Adjuvant Zometa: Am I crazy to try this?

[dblwhammy]

I'm strongly considering IV Zometa to prevent (hopefully) recurrence of my stage 1 IDC. details:Age 60, diagnosis age 59, 1.2cm, grade II, SN neg, bilat mastectomy, ER pos, Ki-67 13%, PR neg, Her2 neg. Oncotypedx score 27, had 4 cycles CT, on Arimidex. I know about the studies by Austrian team on pre-menop women, and that adjuvant use of Zometa is 'off-label'. My oncologist will authorize the treatments as it will also help prevent bone loss on Arimidex. My dental health is very good, no kidney disease, general health very good. I'm driving myself nuts reading information online about a recent study that associates high bone mineral density with increased risk of BC. Zometa will strengthen bone but does this mean higher bone mineral density? Or am I comparing apples to baseballs? I'm immobilized by fear and wanting to do all that I possibly can to avoid recurrence. (Yes, I should stop researching online!)

[Cleveland Clinic]

Dear dblwhammy:  The study that you are referencing was presented at the American Society of Clinical Oncology meeting in May 2008.  This study was done on premenopausal women who were made menopausal chemically.  At this time, the recommendation regarding use of Zometa to “treat” cancer is that it should be limited to premenopausal women.  Further, because this is not an indicated use, insurance may not cover the cost for this purpose.  If your doctor, based on your bone health and armidex feels that Zometa is indicated for bone health, then that may be a different issue.  The Zometa may be given to prevent bone loss and could increase the bone density which would be considered a benefit in terms of reducing the risk of fracture. There are no data to suggest that higher bone density will increase the risk of recurrence of a known breast cancer. The correlation between higher bone density and risk of developing breast cancer is felt to relate to the fact that both may be related to higher estrogen levels. That does not mean the high bone density is a cause of breast cancer. You should have a very frank discussion with your oncologist regarding all of this information, risks vs benefits, etc.  A second opinion may also be a good idea just to see how another oncologist might approach your situation.  To date, there is only limited evidence in the premenopausal population that zometa may reduce the risk of recurrence and other ongoing studies anticipated to be presented soon should help clarify the role for this class of drugs.