a quick search for me did not show a lot of info that cancers are a lot more common in people on biologics. i know that the suppression of the immune system can contribute to active cancers. we don't catch cancers, they are really just cells that go haywire and mutate out of control in our bodies. in healthy people with solid immune systems and limited environmental concerns, the immune system stops that process from happening. in the rest of us, well.... you know.

you mention not being willing to take the risk of cancer for a decade of treatment. doctors weigh cost and benefit before prescribing medications. most doctors believe that the risk of cancers from biologics is far less than the potential good they can do. this is a discussion i had with my doctors already. on a biologic, there is a risk of infection and cancer. without a biologic, it's not a risk of pain and deformity - it's a definite.


http://onlinelibrary.wiley.com/doi/10.1002/art.22579/full

http://onlinelibrary.wiley.com/doi/10.1002/acr.20129/full

http://onlinelibrary.wiley.com/doi/10.1002/art.24941/full

You make a very valid point. I suppose I should say no I don't want the negatives. I don't want to be in a wheelchair like gma was. I also don't want cancer like she had (though not from biologics). I meant, more so, that I'd be willing to drug hop every 6-8 years to keep myself from potentially developing cancer, if the risks were in fact high. Dmard, to bio, back etc. Of course that isn't practical. I wish our medicines didn't come with the risks of suppressed immune system and potential cancer. In spite I am very grateful for our current treatments and we don't have to suffer like our grandparents did back in the day.

Thx for the links. They were quite reassuring.

welp, mtx is used to treat cancer, right? so i figure if i keep taking it with a biologic it kind of nixes the risk. ;)

i'm not a doctor or a scientist or anything. i'm the kid who asked my mom that, since you get farsighted when you get older, if i wouldn't need my glasses since i'm nearsighted. i like when things even themselves out. so, you know.

it's a good question lion.

my rheumie pontificates about how we (RA patients) are more at risk of cancer having RA untreated that treated with the black box drugs. where are the studies for that assertion?

unfortunately we are all victims of not being able to perform some activities of daily life no less earn a living. so sometimes the immediate gets in my face decision wise.

my friend died recently cancer. 50. remicaide. chrohns sufferer a decade.

enbrel and humira seem to have been out the longest. are they tracking patients who have been on it since 15 years ago? I hope so.

I have said no to actemra not wanting a 4th cellular interference. Three biologics is enough for me. there is no science in that that no to me. just a no.

i realize that this is no help. but maybe i could just sit with you in the conflict that I sometimes feel and you are feeling.

you are young. you haven't even grown your kids, mine recently graduated from high school and are both in college. i worry. you worry. let's worry together.

Ros

From what I can find out, the increase in cancers was seen in young (teens & 20s) men being treated for Crohn's disease and ulcerative colitis. I've also seen a study finding that people with untreated RA had more cancers than those on biologics. I'll see if I can find that one.

Next problem: if one of us, God forbid, does develop cancer, there is no way of knowing what would have happened had we made different choices. "Cancer" covers a huge number of diseases. As Steph touches on, we all develop tiny cancers all the time. Almost always, our bodies take care of them before they start causing trouble. No one has any idea why these microscopic problems sometimes get out of control.

http://www.arthritistoday.org/news/biologics-and-cancer-rate210.php

http://jama.jamanetwork.com/article.aspx?articleid=1356358

Here are links to a couple of articles, both published in respected, peer-reviewed journals, about cancer risks in general. I can't find the other one right now, although I'm pretty sure I linked to it another discussion recently, showing a lower cancer rate for Enbrel users.

I'm glad you posted this-deciding what to do and the pro vs con of the disease, biologics, has been consuming and contributes somewhat to my concentration issues even though I really try to push it away during work. Can't help but have it creep in since this disease effects work so much.
I'm in a different place since my kids are raised and I have been thinking about what I want my future to hold. Dreams are dashed, I know that . The only sure thing I know is I need to find out what does work for my children's sake, my son already has Spondylitis, and in the event either of them develop more immune diseases or RA I feel like I owe it to them to make headway in sorting out treatment.

Beech that's very loving.

Ros

...but I'm unsatisfied with what we're being offered. Understood its helped many, failed many, better than what's been available in the past and the best there is to offer right now. Fortunately there are researchers specifically targeting RA as we type ;)
I know me, I have to push more, its what I do.
BTW, really appreciate the links to websites whenever there is a topic.
I have a lot of research before I decide what I'm going to do.

This is why I refer to our situation as living in The Land of No Good Choices. If you are younger, you are looking at years/decades more on various drugs. You are also looking at decades more joint destruction if you don't get the disease controlled. I guess I'm firmly ensconced in middle age. My disease is stopping me from doing many things I wish I could still do, and I'm a little alarmed at how far downhill I've gone over the past couple of years. Even so, with my family history, I may have 40 years left to deal with this. 40 more years of mtx? Yuck!

My rheumatologist assures me there are new treatments in the pipeline. I'm sure they will all come with a different risk/benefit picture.

So true altoclef. Even in the last 4 months or so I've noticed worsening, can hardly write with my right hand even after cortisone injections, so I know I have to get off the pot and do something soon.
risks vs benefits-such is life.

I too am grateful for the articles. Thank you for the insight. I am 35 with kids still in diapers, and bigger kids as well. I have to remain active, a good 20 years still. Quality of life is highly important, being able to function at optimal speed every day. Starting this disease in my 30s puts me at risk for deformities I suppose, since my disease will last longer than a typical RA patient, if there is such a thing as "typical". I also do not want to be battling cancer. I know we all have small altered"cancer cells" our immune system fights on a daily basis. For whatever reason, some people's gets out of control and turns into full blown cancer. I assume cancer is a higher death sentence than RA related death, thus I weigh heavily the decision to begin a biologic. That is only an assumption. I must research the different cancer rates amongst biologics vs heart disease or stroke for RA untreated. Thx again for the links, it will help. I am just unsure long term which is the lesser or two evils. 15, 20 yrs down the line you know?

What a crap decision lol.

At one point, I put together my own spreadsheet on this. But, you know, even if you know every statistic perfectly, the choice is basically:

Take the biologic and have a fairly normal life with a miniscule increased risk of cancer. (specifically skin cancer - so stay out of the sun!)

or

Don't take it and hurt each and every down, downing prednisone, advil, Tylenol, prevacid, etc and milder dmards to quell the miserableness. While you feel like this, you take on greater risk of heart disease with the increased inflammation, have mild to severe depression, and joint erosion.

If you need a biologic AND it works, isn't it worth it?

I have RA. My aunt has RA. My mom doesn't. She has Non Hodgkin's Lymphoma. go figure.

edit above **hurt each and every DAY**

Thx bcatz. At least I do remain virtually sun free, except the occasional work in my garden or grocery trip.