The Use Of Vaginal Estrogen By Women With A Current Or Prior History Of Breast Cancer
Data do not show an increased risk of cancer recurrence among women currently undergoing treatment for breast cancer or those with a personal history of breast cancer who use vaginal estrogen to relieve urogenital symptoms 16. A nested casecontrol analysis of a cohort study of women with breast cancer who either did or did not use vaginal estrogen showed no increase of recurrence in vaginal estrogen users 17. In another study, the risk of recurrence in women who used vaginal cream was not increased, irrespective of the total dose prescribed 18.
Concerns remain about recurrence risk with use of vaginal estrogen in women with breast cancer who use aromatase inhibitors. Specifically, the threshold for systemic estrogen levels associated with breast cancer recurrence risk has yet to be determined 19. Some authors note that even a small increase in systemic estradiol levels may have a detrimental effect on recurrence risk and that more data are needed before recommendations can be made regarding the use of vaginal estrogen among this population 1620. Typically, aromatase inhibitors decrease circulating estradiol levels from 20 pg/mL to less than 13 pg/mL 2021. Studies have demonstrated an initial increase of serum estradiol with the use of low-dose vaginal estrogen among women taking an aromatase inhibitor, though these levels were not sustained over time and increased cancer recurrence was not noted 11.
How Big Is The Risk
The study calculated six in every 100 women not taking menopausal hormone therapy would develop breast cancer between the ages of 50 and 69.
If they took oestrogen and progestagen every day for five years, eight of the women would develop breast cancer.
So out of every 50 people taking the combined therapy, one would develop breast cancer as a result of the drugs.
There are other types of hormone replacement therapy and each of those showed an increased risk too.
Taking intermittent hormone therapy led to one extra case of breast cancer in every 70 people.
And just taking oestrogen caused an extra case in every 200 women.
However, taking oestrogen alone increases the risk of womb cancer and is normally used only after a hysterectomy.
What Is Unique About The Young Mammary Gland That Makes It So Susceptible To Cancer Induction And Protection
The fact that two crucial reproductive events, menarche and young age at parity, have the greatest effect on lifetime breast cancer risk suggests that the young mammary gland represents a crucial window in tumorigenic susceptibility. Why this is the case is less clear. Based on the epidemiological evidence for this, a few hypotheses have been generated, but again few have been tested experimentally, and this work is largely restricted to rodent models.
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How Certain Are The Findings
The researchers did not perform any new studies themselves.
Instead they analysed data from 58 studies, all around the world, that involved more than 108,000 women who went on to develop breast cancer..
Stephen Evans, a professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine , said: “This is a ‘tour de force’ in what has been done and the way it has been done – the findings cannot be dismissed.”
Kevin McConway, an emeritus professor of applied statistics at the Open University described the analysis as “a very careful, thorough, excellent piece of research”.
Where Does Evidence About The Health Effects Of Mht Come From
The most comprehensive evidence about the health effects of MHT comes from two randomized clinical trials that were sponsored by the National Institutes of Health as part of the Womens Health Initiative :
- The WHIEstrogen-plus-Progestin Study, in which women with a uterus were randomly assigned to receive either a hormone pill containing both estrogen and progestin or a placebo. The median duration of treatment was 5.6 years.
- The WHI Estrogen-Alone Study, in which women without a uterus were randomly assigned to receive either a hormone pill containing estrogen alone or a placebo. The median duration of treatment was 7.2 years.
More than 27,000 healthy women who were 50 to 79 years of age at the time of enrollment took part in the WHI hormone therapy trials. The goals of these trials were to see if MHT prevents heart disease and bone fractures in postmenopausal women and to determine if MHT affects risks of breast cancer and, for women with a uterus, endometrial cancer. Both trials were stopped early , when it was determined that both types of therapy were associated with specific health risks, but long-term follow up of the participants continues to provide new information about the health effects of MHT.
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Can A Person Lower Their Breast Cancer Risk
If a person decides to take HRT, they can ask for a lower-dose formula. They can also discuss with a doctor how to take it for the shortest possible time.
BreastCancer.org notes that a person can take certain steps to reduce their risk of developing breast cancer whether they use HRT or not.
They recommend that a person:
- exercise regularly
- quit smoking, if applicable
- limit their intake of alcohol
It is also important to achieve and maintain a healthy weight. This is because having more fat tissue can raise a persons estrogen levels, and as a result, increase the chance of developing breast cancer.
The ACS adds that a person at higher risk for breast cancer may benefit from taking additional steps, such as:
- getting closer monitoring
- seeking genetic testing and counseling
- getting preventative surgery
For those with a high risk of developing breast cancer, an oncologist may prescribe medications such as tamoxifen and raloxifene.
Alternatives To Hrt For Protecting Your Bones From Osteoporosis
HRT is no longer recommended for treatment of osteoporosis due to its risks and available alternative options. Bisphosphonate medications are generally recommended to treat osteoporosis instead. Other medications that may be considered are teriparatide, denosumab, or selective estrogen receptor modulators . SERMs are a newer class of drugs, similar to estrogen, that protect against osteoporosis by increasing bone density, while also protecting against the development of breast cancer.
Evista is a widely used SERM that has been shown to increase bone growth and density and reduce the risk of breast cancer. Unfortunately, it does not relieve symptoms of menopause such as hot flashes and may actually worsen them. It is primarily used in women who are at high risk for developing breast cancer or for those who cannot tolerate other medications used to treat osteoporosis.
Additional steps you can take to prevent and/or treat osteoporosis include:
- Performing weight-bearing exercises
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Does Hrt Increase The Risk Of Breast Cancer
Most types of HRT increase the risk of breast cancer. But the risk is higher for those using combined HRT, which uses both oestrogen and progestogen.
Vaginal oestrogens are not linked to an increased risk of breast cancer, whereas tibolone is.
Taking HRT for 1 year or less only slightly increases breast cancer risk. However, the longer you take HRT the greater the risks are, and the longer they last.
The risk of breast cancer due to HRT can also vary from person to person. Things such as what age you are when you first start taking HRT, other medicines you may be taking, and your general health can impact the risk.
People who begin HRT before or soon after the menopause may have a bigger risk than those who start HRT later.
What Are Hormones And Hormone Receptors
Hormones are substances that function as chemical messengers in the body. They affect the actions of cells and tissues at various locations in the body, often reaching their targets through the bloodstream.
The hormones estrogen and progesterone are produced by the ovaries in premenopausal women and by some other tissues, including fat and skin, in both premenopausal and postmenopausal women and in men. Estrogen promotes the development and maintenance of female sex characteristics and the growth of long bones. Progesterone plays a role in the menstrual cycle and pregnancy.
Estrogen and progesterone also promote the growth of some breast cancers, which are called hormone-sensitive breast cancers. Hormone-sensitive breast cancer cells contain proteins called hormone receptors that become activated when hormones bind to them. The activated receptors cause changes in the expression of specific genes, which can stimulate cell growth.
Breast cancers that lack ERs are called ER negative, and if they lack both ER and PR they may be called HR negative.
Approximately 67%80% of breast cancers in women are ER positive . Approximately 90% of breast cancers in men are ER positive and approximately 80% are PR positive .
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Strengths And Weaknesses Of This Study
Some limitations of this study arise from inevitable shortfalls in completeness and accuracy within any routinely collected dataset. A small proportion of women had missing information on smoking status, alcohol consumption, and BMI, but these were dealt with by multiple imputation. As we did not have reliable data for age at onset of menopause for all women, we estimated onset from the first menopause specific record before the earliest HRT prescription. For women with no such record we assumed onset within the most common age range of 50 to 54 years. We did not investigate the differences between continuous and sequential HRT because these regimens are prescribed at different times after menopause. As our cases and controls were matched by age, they would likely have been prescribed similar regimens, making a comparison infeasible. Our primary focus, anyway, was recent long term exposure.
What Types Of Hormone Therapy Are Used For Breast Cancer
Several strategies are used to treat hormone-sensitive breast cancer:
Blocking ovarian function: Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. Blocking ovarian function is called ovarian ablation.
Ovarian ablation can be done surgically in an operation to remove the ovaries or by treatment with radiation. This type of ovarian ablation is usually permanent.
Alternatively, ovarian function can be suppressed temporarily by treatment with drugs called gonadotropin-releasing hormone agonists, which are also known as luteinizing hormone-releasing hormone agonists. By mimicking GnRH, these medicines interfere with signals that stimulate the ovaries to produce estrogen.
Estrogen and progesterone production in premenopausal women. Drawing shows that in premenopausal women, estrogen and progesterone production by the ovaries is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which then causes the pituitary gland to make and secrete LH and follicle-stimulating hormone . LH and FSH cause the ovaries to make estrogen and progesterone, which act on the endometrium .
Examples of ovarian suppression drugs that have been approved by the U.S. Food and Drug Administration are goserelin and leuprolide .
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Why Would A Woman In Menopause Take Hrt Some Women Take Hormone Replacement Therapy To Ease Menopausal Symptoms Hrt Is Medicine That Contains Hormones That The Ovaries Make Less Of As Women Age And Reach Menopause Hrt Can Be Taken As Estrogen Only Or As A Combination Of Estrogen Plus Progestin Combined Hrt Is Most Commonly Used Estrogen
Combined HRT may help relieve menopausal symptoms, protect against osteoporosis and reduce the risk of colon cancer.
Research shows that long-term use of combined HRT increases the risk of breast and ovarian cancer, heart disease, stroke and pulmonary embolism . The research suggests that the risks of long-term combined HRT use outweigh the benefits for most women.
The decision to take HRT is personal and should be made with the help of your doctor. Concerns about cancer, heart disease and stroke should be discussed when considering the benefits and risks of HRT.
Should A Person Take Hrt
The benefits of taking HRT can vary from person to person. Some people decide that the benefits outweigh the risks.
HRT can help relieve the symptoms of menopause. It can also help reduce the risk of developing osteoporosis.
A person should discuss the benefits and risks with a healthcare professional before deciding whether HRT is right for them.
If a person decides to take HRT, they should attend all their breast cancer screening appointments.
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What Should Women Do If They Have Menopausal Symptoms But Are Concerned About Taking Mht
Women who are seeking relief from hot flashes and vaginal dryness should talk with their health care provider about whether to take MHT, the possible risks of using MHT, and what alternatives may be appropriate for them. FDA currently advises women to use MHT for the shortest time and at the lowest dose possible to control menopausal symptoms. The FDA provides additional information about the risks and benefits of MHT use for menopausal symptoms on its Menopause & Hormones: Common Questions fact sheet.
Bioassay Of Clampede2 On Uterine Weight
Our various strategies to examine the ER-independent effects of E2 critically depended on complete blockade of any residual ER activity resulting from a truncated ER or from low levels of ER. Measurement of uterine weight provided a robust bioassay of E2 to determine whether complete blockade was achieved. We measured uterine weight after at least 2 months of E2 exposure under each experimental condition . In the ERKO castrate animals, E2 stimulated uterine weight to 18% of that observed in ER+/+/Wnt-1 animals, an effect resulting from a biologic effect of the truncated 56KD receptor . Fulvestrant completely blocked the residual ER responsiveness in the ERKO/Wnt-1 animals. Uterine weight fell to 7 ± 1 mg in the animals receiving 240 pg/ml E2 plus fulvestrant, a uterine weight similar to that observed in castrate animals . In aggregate, these data demonstrated that fulvestrant was capable of completely abrogating the effects of residual ER activity in ERKO animals.
Uterine wet weights in ER+/Wnt-1 and ERKO/Wnt-1 animals. Shown are mean weights of the uterus under various conditions. Data from ER-animals were pooled from different experiments . 17-E2/ovx: castrate animals receiving 17-OH-E2 to produce plasma levels of 240 pg/ml . Statistical analysis: ER+ groups: compared to intact , compared to ovx , compared to ovx + E2 ERKO groups: compared to intact , compared to ovx , compared to ovx + E2 with all p-values less than 0.001.
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Intimacy Sex And Breast Cancer
Menopausal symptoms such as hot flushes, night sweats and vaginal dryness as well as a decreased sex drive can affect new and existing relationships and your sex life.
It may feel difficult or embarrassing talking about these problems, but it can help to discuss it with your treatment team or GP as they may be able to help.
Can Eating Soy Cause Breast Cancer
There is no shortage of claims on the internet that certain foods can cause cancer. For example, you may have read or heard the myth that eating soy can increase your risk for breast cancer. But is it actually true? Here, we discuss where this idea comes from, what the science says about soy and cancer risk, and what to know about incorporating soy into your diet.
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Hormone Replacement Therapy Hrt Does Not Cause Breast Cancer New Study
Estrogen Actually Prevents Breast Cancer
In March 2012, a new study concluded that hormone replacement with estrogen DOES NOT INCREASE RISK for breast cancer. This report appeared in Lancet Oncology and provided data on the 11.8 year follow up on the Womens Heath Initiative Study which was originally published in JAMA in 2004.
The Original 2004 WHI Report 6.8 years of Follow Up
The original WHI study enrolled about 10,000 women after hysterectomy. Half were given placebo, and the other half were given Premarin Premarin is also called CEE for Conjugated Equine Estrogen.
23% Less Breast Cancer
The original report in JAMA 2004 included 6.8 years of follow up showing 23% less invasive breast cancer in the Premarin treated group compared to placebo group . There were 94 breast cancer cases in the estrogen hormone group and 124 cases of breast cancer in the placebo group.
Less Heart Disease- Less Hip Fracture
In addition, there was 9% less heart disease, and 39% less hip fracture in the estrogen hormone treated group.
Problems With Blood Clots
The Premarin pill caused increased clotting resulting in increased stroke and pulmonary embolus in the Premarin Pill users, which caused early termination of the study. This is one reason why topical estrogen is preferable to pill form estrogen. Topical delivery of estradiol does not cause increased coagulability, does not increase risk for CVA or stroke, is safer and the preferred delivery route.
Here is what they found:
Coping With Hot Flushes And Sweats
To reduce the number or intensity of flushes, you can try the following suggestions:
- cut out coffee, tea and nicotine
- keep your room cool use a fan if necessary
- spray your face with a cool water atomiser
- wear several layers of light clothing you can easily take off or put back on
- wear natural fibres such as silk or cotton instead of man-made fabrics
- cut down on alcohol
- sip cold or iced drinks
- have a lukewarm shower or bath instead of a hot one
- put a towel on your bed so you can easily change it if you sweat a lot at night
- if taking tamoxifen, you could try taking half the dose in the morning and half in the evening – but check with your doctor first
- acupuncture
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