In the mid-1970s, when tamoxifen was first made available for the treatment of women with metastatic breast cancer, I would not infrequently have women come to my office soon after starting this new medicine (it was revolutionary at that time because it was a pill, easy to take and generally free of side effects) complaining of bone pain. Some of these women also had significantly elevated blood calcium levels.
Imagine reassuring a woman with significant pain that -- based on your limited medical experience with this new pill -- this was in fact a good sign, since it had meant in many other women who had developed those same symptoms that they responded to the treatment with improvement in their breast cancer.
I went back into the medical literature and actually found an article from 1978 that described this observation, and called it a "tamoxifen flare." It also confirmed my recollection that these women actually did well with respect to their cancer.
So, with all of the fancy tests we have to measure the impact of the drugs we use, it turns out that symptoms such as joint pain and hot flashes in a woman with breast cancer treated with a hormone-blocking drug may actually be a good sign that the drug is working.
Sometimes, our bodies are better indicators of our conditions than our science.
That's actually not a new observation, but it helps remind us that with all our knowledge, we can't measure everything with a lab test or X-ray. Listening to our patients still has value.
Len Lichtenfeld is deputy chief medical officer of the American Cancer Society. You can view the full blog by clicking here.