Questions To Ask Your Doctor
To learn more about estrogen and progesterone receptor testing for breast cancer, consider asking your doctor the following questions:
What are the results of the ER and PR tests on my tumor sample? What do they mean?
Does this laboratory meet the standard guidelines like those from ASCO and the CAP?
Has a board-certified pathologist diagnosed my cancer?
Do you know if this is an experienced lab and if my tissue was quickly given to the pathologist after my biopsy or surgery, as recommended by guidelines?
Can I obtain a copy of my pathology report ?
Is my ER and PR status indicated on the pathology report? Was the ASCO-CAP guideline recommendation used to define the status?
Based on these test results, what treatments do you recommend and why?
- What are the possible side effects of these treatments?
Is There A Progesterone
Roshni Rao, MD, Chief of the Breast Surgery Program at Columbia University Medical Center, tells LIVESTRONG.com that, “Most of the studies show that progesterone does not increase the risk of breast cancer 5. , there is a very small, increased risk with birth control pills, especially combination birth control ,” says Rao. But the risk is so small, Rao considers progesterone-related treatments to be safe. She says studies of progesterone on its own– that is, without estrogen– have not found a breast cancer risk. “The risk of being overweight and breast cancer is much, much, higher than birth control and breast cancer,” says Rao.
Summary Of Key Terminologies
cBHRT: Compounded Bioidentical Hormone Replacement Therapy: Precise duplicates of human hormones which are produced by specialist pharmacies and do not follow the same MHRA regulatory pathway as conventional rBHRT
rBHRT: Regulated Bioidentical Hormone Replacement Therapy: Precise duplicates of human hormones developed in a conventional way by the pharmaceutical industry and authorised by the regulators such as the MHRA in the UK
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Progesterone For Breast Cancer Prevention
Comments: 4 | October 6th, 2021
October is Breast Cancer Awareness Month. The goal of the pink ribbon campaign is to raise awareness and find a cure. However, can you tell us what is missing from this campaign? There is something you can start doing now to be proactive and help prevent you from getting breast cancer in the first place. A missing link that has been grossly overlooked is progesterone.
Progesterone is a key factor in preventing breast cancer that is not being recognized by mainstream medicine. Breast cancer is commonly caused by hormonal imbalance. Almost all risk factors associated with breast cancer are directly or indirectly related to excess estrogen, or estrogen that is not balanced with progesterone, a condition called estrogen dominance. This hormonal imbalance can be easily corrected with bioidentical progesterone, which is identical to the progesterone made by your body.
The past quarter-century of research has clearly demonstrated that low levels of human progesterone increase the risk of breast cancer. A number of studies have found that insufficient progesterone may be a more important factor than excessive estrogen in increasing a womans risk of breast cancer. Take a look at the amazing results of the following three research studies:
What Are The Side Effects Of Hormone Therapy
The side effects of hormone therapy depend largely on the specific drug or the type of treatment . The benefits and harms of taking hormone therapy should be carefully weighed for each person. A common switching strategy used for adjuvant therapy, in which patients take tamoxifen for 2 or 3 years, followed by an aromatase inhibitor for 2 or 3 years, may yield the best balance of benefits and harms of these two types of hormone therapy .
Less common but serious side effects of hormone therapy drugs are listed below.
- Breathing problems, including painful breathing, shortness of breath, and cough
- Loss of appetite
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Pr Structure & Function: Classical & Membrane
PR isoforms are classically defined as ligand-activated transcription factors and members of a larger family of related steroid hormone receptors that regulate gene expression by binding directly or indirectly to specific sites in DNA . PRs are activated upon binding to the naturally occurring ovarian steroid hormone, progesterone, or via binding to synthetic ligands . Three PR isoforms are the distinct protein products of a single gene located on chromosome 11 at q2223 that undergoes transcription via the use of two alternate distal and proximal promoter regions . The use of two internal translational start sites within common mRNAs results in the creation of three protein isoforms that consist of the full-length PR-B , N-terminally-truncated PR-A , and PR-C-isoforms . PR+ cells usually coexpress PR-A and PR-B isoforms these receptors have different transcriptional activities within the same promoter context, but can also recognize entirely different gene promoters . PR-B is required for normal mammary gland development , while PR-A is essential for uterine development and reproductive function . PR-C is devoid of classical transcriptional activity, but when expressed, can enhance PR activity in breast cancer cells or function as a dominant inhibitor of PR-B in the uterus .
Progesterone receptor structureProgesterone receptor function
ER: Estrogen receptor PR: Progesterone receptor.
Other Hormones And Breast Carcinogenesis
Elevated circulating androgen levels are consistently associated with increased breast cancer risk, but the underlying mechanism of action is unclear . Androgens may increase risk indirectly through aromatization to estrogens, whose role in breast cancer etiology is well established , or decrease risk by exerting antiestrogenic and antiproliferative effects via androgen receptor signaling . Androgenic activity via the AR is responsible for healthy functioning of many organs in women including the breast, where estrogens stimulate while androgens inhibit development, and the balance between these regulates breast development. In breast tumors, AR expression has been detected in up to 85% of cases , although this varies by breast cancer subtype while almost all ER+ cancers express AR, only 1035% of triple negative breast cancers express AR .
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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 Questions Should I Ask My Doctor
You may want to ask your healthcare provider:
- Is the cancer estrogen-dependent or hormone-receptor-positive?
- What is the best treatment for this type of cancer?
- What are the treatment risks and side effects?
- What changes can I make to protect my health?
- Should I use a different form of birth control?
- Can I use hormone therapy?
A note from Cleveland Clinic
Most of the time, estrogen plays a positive role in healthy body functions. Estrogen-dependent cancers are an exception. In these cancers, estrogen fuels cancer growth. If you develop a cancer that could be hormone-sensitive, your healthcare provider will do tests to find out if its related to estrogen. This information helps your healthcare provider select the most effective treatment for you.
Last reviewed by a Cleveland Clinic medical professional on 09/10/2021.
Breast Cancer In Postmenopausal Women
Breast cancer is most common in postmenopausal women, and most breast cancers in postmenopausal women are hormone receptor positive. As women age, the fat cells in their breasts tend to produce greater and greater amounts of an enzyme called aromatase. Aromatase promotes the production of oestrogen. Consequently, with age, the levels of oestrogen present in women’s breasts increases. This locally produced oestrogen plays a role in both the development and growth of breast cancer in postmenopausal women. Once established, the tumour acts to increase oestrogen levels to help it grow, with immune cells appearing to boost oestrogen production. Recent studies have also identified a link between obesity and oestrogen production. Data demonstrating that obesity carries a two-fold increased risk of developing breast cancer in older women supports these findings. This makes sense considering that obese women have more of the fat cells responsible for producing oestrogens.
Herbs And Supplements During Menopause
Many over-the-counter natural products are promoted in stores and online as helpful with menopausal symptoms. These include vitamins and soy-based and herbal products . There are also endless arrays of special blends of herbs and vitamins that claim to reduce the discomforts of menopause.
These products are considered dietary supplements . They have not been evaluated by the Food and Drug Administration to be sure that they work or even that they are safe. Some supplements have been tested in small clinical trials, but often the studies only looked at taking the substance for a short time , so it isnt clear how safe it would be if taken for a long time. Another concern has been applying the results of a study of a particular version and dose of a supplement to others that werent tested.
Most of the plain herbs that are touted for menopausal symptoms carry a low risk of harm for most women, but some can interact with other drugs and/or cause unexpected problems. You should discuss herbs or supplements with your doctor before taking them.
Well-controlled scientific studies are needed to help find out if these products work and if they are any safer than the hormone therapy drugs now in use.
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Hormones And Breast Canceraddendum
The Womens Health Initiative, a large study sponsored by the National Institutes of Health, came out with surprising results several years ago. Previously it had been believed that hormone replacement in post-menopausal women prevented osteoporosis, heart disease and dementia, and had no adverse effects. Doctors and women were disabused of that belief by statistics indicating an increased incidence of breast cancer, blood clots, heart attacks and strokes.
The medical professions response was immediate, and overwhelmingly in the direction of discontinuing estrogen and progesterone replacement therapy. Women were left to their own resources, to suffer again the hormonal deprivation they had known before hormones were introduced. Another alternative was to start them on antidepressant medications or sedatives, as if they were mentally ill. These drugs reduced some symptoms but not others, and worsened sexual difficulties.
The conclusions drawn, that all hormones were dangerous and should not be used except in extreme circumstances, were erroneous. Yet they are still held to this day by many physicians, who deny their female patients the benefits of hormones.
The hormone studies used only oral formulations, now known to increase blood clotting factors and elevate the risk of phlebitis, heart attacks and strokes. Non-oral formulations do not have this effect.
Reducing The Cancer Risks Of Hormone Therapy
If you and your doctor decide that MHT is the best way to treat symptoms or problems caused by menopause, keep in mind that it is medicine and like any other medicine its best to use it at the lowest dose needed for as short a time as possible. And just as you would if you were taking another type of medicine, you need to see your doctor regularly. Your doctor can see how well the treatment is working, monitor you for side effects, and let you know what other treatments are available for your symptoms.
All women should report any vaginal bleeding that happens after menopause to their doctors right away it may be a symptom of endometrial cancer. A woman who takes EPT does not have a higher risk of endometrial cancer, but she can still get it.
Women using vaginal cream, rings, or tablets containing only estrogen should talk to their doctors about follow-up and the possible need for progestin treatment.
For women who have had a hysterectomy , a progestin does not need to be a part of hormone therapy because theres no risk of endometrial cancer. Adding a progestin does raise the risk of breast cancer, so ET is a better option for women without a uterus.
Women should follow the American Cancer Society guidelines for cancer early detection, especially those for breast cancer. These guidelines can be found in Breast Cancer Early Detection.
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Why Are Estrogen And Progesterone Important
Estrogen and progesterone serve as the two main female reproductive hormones. A healthy cycle starts with a healthy balance between estrogen and progesterone.
In the first half of your cycle also called the follicular phase estrogen rises as your body prepares for ovulation. Estrogen thickens your uterine lining to make it a comfy place for an embryo to implant, given that sperm fertilizes an egg.
Estrogen also plays an important role during puberty, by promoting physical changes such as growth of the breasts, pubic and underarm hair, and the start of your cycles. Additionally, estrogen encourages healthy cholesterol levels and preserves bone health, along with impacting things like your brain, mood, and heart, among others.
Then, during the second half of your cycle , progesterone levels rise and become dominant. After ovulation, the empty follicle from which the egg was released produces progesterone to support implantation and pregnancy.
Progesterone stabilizes the already thick uterine lining and makes it sticky enough so an embryo could successfully implant. Progesterone needs to remain elevated to a healthy level for the entire implantation window to allow for the best possible chance at successful implantation and pregnancy.
Like estrogen, progesterone also impacts other parts of the body, such as mood, bone health, and sleep patterns. Progesterone can also help relieve symptoms of menopause.
Selective Estrogen Receptor Response Modulators
Selective estrogen receptor response modulators attach to and block estrogen receptors in breast cells. This stops the estrogen from signaling to the cells to grow.
Examples of SERMs include:
- toremifene for people with advanced ER-positive breast cancer after menopause
A doctor may prescribe one of these drugs with another medication.
Possible adverse effects of SERMs include:
- changes in mood
- vaginal dryness or unusual discharge
Less commonly, SERMs may increase the risk of:
- uterine cancer
from the age of 5074. Those aged 4049 years should ask their doctor about whether screening is a good idea.
Other organizations have different recommendations. For example, the ACS recommends annual breast screenings for females aged 4554 years .
However, each persons situation is different. A doctor may recommend a different screening schedule for someone with a higher risk of breast cancer.
The outlook for people with ER-positive breast cancer tends to be good, especially when a doctor diagnoses it early.
A person with an early diagnosis of any type of breast cancer has a 99% chance of living for at least another 5 years, and often longer, the ACS reports.
However, if the cancer has spread to other organs, the chance of surviving for at least another 5 years is 29%, it notes.
Taking these steps may ultimately lead to a better outlook if a person develops breast cancer:
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Data Synthesis And Statistical Analysis
We extracted or calculated the relative risk of the outcomes of interest with 95 % confidence interval . The I2 statistic was used to assess heterogeneity of the treatment effect among studies for each outcome. I2 value > 50 % and p value < 0.10 of the Cochrane Q test suggested substantial heterogeneity that is due to real differences in study populations, protocols, interventions, and/or outcomes. Publication bias was not assessed due to the small number of the studies included. The statistical analyses using DerSimonian and Laird random effects model were performed with CMA version 2 .
What Types Of Cancer Does Progesterone Cause
Studies have also shown that a womans risk of breast cancer is linked to the estrogen and progesterone produced by her ovaries . Prolonged exposure and/or high levels of these hormones have been associated with an increased risk of breast cancer.
What are the dangers of taking progesterone?
However, progesterone can cause many side effects, including upset stomach, changes in appetite, weight gain, fluid retention and swelling , fatigue, acne , drowsiness or insomnia, allergic rashes, hives, fever, headache, depression, breast discomfort or enlargement, premenstrual syndrome type symptoms.
Can I take progesterone every day?
Progesterone comes in capsule form to be taken by mouth. It is usually taken once a day in the evening or at bedtime.
What are the side effects of too much progesterone?
Progesterone can cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
Is there a link between breast cancer and progesterone?
Researchers found that postmenopausal women with higher circulating progesterone levels had a 16% increased risk of breast cancer. In addition, the risk associated with progesterone appears to be modified by estradiol concentrations.
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