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Estrogen Therapy And Breast Cancer

Estrogen Dominance And Hormone Imbalance

Hormone replacement therapy and breast cancer risk

Remember that estrogen isnt all bad. You need it! But our sex hormones dont exist alone in a bubble. The ratio of estrogen alongside other hormones like progesterone and testosterone can impact how estrogen acts in your body and how much of it you should have during different phases of life.

While estradiol rules your reproductive years, it should naturally drop after menopause. Women with higher estradiol in postmenopausal years appear to have an increased risk of breast cancer. This makes sense as our estrogen levels should naturally drop once we enter menopause.

But, due to lifestyle and environmental factors , women in their 40s and 50s can experience estrogen dominance even after going through menopause.

And while the risk of breast cancer tends to be higher for postmenopausal women, theres some indication that high estrogen levels can increase the risk of breast cancer diagnosis even before menopause. It is challenging to study this for women who still get their periods, though, since estrogen levels fluctuate so much during the month, so the studies arent as reliable.

If You Cant Have Surgery

Surgery is the main treatment for breast cancer, but some women have health problems that mean they cant have surgery. Some women choose not to have surgery.

In this case, if your breast cancer is oestrogen receptor positive, your doctor might recommend hormone therapy. This treatment won’t get rid of the cancer but can stop it growing or shrink it.

The treatment can often control the cancer for some time. Your doctor might change you to a different type of hormone treatment if your cancer starts growing again.

Surgery To Stop The Ovaries From Working

This is also a type of ovarian ablation. You might choose to have an operation to remove your ovaries instead of having drug treatment to stop them working. You have this operation as keyhole surgery. It is called laparoscopic oophorectomy and you have it under general anaesthetic . You usually stay in hospital overnight.

The surgeon makes a number of small cuts into your tummy . They put a long bendy tube called a laparoscope into one of the cuts. The laparoscope connects to a video screen.

The surgeon puts small instruments through the other cuts to carry out the operation and remove the ovaries. They close the cuts with stitches and cover them with small dressings.

Removing your ovaries causes you to have a sudden menopause. The symptoms include hot flushes, sweating and mood swings.

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What Does Estrogen Do For Your Health

Before diving into its role in breast cancer, lets begin by looking at all the beautiful things estrogen does for us. Aside from all the ways it impacts reproductive health, from your monthly cycle to pregnancy, estrogen plays a positive role in functions like:

  • Libido, fertility, and sexual health
  • Healthy stress response
  • Cognitive function

Is It Safe To Take Estrogen After Breast Cancer

Systemic Therapy for Estrogen ReceptorPositive, HER2

Local estrogen therapy likely reduces the risk of breast cancer recurrence in breast cancer survivors considerably. But by how much is a difficult question to answer, for three reasons: More clinical studies are needed. Only a limited number of small studies have examined the effects of local estrogen therapy on breast cancer survivors.

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Is Her2 A Cancer

HER2 breast cancers are likely to benefit from chemotherapy and treatment targeted to HER2. Group 4 . This type, which is also called triple-negative breast cancer, includes tumors that are ER negative, PR negative and HER2 negative. Basal-like breast cancers are likely to benefit from chemotherapy.

How Does Hormone Therapy For Breast Cancer Work

Hormones control nearly all of our bodily functions, from growth and development to emotions, sexual function and even sleep. But hormones, which occur naturally in our bodies, can also fuel the growth of certain breast cancers. We talked with breast medical oncologist Rachel Layman, M.D., to learn about hormone therapy for breast cancer, which can stop or slow the cancer-fueling action of hormones.

What is hormone therapy for breast cancer?

Hormone therapy is a form of treatment that deprives breast cancer of estrogen and progesterone, the two main female hormones that it needs to survive and grow.

Estrogen and progesterone are carried along in the bloodstream. When they encounter a breast cancer cell, they stick to proteins called hormone receptors on the cells surface. This connection acts as an on switch and triggers the cancer cell to grow. The goal of hormone therapy is to prevent hormones from attaching to cancer cells, which deprives the cancer cells of the fuel they need to grow.

Are all breast cancers fueled by hormones?

No, but most are. About 70% of all breast cancers depend on estrogen or progesterone for growth.

How do hormone therapies for breast cancer work?

Hormone therapies reduce or eliminate contact between hormones and breast cancer cells in several different ways:

How and when are hormone therapy medications delivered?

Most hormone therapy drugs are taken as a daily oral pill, though a few are given as injections in the clinic.

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How Exactly Is Estrogen Linked To Breast Cancer

While not always the case, estrogen does play a role in most common types of breast cancer around 80% of cases according to evidence. While scientists and researchers are still working to build a better understanding of this complex area, current research points to how much estrogen you are exposed to over time and how your cells respond to the hormone as being the main factors.

New Analysis Of Estrogen Therapy And Breast Cancer Risk

Studying new estrogen therapies for breast cancer

Estrogen-alone hormone therapy does not increase the risk of breast cancer in postmenopausal women, according to a new analysis of results from the Women’s Health Initiative , one of the largest medical studies ever.

The Estrogen-Alone portion of the WHI involved 10,739 generally healthy postmenopausal women ages 50-79 who did not have a uterus. Estrogen-alone therapy is only recommended for women without a uterus those with a uterus who take estrogen have an increased risk of endometrial cancer, so they are advised to take estrogen combined with progestin.

The study was stopped at the end of February 2004 because of an increased risk of stroke and no significant effect on heart disease. Other findings from the study at the time were that estrogen increased the risk of blood clots in the legs, reduced the risk of hip fractures and had no significant effect on colorectal cancer.

The effect of estrogen on breast cancer was uncertain. This new report, published in the April 12 issue of the Journal of the American Medical Association, provides a more detailed analysis of 237 invasive breast cancers.

Dr. Elizabeth G. Nabel, Director of NIH’s National Heart, Lung, and Blood Institute, which sponsored the study, commented, “The findings still support current recommendations that hormone therapy should only be used to treat menopausal symptoms and should be used at the smallest effective dose for the shortest possible time.”

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What Hormones Are Used To Treat Breast Cancer

Hormone Therapy for Breast Cancer. Some types of breast cancer are affected by hormones, like estrogen and progesterone. The breast cancer cells have receptors that attach to estrogen and progesterone, which helps them grow. Treatments that stop these hormones from attaching to these receptors are called hormone or endocrine therapy.

Antiestrogen Vs Estrogen Blockers

Both antiestrogen and estrogen blockers aim to slow or stop the progression of breast cancer. The two different treatments dont work the same way, though.

Tamoxifen, a widely used estrogen blocker, stops estrogen from affecting breast tissue. Aromatase, an antiestrogen therapy, lowers the production of estrogen in postmenopausal women.

Tamoxifen is well known and widely used as chemoprevention a medication to prevent disease for women with a high risk of developing invasive breast cancer, according to

, researchers found that when postmenopausal women in the increased risk category took tamoxifen for 5 years, it lowered their risk of developing invasive breast cancer by 50 percent.

A 2017 study found that use of tamoxifen and antiestrogen medications led to a 50 to 65 percent decrease in breast cancer development in high risk groups.

Both estrogen blockers and antiestrogen therapies are effective, but there are side effects, too. Its important to weigh the benefits and risks with your care team before deciding on this course of action.

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Benefits Of Hormone Therapies In Early And Locally Advanced Breast Cancer Treatment

Treatment with the hormone therapies tamoxifen and/or an aromatase inhibitor lowers the risk of :

  • Breast cancer recurrence
  • Breast cancer in the opposite breast
  • Death from breast cancer

Premenopausal women who get ovarian suppression plus tamoxifen or an aromatase inhibitor may lower these risks more than premenopausal women who get tamoxifen or an aromatase inhibitor alone .

Learn more about tamoxifen.

Aromatase inhibitor plus androgen deprivation therapy

Interpreting The Lnning Et Al Estrogen Trial

Challenges in Treating Estrogen Receptor

Care must be taken in attempting to place the results of the Lønning et al. phase II trial in the proper context because this involves the perilous process of cross-study comparisons. This is particularly the case when utilizing the parameter of response rate, as this can be greatly modulated by patient selection. Some observations are possible, however, regarding levels of response seen with the most efficacious endocrine agents available today, albeit in less heavily pretreated patient populations.

Two trials evaluated third-generation AIs in patients who had disease progression after tamoxifen and megestrol acetate. Jones et al. evaluated the steroidal AI exemestane in 91 patients and identified a response rate of 13% . Letrozole was evaluated in a similar population and in 45 patients treated at the recommended dose of 2.5 mg/day the response rate was 18% using different criteria .

In a second-line endocrine therapy setting in patients having received prior tamoxifen, the response rates observed for the third-generation AIs anastrozole, exemestane, and letrozole were 10% , 15% , and 24% , respectively. These rates were observed in phase III studies in comparison with megestrol acetate. The 31% objective response rate observed in the Lønning et al. trial with DES is thus remarkable and encouraging even considering all the cautionary caveats regarding interpretation of a small phase II trial.

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Can Oral Contraceptives Increase Breast Cancer

There is a small transient increase in the relative risk of breast cancer among users of oral contraceptives but, since use typically occurs at young ages when breast cancer is relatively rare, such an increase would have little effect on overall incidence rates. In contrast, exposure to menopause hormone treatment occurs when the baseline risk

What Happens When You Stop Taking Estrogen

The most likely risk is that your menopausal symptoms return. Some research also suggests a rise in blood pressure and a slight increase in risk of heart attack or stroke in the year after stopping HRT. But overall, the risks of stopping HRT are low. And you can do it in a slow, comfortable, and safe way.

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Having Hormonal Therapy For Breast Cancer

Hormonal therapy drugs reduce the risk of breast cancer coming back. It is important to take it for as long as you have been prescribed it for. Try to make taking it part of your daily routine so it becomes a habit.

Most women cope well with the side effects of hormonal therapy. They may be more of a problem in the first few months, but usually get better over time. If the side effects do not improve or are difficult to cope with, talk to your specialist nurse or cancer doctor. They can prescribe drugs to help and suggest ways of coping.

If you are still having problems after this, then your cancer doctor may suggest changing to a different type of hormonal therapy.

What Is Hormonal Therapy

Adjuvant Hormonal Therapy for Estrogen Receptor Positive Early Stage Breast Cancer – Mayo Clinic

Hormones help control how cells grow and what they do in the body. The hormones oestrogen and progesterone, particularly oestrogen, can encourage some breast cancers to grow.

Hormonal therapies reduce the amount of oestrogen in the body or stop it attaching to the cancer cells. They only work for women with oestrogen-receptor positive cancers.

Your cancer doctor will advise you to take hormonal therapy to reduce the risk of the breast cancer coming back. It also helps reduce the risk of getting a new breast cancer in your other breast. Sometimes hormonal therapy drugs are given before surgery to shrink a cancer and avoid a mastectomy.

You usually take hormonal therapy drugs for a number of years. For some women, this could be up to 10 years. You usually start taking them after surgery or chemotherapy.

The type of hormonal therapy you have depends on:

  • whether you have been through the menopause or not
  • the risk of the cancer coming back
  • how the side effects are likely to affect you.

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What Role Do Hormones Play In Some Cancers

Hormones are therefore capable of acting as powerful carcinogens, and are considered a complete carcinogen because of their ability to both initiate and promote the development of cancers. Hormones have been implicated in the genesis of breast, prostate, uterine, ovarian, testicular, thyroid and bone cancers.

What Are Estrogen And Progesterone Receptors

Receptors are proteins in or on cells that can attach to certain substances in the blood. Normal breast cells and some breast cancer cells have receptors that attach to the hormones estrogen and progesterone, and need these hormones for the cells to grow.

Breast cancer cells may have one, both, or none of these receptors.

  • ER-positive: Breast cancers that have estrogen receptors are called ER-positive cancers.
  • PR-positive: Breast cancers with progesterone receptors are called PR-positive cancers.
  • Hormone receptor-positive: If the cancer cell has one or both of the receptors above, the term hormone-receptive positive breast cancer may be used.
  • Hormone receptor-negative: If the cancer cell does not have the estrogen or the progesterone receptor, it’s called hormone-receptor negative .

Keeping the hormones estrogen and progesterone from attaching to the receptors can help keep the cancer from growing and spreading. There are drugs that can be used to do this.

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How Do The Hormones Used In Mht Differ From The Hormones Produced By A Womans Body

The hormones used in MHT come from a variety of plants and animals, or they can be made in a laboratory. The chemical structure of these hormones is similar, although usually not identical, to those of hormones produced by womens bodies.

Non-FDA-approved hormone products, sometimes referred to as bio-identical hormones, are widely promoted and sold without a prescription on the Internet. Claims that these products are safer or more natural than FDA-approved hormonal products are not supported by credible scientific evidence. The FDA provides more information about these products on its Menopause page.

Can You Reduce Your Risk Of Breast Cancer Related To Estrogen

How does hormone therapy work?

The connection between estrogen and breast cancer is clear, so optimal levels are vital. I wish I could tell you exactly what to do to avoid a breast cancer diagnosis altogether, but of course, I cant because it’s an issue that’s too complex to offer that type of advice.

That said, there are things you can do to keep your estrogen in check:

Remember that estrogen helps us feel healthy and sexy. The key is maintaining balance with other hormones. Here are my top lifestyle habits that promote healthy estrogen metabolism.

  • Maintain a healthy body weight. Remember that your fat tissue can make estrogen by converting androgens into estrogens. This means that as body fat increases, so does the amount of estrogen produced and circulated throughout your tissues.

Scientists estimatee that your risk for developing breast cancer jumps by 30% after menopause if your BMI is above 30. And being overweight appears to be linked to ER+ breast cancers, likely related to the increased estrogen production. While its much easier said than done to maintain body weight, the number one tip I advise for healthy weight is a healthy fiber intake. Try swapping your mindset from how many calories did I eat today to how much fiber from real, whole vibrant foods did I enjoy today?

  • Keep xenoestrogens out of your kitchen. Chemicals like BPA, phthalates, and BHT all mimic estrogen in the body. They sneak into our kitchen via canned goods, plastic containers, and other food storage items.

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Hormone Therapy For Breast Cancer

Some types of breast cancer are affected by hormones, like estrogen and progesterone. The breast cancer cells have receptors that attach to estrogen and progesterone, which helps them grow. Treatments that stop these hormones from attaching to these receptors are called hormone or endocrine therapy.

Hormone therapy can reach cancer cells almost anywhere in the body and not just in the breast. It’s recommended for women with tumors that are hormone receptor-positive. It does not help women whose tumors don’t have hormone receptors .

Can Hormone Therapy Be Used To Prevent Breast Cancer

Yes. Most breast cancers are ER positive, and clinical trials have tested whether hormone therapy can be used to prevent breast cancer in women who are at increased risk of developing the disease.

A large NCI-sponsored randomized clinical trial called the Breast Cancer Prevention Trial found that tamoxifen, taken for 5 years, reduces the risk of developing invasive breast cancer by about 50% in postmenopausal women who were at increased risk . Long-term follow-up of another randomized trial, the International Breast Cancer Intervention Study I, found that 5 years of tamoxifen treatment reduces the incidence of breast cancer for at least 20 years . A subsequent large randomized trial, the Study of Tamoxifen and Raloxifene, which was also sponsored by NCI, found that 5 years of raloxifene reduces breast cancer risk in such women by about 38% .

As a result of these trials, both tamoxifen and raloxifene have been approved by the FDA to reduce the risk of developing breast cancer in women at high risk of the disease. Tamoxifen is approved for this use regardless of menopausal status. Raloxifene is approved for use only in postmenopausal women.

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