Hormones And Breast Cancer
The hormones estrogen and progesterone make some breast cancers grow. They are called hormone-sensitive breast cancers. Most breast cancers are sensitive to hormones.
Estrogen and progesterone are produced in the ovaries and other tissues such as fat and skin. After menopause, the ovaries stop producing these hormones. But the body continues to make a small amount.
Hormone therapy only works on hormone-sensitive cancers. To see if hormone therapy may work, doctors test a sample of the tumor that has been removed during surgery to see if the cancer might be sensitive to hormones.
Hormone therapy can work in two ways:
What Is Hormone Receptor
Breast cancer tumors that are hormone receptor-positive need the hormones estrogen or progesterone to grow. Approximately 75% of breast cancers are hormone-positive in post-menopausal patients. Your healthcare provider will perform a biopsy and laboratory testing to determine the cancer type and most effective treatment.
What About The Pill And Breast Cancer Risk
Youre probably wondering, if increased exposure to estrogen can raise your risk for breast cancer, what about the pill? Is it a risk factor for breast cancer?
Studies are a bit mixed and therefore inconclusive, but not surprisingly, there does seem to be somewhat of an increased risk for breast cancer in women who use the pill. An early study that examined more than 50 studies on the pill found that women who were currently taking the pill, or even those that took the pill in the past ten years, had a slightly higher risk of breast cancer diagnosis. This risk returned to normal ten years after stopping oral contraceptives.
It may also be that once again, the balance of estrogen with other hormones like progesterone and testosterone is the real reason oral contraceptives might increase the risk.
The bottom line is this: while we don’t have a high-quality smoking gun study showing conclusively that birth control will increase your risk of breast cancer, the mixed results are still reason for caution.
Taking a synthetic hormone pill disrupts your bodys ability to regulate levels on its own, so it stands to reason that at least some of the time, for some women, using hormonal birth control could contribute to breast cancer risk.
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When Are Hormone Blockers Used
Hormone inhibitors and blocker options may depend on a persons stage of life.
- Hormone inhibitors are only used in postmenopausal women. They can be given to premenopausal women if steps are taken by the treatment team to put the ovaries to sleep by blocking the ovaries from producing estrogen or progesterone.
- Hormonal therapy may also be called anti-hormone treatment. Think of it as the opposite of hormone replacement therapy . If pathology tests show that the tumor in your breast has hormone receptors , then hormonal therapy may be recommended for you after the completion of your acute treatment .
- Hormonal therapy keeps breast cancer cells from receiving or using the natural female hormones in your body which they need to grow. Hormonal therapy also blocks the ability of health breast cells to receive hormones that could stimulate breast cancer cells to regrow again in the form of recurrence of the breast cancer within the breast or elsewhere in the body.
If Cancer Comes Back Or Has Spread
AIs, tamoxifen, and fulvestrant can be used to treat more advanced hormone-positive breast cancers, especially in post-menopausal women. They are often continued for as long as they are helpful. Pre-menopausal women might be offered tamoxifen alone or an AI in combination with an LHRH agonist for advanced disease.
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Menopausal Hormone Therapy And Cancer Risk
For decades, women have used hormone therapy to ease symptoms of menopause, such as hot flashes and sweating. This is called menopausal hormone therapy, and you may see it abbreviated as HT or MHT. You may also hear it described as hormone replacement therapy , postmenopausal hormone therapy , or postmenopausal hormones .
In the past, many doctors and their patients believed that MHT didnt just help with hot flashes and other symptoms it had important health benefits. But well-conducted studies have led many doctors to conclude that the risks of MHT often outweigh the benefits.
This information covers only how MHT can affect a womans risk of getting certain cancers. It does not cover other possible risks of MHT such as heart disease or stroke.
You can use this information when you talk to your doctor about whether MHT is right for you.
Hormone Therapy For Breast Cancer Pros And Cons
One main use of hormone therapy is, it lowers the risk of breast cancer reappearance in persons suffering from early-stage hormone-sensitive breast cancers. It can even effectively lower the risk of metastatic breast cancer growth and development in people with hormone-sensitive tumors.
Coming to the side effects of breast cancer hormone therapy, it depends on the medication type and as such varies.
SERMs
Tamoxifen and other SERMs can lead to
- Hot flashes
- Vaginal discharge
- Vaginal dryness
These medications may even increase the risk of endometrial cancer and blood clots. In a few cases, tamoxifen can lead to stroke and can enhance the risks of a heart attack.
Side effects for AIs consist of
- Muscle pain
- Joint pain
- Joint stiffness
On the whole keeping in view, the hormone therapy for breast cancer pros and cons Hormone therapy is a good treatment option and the need for refusing hormone therapy for breast cancer is very less.
Sudheendra is a passionate blogger for 8 years and holds a Degree in Journalism & Mass Communications. His writings particularly focus on health, medicine, diet & lifestyle. For him, everything that interlinks and relates to health & medical world entices him. His write-ups aim at educating people not by just giving facts but by infusing human touch.
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Postmenopausal Hormone Use Linked With Specific Types Of Breast Cancer
According to the results of a study published in the journal Lancet Oncology, use of postmenopausal hormones increases the risk of lobular and tubular breast cancers more than other types of breast cancer.13
A question that has remained uncertain is whether the link between postmenopausal hormones and breast cancer varies by type of breast cancer. To explore this question, researchers evaluated information from the U.K. Million Women Study.9 The study enrolled over one million women between the ages of 50 and 64.
During follow-up, roughly 14,000 of the women were diagnosed with breast cancer. Close to 12,000 of these diagnoses were invasive breast cancer and the remainder was in situ breast cancer .
Will The Nhs Fund An Unlicensed Medicine
It’s possible for your doctor to prescribe a medicine outside the uses it’s licensed for if they’re willing to take personal responsibility for this ‘off-licence’ use of treatment.
Your local integrated care board may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medicine from NHS budgets.
Page last reviewed: 28 October 2019 Next review due: 28 October 2022
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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
Hrt And Cancer There Is Strong Evidence That Using Hrt Raises A Womans Risk Of Breast Ovarian And Uterine Cancers At The Same Time It May Lower The Risk Of Colorectal Cancer
Combined HRT for menopause is a known cause of breast cancer, mainly in women who recently used or are still using the therapy. There is also some evidence suggesting that estrogen-only HRT may also increase the risk of breast cancer.
Studies suggest that both combined and estrogen-only HRT increase a womans risk of ovarian cancer but the risk is low.
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Overall Survival According To History Of Mht Use
During follow-up, a total of 111 patients died of which 59 patients had a previous recurrence. There were 51 deaths in ever MHT users and 60 deaths among never users. KaplanMeier analysis showed a significant association between ever MHT use and a longer OS vs. patients who never used MHT . The crude HR for ever MHT use was 0.68 compared with never use. However, when adjusted for covariates, the statistical analysis showed no significant difference in survival between ever MHT users and never MHT users, HRadj 0.81 . There were significant effect modifications between ever MHT use and OS depending on axillary lymph node involvement and AI treatment but not with other patient, tumor, or treatment related factors.
Ever MHT use was associated with lower risk of death in node-positive patients with a HRadj of 0.48 but not in node-negative patients, HRadj of 1.27 . Moreover, any MHT use was associated with a lower risk of death in AI-treated patients with a HRadj of 0.41 , but not in non-AI-treated patients HRadj of 1.23 , adjusted Pinteraction = 0.015), see Table 2 and Figure 4.
What Questions Remain In This Area Of Research
The WHI trials were landmark studies that have transformed our understanding of the health effects of MHT. Its important to note that women who were enrolled in the WHI trials were, on average, 63 years old, although about 5,000 of them were under age 60, so the results of the study may also apply to younger women. In addition, the WHI trials tested single-dose strengths of one estrogen-only medication and one estrogen-plus-progestin medication .
Follow-up studies have expanded and refined the original findings of these two trials. But many questions remain to be answered:
- Are different forms of hormones, lower doses, different hormones, or different methods of administration safer or more effective than those tested in the WHI trials?
- Are the risks and benefits of MHT different for younger women than for those studied in the WHI trials?
- Is there an optimal age at which to initiate MHT or an optimal duration of therapy that maximizes benefits and minimizes risks?
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Do The Benefits Of Hrt Outweigh The Risk
Hormone replacement therapy is an effective treatment for relieving hot flashes from menopause. But the known link between hormone therapy and increased breast cancer among risks has discouraged many women and their doctors from choosing or recommending this treatment.
The type of hormone therapy , as well as the woman’s individual characteristics, risk factors, and severity of menopause symptoms, should be considered when weighing the risks and benefits of HRT. The decision to use hormone therapy after menopause should be made by a woman and their health care provider after weighing all of the potential risks and benefits .
The known association between HRT and breast cancer has prevented many breast specialists from recommending it for breast cancer survivors. Unfortunately, many women experience menopause symptoms after breast cancer treatment. Some forms of chemotherapy may also cause early menopause in premenopausal women.
In the past, doctors may have offered HRT after breast cancer treatment because there weren’t clearcut studies showing any harm. However, early in 2004, a study was stopped early after showing that cancer survivors on HRT were more likely to develop a new or recurrent breast cancer. Doctors now feel it is too risky to treat breast cancer survivors with HRT.
Hormone Replacement Therapy In Newly Menopausal Women May Carry More Benefit
Hormone replacement therapy for newly menopausal women may not be as risky as once believed.3 In fact, the researchers concluded that combination HRT in newly menopausal women relieves symptoms and improves mood, bone density, and several markers of cardiovascular risk.
The Kronos Early Estrogen Prevention Study trial was a multi-center, randomized study that included 727 healthy women ages 42 to 58, all within three years of onset of menopause at baseline. The study differs from many previous studies on HRT, including the WHI, because the participants were youngerthe mean age was 52, compared to 60s for the other trials.15
Women in the KEEPS trial were randomly assigned to one of three groups: placebo, progesterone plus oral estrogen, progesterone plus an estrogen patch. Both intervention groups experienced a reduction in menopausal symptoms, including hot flashes and night sweats, as well as improved sexual function and improved bone mineral density compared to the placebo group. Whats morethe results indicated that oral estrogen plus progesterone improved lipid levels and the estrogen patch improved insulin sensitivity. Neither combination raised blood pressure or altered the progression of atherosclerosis .
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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.
Pros And Cons Of Hormone Therapy For Breast Cancer
Hormone therapy for breast cancer is a good option for breast cancers that are sensitive to hormones. Most common types of hormone therapy for breast cancer work by obstructing hormones from getting attached to receptors on cancer cells or by lowering the making of hormones in the body. Although a trustable treatment for breast cancers that have receptors for the naturally happening hormones estrogen or progesterone it is good to have an overview of hormone therapy for breast cancer pros and cons.
It is commonly used following surgery to lower the risks of cancer recurrence. This treatment can even be used to lessen a tumor before surgery. Once the breast cancer diagnosis traces it is due to hormones this treatment should be the best option.
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Do Local Formulations Of Menopausal Hormone Therapy Have Different Risks
Both systemic and local treatment options for MHT are available in the United States. Which option a woman receives depends on the menopausal symptoms the treatment is meant to address. Systemic MHT is usually prescribed to treat hot flashes and to prevent osteoporosis. Systemic MHT with combined estrogen plus progestin or with estrogen alone can be given as oral medications as transdermal patches, gels, or sprays and as implants.
Local MHT is prescribed to treat genitourinary symptoms such as vaginal dryness. Local MHT contains low-dose estrogen only and is prescribed to women regardless of their hysterectomy status. Local MHT with low-dose estrogen alone includes creams, tablets , and rings.
Findings from the Womens Health Initiative Observational Study showed that, among women with an intact uterus, those who used vaginal estrogen and those who didnt had similar risks of stroke, invasive breast cancer, colorectal cancer, endometrial cancer, and pulmonaryembolism/deep vein thrombosis .
Are There Alternatives For Women Who Choose Not To Take Menopausal Hormone Therapy
Women who are concerned about the changes that occur naturally with the decline in hormone production that occurs during menopause can make changes in their lifestyle and diet to reduce the risk of certain health effects. For example, eating foods that are rich in calcium and vitamin D or taking dietary supplements containing these nutrients may help to prevent osteoporosis. FDA-approved drugs such as alendronate , raloxifene , and risedronate have been shown in randomized trials to prevent bone loss.
Medications approved by the FDA for treating depression and seizures may help to relieve menopausal symptoms such as hot flashes . Drugs that have been shown in randomized clinical trials to be effective in treating hot flashes include venlafaxine , desvenlafaxine , paroxetine , fluoxetine , citalopram , gabapentin , and pregabalin .
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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.
Less Common Types Of Hormone Therapy
Some other types of hormone therapy that were used more often in the past, but are rarely given now include:
- Megestrol acetate , a progesterone-like drug
- Androgens , like testosterone
These might be options if other forms of hormone therapy are no longer working, but they can often cause side effects.
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