But When I Go To Pubmed And Search For Hormone Replacement For Breast Cancer Patients I See A Ton Of Studies On Tamoxifen And Aromatase Inhibitors I Dont See Studies On Giving Breast Cancer Patients Hormone Replacement
As just one example, getting out of our United States medical bubble, I found a French Study from 2008, which concludes hormone replacement increases breast cancer risk, whether estrogen alone or combined therapy, and regardless of oral or patch:
Large numbers of hormone replacement therapies are available for the treatment of menopausal symptoms. It is still unclear whether some are more deleterious than others regarding breast cancer risk. The goal of this study was to assess and compare the association between different HRTs and breast cancer risk, using data from the French E3N cohort study. Invasive breast cancer cases were identified through biennial self-administered questionnaires completed from 1990 to 2002.
- During follow-up , 2,354 cases of invasive breast cancer occurred among 80,377 postmenopausal women.
- Compared with HRT never-use, use of estrogen alone was associated with a significant 1.29-fold increased risk
- The association of estrogen-progestagen combinations with breast cancer risk varied significantly according to the type of progestagen:
- the relative risk was 1.00 for estrogen-progesterone,
- 1.16 for estrogen-dydrogesterone, and
- 1.69 for estrogen combined with other progestagens. This latter category involves progestins with different physiologic activities , but their associations with breast cancer risk did not differ significantly from one another.
Your Race And Ethnicity
White and Black women have the highest risk of developing breast cancer in their lifetime. Asian/Pacific Islander and Hispanic/Latina womens breast cancer rates fall in between two major groupings while American Indian and Alaska Native women are on the lowest end of risk.
While white women are more likely to develop breast cancer than Black women overall, they tend to be diagnosed at an older age . Black women have the highest breast cancer rates among women under age 40. Black women make up a higher percentage of triple-negative breast cancer cases.
What to do: If your race or ethnicity places you at higher risk, make sure you follow all screening recommendations to improve your chances of catching cancer early.
Estrogen Side Effects And Risks
Hormone therapy is not without its risks. In fact, hormone therapy is not used as widely as it once was because research began revealing complications with long-term use, such as cancer and heart risks.
However, thanks to these studies, doctors and medical researchers have a better understanding of who will benefit most from estrogen therapy and who should try other treatments.
The risk factors and side effects associated with estrogen use include:
- Blood clots: Estrogen increases your risk of blood clots, which can cause stroke, heart attack, and even death.
- Cancer: Estrogen may increase your risk of certain cancers, specifically breast cancer. Talk with your doctor about your personal health history, your family history, and your risk of breast cancer.
- Birth defects: If youre using estrogen or hormone therapy and become pregnant, your pregnancy may end prematurely. If youre able to carry a pregnancy to full term, birth defects are common for babies born to women using estrogen.
- Dense breast tissue: Women who take estrogen may develop dense breast tissue. Dense tissue makes reading mammograms harder, so detecting breast cancer in its early stages may be difficult.
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New Research Again Links Increased Breast Cancer Risk To Longer Use Of Hormone Therapy
The link between hormone therapy and breast cancer has been recognized for years. But an analysis published Aug. 29, 2019, in The Lancet has added some additional information to the discussion. The analysis looked at 58 studies that included information on the type and timing of hormone use in individual women, and their body mass index. Researchers began gathering the studies in 1992 and continued until 2018.
We asked Dr. Wendy Chen, an assistant professor of medicine at Harvard Medical School, to help us sort through both the old and new information on hormone use and breast cancer and what it means for women considering starting hormone therapy.
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- Research health conditions
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What Is The Life Expectancy For Each Cancer Stage
Your outlook depends on the stage of your cancer when its discovered. Cancer is staged by number, starting with 0 and going to 4. Stage 0 is the very beginning and stage 4 is the last stage, also called the metastatic stage because its when cancer has spread to other areas in the body.
Each number reflects different characteristics of your breast cancer. These include the size of the tumor and whether cancer has moved into lymph nodes or distant organs, like the lungs, bones, or brain.
The cancer subtype doesnt play a role in staging, only in treatment decisions.
Survival statistics of women with the major subtypes of breast cancer such as ER-positive, HER2-positive, and triple-negative are grouped together. With treatment, most women with very early stage breast cancers of any subtype can expect a normal life span.
Survival rates are based on how many people are still alive years after they were first diagnosed. Five-year and 10-year survival are commonly reported.
According to the
- stage 3 72 percent
- stage 4 22 percent
One thing to note is that these statistics also included women with the more aggressive HER2-positive and triple-negative cancers. And it takes five years to get to a five-year statistical survival rate, so newer therapies are not included in these numbers.
Its likely that a woman with ER-positive breast cancer diagnosed today may have a higher chance of survival.
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Promoted To Treat Vague Symptoms And Conditions Like Hormone Imbalance Custom
Only when Wierman did an in-depth history did the woman finally reveal that she and her husband had gone to an anti-aging clinic and been implanted with testosterone pellets. I watched her for over 12 months, as her testosterone slowly fell, says Wierman, who is professor in medicine, OBGYN, physiology, and biophysics at the University of Colorado School of Medicine and chief of endocrinology at the Rocky Mountain Regional Veterans Affairs Medical Center. The patient didnt know to mention the testosterone treatment to earlier providers, perhaps because she didnt actually know what she had gotten, Wierman says.
The patient had received a treatment known as bioidentical hormone replacement therapy that is being promoted on the internet, at anti-aging clinics, and by many practitioners. BHRT pellets are subcutaneous implants generally inserted into the hip area and used to treat everything from low libido to hair loss. Hormones may include various estrogens and prohormones such as DHEA or androstenedione, but the most commonly reported problems seem to stem from women given long-term supraphysiologic doses of testosterone, a treatment for which there is no generally accepted medical indication.
AT A GLANCE
Study Suggests Progestin Not Estrogen Is The Real Cancer Culprit In Hormone Replacement Therapy
Hormone therapy that includes progestin plus estrogen may increase breast cancer risk, but estrogen alone may lower risk, according to long-term review.
A long-term review of two clinical trials has shed new light on menopausal hormone therapy and breast cancer risk over time.
In earlier clinical trials, combination hormone replacement therapy consisting of progestin plus estrogen was linked to an increased risk of breast cancer and death from that disease.
Women who had a hysterectomy and took estrogen alone were found to have a reduced risk of breast cancer and breast cancer death.
Following those reports, use of both types of HRT declined.
Thirteen years later, researchers set out to determine both the short-term and long-term effects of HRT.
One analysis involved 16,608 women who had not had a hysterectomy. The women were assigned to receive estrogen plus progestin. Results showed this group was at increased risk of breast cancer while taking combination HRT. Within 2.75 years after stopping therapy, the risk was still present but not as high.
Another group of 10,739 women who previously had a hysterectomy were asked to take estrogen alone. This group had a reduced risk of breast cancer while receiving estrogen therapy. That lower risk continued for a few years after therapy ended. The benefit was lost after that.
This research focused on breast cancer risk and did not involve other potential risks of HRT.
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Controlling Estrogen Level To Combat Breast Cancer
Regardless of exactly how estrogen causes increased breast cancer risk, it is worth keeping low estrogen levels in your body because this is shown to potentially reduce your breast cancer risk and is an excellent natural remedy for hormone-receptor-positive breast cancers that do arise.
- Stop smoking
- Reduce saturated and trans fats
- Reduce usage or eliminate hormone replacent therapy during and after menopauseThe end of a womans menstrual cycles, defined as 12 consecutive months of no menstrual periods.
- Choose to breastfeed, if possible
All of the above factors contribute to reducing estrogen levels in the body. Controlling them helps decrease your risk for breast cancer and gives you a healthier lifestyle in general.
Of course, there are also a number of factors relating to estrogen which cannot be controlled. Women who start their period early or begin the menopause late are believed at higher risk of developing breast cancer, for example. So are those who have children late or dont have any at all. This is possibly because these women are exposed to more estrogen overall in their lifetimes. On the flipside, each time you get pregnant for a prolonged period, you effectively decrease the number of menstrual cycles and hormone fluctuations in your lifespan, reducing the breast cancer risk.
Subcutaneous Implants The Evolution Of T Therapy In Clinical Practice And T With And Without E Implants
The T and E implants used at the Institute for Hormone Balance and its satellite offices are compounded by a 503b outsourcing pharmacy in Denton, Texas. They are composed of USP T and steric acid or USP E and steric acid . A proprietary Food and Drug Administration approved process compresses substrates into 3.1 mm cylinders, sealed in glass ampoules, and sterilized by E beam sterilization. Sterile implants are inserted into the subcutaneous tissue of the upper gluteal area or lower abdomen through a small anesthetized incision using a stainless-steel sterile trocar or a disposable trocar kit.
The IHB has been involved in bio-identical HRT over the past 24 years. Oral ET therapy and ET and/or T creams were used in majority of patients needing replacement through 2007. The practice augmented our armamentarium of HRT adding the use of subcutaneous hormone pellet therapy in 2008. From our experience, subcutaneous hormone pellet therapy provides improved relief of symptoms with fewer side effects than more traditional HRT therapies. The success of T implants in treating symptoms of pre- and post- menopausal patients was additionally shown by Glaser et al . The IHB developed a proprietary dosing computerized algorithm for pellet dosing based on patient demographics, symptoms, laboratory values, and medical co-morbidities.
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Breast Cancer Risk From Using Hrt Is Twice What Was Thought
Study prompts medicines regulator to advise all women using HRT to remain vigilant
The risk of breast cancer from using hormone replacement therapy is double what was previously thought, according to a major piece of research, which confirms that HRT is a direct cause of the cancer.
The findings of the definitive study will cause concern among the 1 million women in the UK and millions more around the world who are using HRT. It finds that the longer women take it, the greater their risk, with the possibility that just one year is risk-free. It also finds that the risk does not go away as soon as women stop taking it, as had been previously assumed.
The UKs drug licensing body suggested women who have used HRT in the past or use it now should be vigilant for signs of breast cancer in the light of the findings, while the Royal College of GPs urged them not to panic but to consult their doctor if they are concerned.
The research, , says one in 50 women of average weight taking the most common form combined daily oestrogen and progestogen for five years will get breast cancer as a result.
That risk is twice what was thought, because it continues at some level for 10 or more years after women stop taking HRT. There are about 1 million women in the UK on HRT, 5 million in the rest of Europe and 6 million in the US.
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Metabolism And Thyroid Hormone Balance
The Colorado Thyroid Disease Prevalence Study in 2000 found the rate of hypothyroidism in the general population to be approximately 10%, with an estimated 13 million undiagnosed cases of low thyroid among American adults. Interestingly, women have an approximately seven times greater risk for developing thyroid problems than do men. Thyroid hormone regulates metabolic rate, so low levels tend to cause unwanted weight gain, depression, low energy and cold intolerance. High thyroid levels cause hyper energy levels, a feeling of being too warm all the time, and persistent weight loss. But it is hypothyroidism, or low thyroid, that is most common in women during the perimenopausal and postmenopausal years in fact, some 26% of women in or near menopause are diagnosed with hypothyroidismand this is the period when breast cancer begins to rise sharply!
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Effects On Other Target Organs
Tamoxifen and raloxifene have effects on other target sites that may affect the balance of clinical benefits and risks.
Tamoxifen has an agonist effect on bone and promotes a gain in bone density at least in post-menopausal women . Raloxifene also has estrogen agonistic activity in bone and increases bone mineral density . Raloxifene also decreases the risk of vertebral fractures in post-menopausal women with osteoporosis .
Both tamoxifen and raloxifene have estrogen agonist effects on serum lipids with an increase in high density lipoprotein and a decrease in low density lipoprotein cholesterol and total cholesterol. Raloxifene decreased cardiovascular events by 40% in the MORE trial . Tamoxifen has been associated with a reduction in coronary artery disease in some but not all adjuvant or prevention trials . It is of interest that estrogen also increases high density lipoprotein cholesterol concentration, but does not decrease coronary artery disease events .
Tamoxifen has agonist effects on uterine endothelium and is associated with an increased risk of endometrial cancer in adjuvant trials . In contrast, raloxifene appears to have neutral actions on uterine endothelium and is not associated with an increased risk of endometrial cancer.
Central nervous system
Breast cancer prevention
Risks For Breast Cancer
A risk factor is something that increases the risk of developing cancer. It could be a behaviour, substance or condition. Most cancers are the result of many risk factors. But sometimes breast cancer develops in women who dont have any of the risk factors described below.
Most breast cancers occur in women. The main reason women develop breast cancer is because their breast cells are exposed to the female hormones estrogen and progesterone. These hormones, especially estrogen, are linked with breast cancer and encourage the growth of some breast cancers.
Breast cancer is more common in high-income, developed countries such as Canada, the United States and some European countries. The risk of developing breast cancer increases with age. Breast cancer mostly occurs in women between 50 and 69 years of age.
Lowering Estrogen Levels From The Ovaries
This type of treatment only works in premenopausal women who have functioning ovaries. It can help some types of hormone therapy work better. It is also used to treat cancer that has spread.
There are three ways to lower estrogen levels from the ovaries:
- Surgery to remove the ovaries
- Radiation to damage the ovaries so they no longer function, which is permanent
- Drugs such as goserelin and leuprolide that temporarily stop the ovaries from making estrogen
Any of these methods will put a woman into menopause. This causes symptoms of menopause:
- Hot flashes
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For years, research has suggested a potential link between MHT and an increased risk of breast cancer. In 2002 and 2004, the Womens Health Initiative released reports that showed women who used combination MHT were more likely to develop breast cancer. MHT use fell after the reports received widespread coverage. That was followed by a decline in breast cancer rates.
But there wasnt much information on whether that risk persisted, or how it differed based on the type of MHT a woman took. So an international group of researchers pulled together data from dozens of studies published and unpublished to examine the issue more closely. They took a womans age at first use of MHT, how long she used the medication, and the time elapsed since she last used it into account. The mean age of women starting menopause was 50, which was also the mean age at which women started using MHT.
The researchers found that compared with women who never used MHT, women who did had a significantly higher risk of developing invasive breast cancer. They estimated that 6.3% of women who never used MHT developed breast cancer, compared to 8.3% of women who used the combination drug continually for five years. Thats roughly one extra cancer diagnosis for every 50 users.
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What Cancer Treatments Can Cause Menopause
Treatments that can cause menopause include:
Surgery to take out your ovaries
Chemotherapy, which may damage the ovaries
Hormone treatments or anti-estrogen treatments that keep your ovaries from producing estrogen
Radiation therapy near your pelvis or lower belly
Ask your health care team if your cancer treatment could cause menopause. If so, you may still be able to have children in the future if you want them. Talk with your health care provider about fertility concerns and preservation, before cancer treatment begins.