they draw the blood) and exam room was priceless.

Six vials of blood, 18 (yes, thats right eighteen xrays) and an hour with my oncologist and I missed my whole shift at Target. You know what? I don't even have my cancer marker results or 16 of 18 xrays analyzed and I feel so much better than this morning.

What I love about my oncologist, Dr. Judy Schmidt, is that she doesn't sugar-coat anything and thus I trust her 100%. I was completely open with her about my bad habit (daily wine consumption) and with my belief that my cancer will recurr. I told her the reason I am so certain is because of my high oncotype , grade and mitoses scores. She did not tell me to just relax and stop being so negative. What she told and showed me is that I will be watched very carefully over the next 4 years. Three years of seeing her every three months, then 1 year of seeing her every 4 months, followed by X years every 6 months. She also told me that the mean recurrence time for an aggressive cancer, if it were to recurr, is 30 months thus the aggressive monitoring.

My complaints were aching and stiff joints, which I've bitched about plenty on this blog. Sore ribs on the cancer side and a sore spot in my clavicle on that side. Although she spotted a torn ligament on physical exam that is undoubtedly the cause of my lower rib pain, she ordered the 16 additional xrays just to rule out cancer in that area. Those xrays combined with the results of a couple of cancer marker blood tests will determine if we look any further into the rib pain. If she doesn't like the blood test results or xrays she will order an MRI.

They are short staffed in the lab so I will likely need to wait until monday for the cancer marker results. I should have the xray results tomorrow. They'll call my cell phone. I have to tell you that phone calls from Guardian Oncology give me a few seconds of terror until I hear the results. Makes me not want to answer my cell phone for the next few days.

Dr. Schmidt also ordered ovarian cancer marker and arthritis tests. She wants to make damn sure I don't have anything bad brewing down below. She stated that I still have an elevated risk of ovarian cancer even though I have my ovaries taken out. NOW THEY TELL ME! I actually think she has her statistics wrong on me still having an elevated risk but I wasn't going to argue. What's another vial of blood right? I had a clear pap smear a couple weeks ago. So that is cool.

My white blood cell count is low which she said is likely still because of one of the chemo drugs, cytoxan. Gonna take more vitamins (folic acid, vitamin d, vitamin b-12) to try to bring it back up.

Well thats it in a nutshell. Where I was quite stressed and panicing this morning, I am feeling better tonight. Thanks to Dr. Schmidt, sister Annie and my sweeter than sweet husband John for calming me down this morning.

Gotta go pack. The laundry that needs to be folded is gonna wait. I'm off to see my Michigan homies tomorrow! Can't wait.

Solidarity

When I was recuperating in the hospital from my oophorectomy/mastectomies, John Brownell Senior, who was also in the hospital at the time, passed a message on to me that he was having his ovaries removed in solidarity with me. Now that is a sense of humor. Classic John Brownell Sr. humor. Even while struggling with his own serious health concerns he gave his gift of humor to make me feel better.

This brings a tear of joy to my eyes. There were many moments like this in the short time I knew this man. Sitting with the family on any given evening Mr. Brownell would get a wry smile on his face. Sometimes he would share the thought with us, most times not. Whether he chose to or not was not very important. I found it easy to connect with him by sharing in the entertainment of sitting back and enjoying a Brownell family discussion.

I found such inspiration in him. He taught me how to make the best of the little moments. His effect on me did not truely bloom until after I recovered from the initial shock of a cancer diagnosis. Later, during chemo, I knew that no matter how crappy I felt he was a thousand miles away doing his best to find joy in each day despite his challenges.

I feel confident that my checkup on Wednesday will generate good news.

If some day I get the news, that cancer people can't bear to hear, I will try hard to continue to find joy in the small moments and help others along. Meaningful relationships happen that way.

I Hope You Know

I hope you know how much you are missed John Sr. The void caused by your passing is felt way out here in Montana.

You live on. In your family's mannerisms, intelligence, integrity and bountiful joy for living.

For those of us fortunate enough to have known you, the 4th of July has new meaning. While the day will forever be tinged with sadness, we can gather each year to celebrate your life, tell stories and perhaps find comfort in shared grief.

You lived well, fought the good fight and took care of your family until the last moment. Rest in peace dear man.

His Extraordinary Courage

My heart is with my father-in-law tonight. He is in the hospital. The hospital is the last place he wants to be and he held off as long as he could before admitting himself late last week.

John Brownell Senior is courageously enduring until he can go home. He has persevered downturns and rebuilt strength several times since I met him a few years ago. I have not seen him complain or feel sorry for himself. In fact, even when feeling deplorable, he generously gives his gift of humor. Taking the burden of harsh sadness off of others onto his shoulders. His family needs him and he does everything in his power to be there with his wise and loving counsel and support.

I believe he can come home again.