ArcaMax

DEAR DR. ROACH: I am 78 years old. Breast cancer runs in my family, and I am one of the lucky ones who had a lump that was caught early through an annual mammogram. I had a partial mastectomy, which entailed the surgical removal of a lump about the size of a pea. I underwent 14 days of radiation and was cleared.

I then saw an oncologist who prescribed anastrozole. I broke out in this terrible case of rash and hives, and my dermatologist prescribed prednisone, which cleared it up. I was told to stop taking anastrozole and was prescribed 20 mg of tamoxifen daily, but the same thing happened. I looked like a leper and was scratched everywhere to the point of bleeding. So, I stopped taking it.

I should mention that I am allergic to most sulfa drugs, Cipro, penicillin and aspirin. I am supposed to take a hormone blocker for the next five years, yet no one can find anything to prescribe that won't give me a reaction. -- A.R.

ANSWER: Between 6% and 11% of people taking anastrozole will develop a rash. Anastrozole is an aromatase inhibitor that prevents women and men with breast cancer from being able to make estrogen hormones. When a person can't tolerate an aromatase inhibitor, we often try tamoxifen, which blocks some but not all the actions of estrogen. Aromatase inhibitors are more effective at preventing cancer recurrence and breast cancer death, so we prefer using them when possible.

There are two other aromatase inhibitors: exemestane and letrozole. Chemically, letrozole is more similar to anastrozole than exemestane is. I recommend that your oncologist tries exemestane. I did read a case report of a woman similar to you who developed a terrible rash of anastrozole but did well on a different AI.

Since they are beneficial in preventing recurrence and death, it's worth it to try one of the other treatments; I tend to prefer exemestane. Unfortunately I can't guarantee that you won't get a reaction, but you can stop it and try letrozole if a serious rash develops.

DEAR DR. ROACH: You always state that alcohol isn't suggested to help with sleeping. Well, if I wish to fall asleep, it is enough for me to drink a small 7.5-ounce beer or a tiny glass of wine. This limited quantity is enough for me to feel drowsy, maybe because I am not a regular drinker. What do you think? -- S.R.E.

ANSWER: No, I don't recommend alcohol for medical reasons in general. For insomnia in particular, many people find that although they fall asleep, they often wake up in the middle of the night and are unable to fall asleep again. Additionally, alcohol can suppress the REM or dream sleep that is essential for our brain function.

However, these alcohol effects on sleep are dose-related, and the dose you are taking is small. It may be that it's more of a behavioral effect than a pharmacological one, meaning that you are relaxing more from the process than from the actual alcohol.

So, if you are really sleeping well with an occasional "tiny glass" and feeling rested during the day, I don't recommend against it, but I still say that you shouldn't do so every night.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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