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What Causes Estrogen Positive Breast Cancer

Can Diet Reduce Your Risk Of Breast Cancer

Understanding Estrogen Receptor-Positive (ER+) Metastatic Breast Cancer (MBC)

Diet has quite an impact on the way the body works, including the development of cancers.

Theres still some controversy surrounding foods containing estrogen-like compounds, like soy, red meats and dairy, and whether they contribute to estrogen-positive breast cancer. These foods all have estrogen and estrogen-like chemicals in them, says Generose. However, research outcomes vary by type of food, how much of that food is eaten over time, the genetic makeup of the person and their diet overall.

Some foods have cancer-fighting properties while others have cancer-causing properties. If you focus on eating healthy, nutritious foods, it may help reduce your risk of developing estrogen-positive breast cancer.

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 characteristics include the size of the tumor and whether the cancer has moved into lymph nodes or distant organs, like the lungs, bones, or brain.

Research on survival statistics for people with breast cancer tends to separate participants into categories of women and men.

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.

Signs Of Estrogen Dominance

Estrogen can be metabolized in your body in different ways. Some pathways lead to estrogen metabolites that can compromise your health. This can be a particular problem if your liver is not functioning well. Then your liver doesnt process estrogen metabolites and help remove them from your body, and you end up with more estrogen circulating, causing havoc and estrogen excess.

ED can mean one of two things: you either have too much estradiol in relation to progesterone, or an imbalance in your estrogen metabolites .

This can lead to the following symptoms:

  • Worsening PMS
  • Lumpy, painful or swollen breasts
  • Weight gain, particularly around the hips

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Age At Menarche Is More Influential Than Age At Menopause On Breast Cancer Risk

The observation that lengthening the reproductive life of a woman, either by an earlier menarche or later menopause, increases the risk of breast cancer would suggest that the overall duration of the exposure to estrogen is underlying the risk. However, a recent meta-analysis of reproductive events and breast cancer risk has found that age at menarche may be more of a deciding factor on the risk than age at menopause .

These findings contradict earlier theories that the influence of age at menarche and menopause on breast cancer risk was simply due to the duration of exposure to cycling ovarian hormones. Instead, it seems that the timing of the first exposure of the mammary gland to cyclic hormones sets up a developmental program that has consequences for breast cancer risk later in life.

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Estrogen And Breast Cancer Risk

Why is the Progesterone/Oestrogen Ratio So Important?

Estradiol, and possibly estrone, increase the risk of developing breast cancer. And a lower level of these estrogens throughout a woman’s lifetime is associated with a lower risk of developing breast cancer.

Factors such as pregnancy and breastfeeding alter estrogen levels in ways that are believed to have a protective effect. Having a first child before the age of 30, having more children, and breastfeeding are all associated with a lower risk of breast cancer. This is due to the reduced production of estrogens during pregnancy and lactation .

Because some oral contraceptives and hormone therapies contain a combination of estrogen and progestins, they may lead to a slightly increased risk of breast cancer for women.

While it is known that estrogen receptor-positive breast cancers are worsened by estrogen, other breast cancer types typically are also more common among women who have had a higher lifetime exposure to estrogen.

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Reproductive Risk Factors Oestrogen And Breast Cancer

Oestrogens have an essential role, together with other hormones, in the development of the female sex organs and secondary sex characteristics, the regulation of the menstrual cycle and reproduction. Thus, it has been proposed that the effects of many established reproductive risk factors for breast cancer are mediated by hormonal mechanisms, for the most part involving oestrogens .

Although risk for breast cancer increases with age, there is a marked decline in the rate of increase in risk with age following the loss of ovarian function, either as a result of a bilateral oophorectomy or due to the menopause , showing that hormone production by the ovaries is a crucial risk factor for breast cancer in humans. The duration of exposure to ovarian hormones seems to be closely related to breast cancer risk: a 1-year delay in the onset of menarche is associated with a 5% reduction in risk for developing breast cancer in later life , and each 1-year delay in the onset of menopause is associated with a 3% increase in risk .

Breast feeding is associated with a modest decrease in risk for breast cancer, above and beyond that associated with multiple pregnancies . This effect might be due to the suppression of ovulation, reducing exposure to ovarian hormones.

Hormone Status Of Breast Cancers Includes:

Estrogen receptor positive: The cells of this type of cancer have receptors that let them use the hormone estrogen to grow. Anti-estrogen hormone therapy can help to impede the growth of cancer cells.

Progesterone Receptor Positive: This type of cancer is sensitive to progesterone and the cells have receptors that let them use this hormone to develop. Treatment with endocrine therapy prevents the growth of cancer cells.

Hormone Receptor Negative: This type of cancer does not have hormone receptors, so it wont be affected by endocrine treatments that are designed at blocking hormones in the system.

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Clinicopathologic Characteristics Of The Study Population

The flowchart of selection process was shown in Supplementary Figure 1. A total of 203406 patients were included, including 133662 patients for ER+PR+HER2-, 16906 for ER+PR-HER2-, 1395 for ER-PR+HER2-, 21439 for ER-PR-HER2- and 15646 for ER+PR+HER2+, 5381 for ER+PR-HER2+, 537 for ER-PR+HER2+, and 8440 for ER-PR-HER2+. The median follow-up duration of the study population was 35 months . The clinicopathologic characteristics of each subtype were summarized in Table 1.

Table 1 Clinicopathologic characteristics of the study population .

Estrogen And Progesterone Receptor Testing For Breast Cancer

Advancements in Estrogen ReceptorPositive Breast Cancer

To help doctors give their patients the best possible care, the American Society of Clinical Oncology and the College of American Pathologists developed evidence-based guidelines to improve the accuracy of testing for estrogen and progesterone receptors for breast cancer. This guide for patients is based on ASCOâs and CAPâs 2020 updated recommendations.

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Most Breast Cancers Are Not Genetic

Only five percent of breast cancers are related to genetics and even then, that doesnt mean that all women with the BRAC genes that make them more vulnerable, will go on to develop breast cancer.

Though you cant alter risk factors like your age or parents, simple lifestyle changes can do a great deal to protect you from developing breast cancer.

One of the least discussed but most important steps is to reduce risks caused by too much estrogen.

In my experience working with women, estrogen dominance is very common, but often women dont know the signs or even realize that ED is a concern or that it kick starts substantial health risks.

You can learn how to rebalance your hormones with food in my books, Cooking for Hormone Balance and Overcoming Estrogen Dominance.

What Is Her2 And What Does It Mean

HER2 is a protein that helps breast cancer cells grow quickly. Breast cancer cells with higher than normal levels of HER2 are called HER2-positive. These cancers tend to grow and spread faster than breast cancers that are HER2-negative, but are much more likely to respond to treatment with drugs that target the HER2 protein.

All invasive breast cancers should be tested for HER2 either on the biopsy sample or when the tumor is removed with surgery.

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How Much Does Hrt Increase Risk

The risk of developing breast cancer between the ages of 50 and 69 is around:

  • 63 in every 1,000 women who have never used HRT
  • 83 in every 1,000 women who use combined HRT for five years from the age of 50
  • 68 in every 1,000 women who use oestrogen-only HRT for five years from the age of 50

Oestrogen-only HRT increases the risk of womb cancer, so is generally only offered to women who have had their womb removed .

Tibolone is another type of HRT that contains a steroid that acts like oestrogen and progesterone. Tibolone users also have an increased risk of breast cancer, but probably less so than combined HRT users.

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Physiologic Hormone Exposures Promote Er+bc Xenograft Growth

Tamoxifen, Possible Natural Alternatives, and AIs

Fig. 1: Effects of physiologic E2 and P4 levels on ER+BC growth.

Next, mice injected with either MCF7:control or MCF7:PGR cells were ovariectomized to mimic the effect of clinical aromatase inhibition. In the absence of ovarian hormones, the growth of MCF7:control cells but not of the MCF7:PGR cells was decreased . IHC showed abrogation of PGR expression by ovariectomy . MCF7:PGR cells showed a trend for increased metastasis in the hormonally-ablated hosts and increased metastasis to the brain . Thus, PR is sufficient to induce tumor cell proliferation, invasion, and metastasis when ER signaling is abrogated, making it an attractive potential target for therapeutic intervention, particularly in endocrine-resistant diseases.

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Obesity And Lack Of Exercise

Gaining weight after menopause can increase a womanâs risk. A 2006 study found that putting on 9.9 kg after menopause increased the risk of developing breast cancer by 18%. Lack of exercise has been linked to breast cancer by the American Institute for Cancer Research.

Obesity has been linked to an increased risk of developing breast cancer by many scientific studies. There is evidence to suggest that excess body fat at the time of breast cancer diagnosis is associated with higher rates of cancer recurrence and death. Furthermore, studies have shown that obese women are more likely to have large tumors, greater lymph node involvement, and poorer breast cancer prognosis with 30% higher risk of mortality.

Weight gain after diagnosis has also been linked to higher rates of breast cancer recurrence or mortality although this finding is not consistent. Weight gain is often less severe with newer chemotherapy treatments but one study found a significant risk of breast cancer mortality in women who gained weight compared to those who maintained their weight. However, other cohort studies and recent clinical trials have not shown a significant relationship between weight gain after diagnosis and breast cancer mortality.

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Estrogen Balance For Reduced Breast Cancer Risk

Theres a strong association between estrogen and breast cancer. While there are no guarantees when it comes to cancer, keeping your estrogen balanced through smart lifestyle changes like those Ive listed above can reduce your risk and benefit your overall hormone health.

If you’re looking for a comprehensive approach that can help you achieve optimal hormonal balance, my free Hormone Starter Kit includes a 7 day meal plan, recipes, and other helpful info to get you on the right track.

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What Foods To Avoid If You Have Estrogen

Research shows that among breast cancer cases,

  • only 5-10% were because of genetic defects.
  • 90-95% were attributable to environmental and lifestyle factors such as diet. Out of these,
  • Diet contributed to approximately 30-35%.
  • Obesity contributed to 10-20%.

Any food that increases your risk of obesity or makes you prone to inflammation triggers breast cancer, be it of any type. These include:

  • Sugary foods:

How Exactly Is Estrogen Linked To Breast Cancer

Estrogen positive breast cancer study

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.

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Factors That Affect Outlook

When considering your outlook, your doctor must analyze many other factors as well. Among them are:

  • Stage at diagnosis. Your outlook is better when the breast cancer hasnt spread outside the breast or has spread only regionally at the start of treatment. Metastatic breast cancer, which is cancer that has spread to distant areas of the body, is harder to treat.
  • Size and grade of primary tumor. This indicates how aggressive the cancer is.
  • Lymph node involvement. Cancer can spread from the lymph nodes to distant organs and tissues.
  • HR status and HER2 status. Targeted therapies can be used for HR-positive and HER2-positive breast cancers.
  • Overall health. Other health issues you may have may complicate treatment.
  • Response to therapy. Its hard to predict whether a particular therapy will be effective or produce intolerable side effects.
  • Age.Younger women and those over age 75 may have a worse outlook than middle-aged women, except for those with stage 3 breast cancer, according to a .

Naturally Occurring Synthetic Plant

Monique Rainford, MD, is board-certified in obstetrics-gynecology, and currently serves as an Assistant Clinical Professor at Yale Medicine. She is the former chief of obstetrics-gynecology at Yale Health.

Estrogen, a hormone that females naturally produce, can be associated with breast cancer. Both women and men can be exposed to other types of estrogen from external sources, such as food, medications, or chemical toxins. This can include synthetic estrogens, plant-based estrogens, and xenoestrogens.

Each estrogen type may impact breast cancer differently. Research continues to explore the associations between estrogen and breast cancer.

This article will review different kinds of estrogens and their associations with breast cancer risk. Knowing more about estrogen and its role in breast cancer risk can help you talk with your doctor about hormone-related decisions.

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How Well Do Different Guidelines Identify Women With Inherited Mutations

The American Society of Breast Cancer Surgeons

ASBrS recommends testing for all women with breast cancer. An XRAY review of the ASBrS recommendations can be found here. Using ASBrS guidelines:

  • According to these guidelines, in this study, all participants with mutations would be identified.

Pro: All women with mutations would be identified none would be missed.

Con: 3,666 women who did not have an inherited mutation were tested, which may have caused unnecessary cost, stress and anxiety.

The National Comprehensive Cancer Network

NCCN has a complex set of guidelines for genetic testing recommendations . Using current NCCN guidelines:

  • 169 of the 3,907 participants had a genetic mutation in one of 9 actionable breast cancer genes and would qualify for genetic testing under NCCN guidelines.
  • These 169 women represented 70% of 241 women with an inherited mutation.
  • 72 participants had a mutation in one of 9 actionable breast cancer genes but did not qualify for genetic testing under NCCN criteria.
  • These 72 women represented 30% of the 241 women with an inherited mutation.
  • Pro: Fewer women without inherited mutations were tested than under ASBrS guidelines and did not unnecessarily face the potential stress and anxiety of genetic testing.

    Con: A large portion women with an inherited mutation were not identified, which prevented them from using this information to guide their treatment and surgical decisions.

    Expanded NCCN guidelines

    Possible Side Effects Of Ais

    Breast cancer

    The most common side effects of AIs are:

    • Hot flashes
    • Bone and joint pain
    • Muscle pain

    AIs tend to have side effects different from tamoxifen. They dont cause uterine cancers and very rarely cause blood clots. They can, however, cause muscle pain and joint stiffness and/or pain. The joint pain may be similar to a feeling of having arthritis in many different joints at one time. Options for treating this side effect include, stopping the AI and then switching to a different AI, taking a medicine called duloxetine , or routine exercise with nonsteroidal anti-inflammatory drugs . But the muscle and joint pain has led some women to stop treatment. If this happens, most doctors recommend using tamoxifen to complete 5 to 10 years of hormone treatment.

    Because AIs drastically lower the estrogen level in women after menopause, they can also cause bone thinning, sometimes leading to osteoporosis and even fractures. If you are taking an AI, your bone density may be tested regularly and you may also be given bisphosphonates or denosumab , to strengthen your bones.

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    Estrogen Linked To Bone Health

    A healthy level of estrogen in your body builds and maintains strong bones. However, if youve had chemotherapy or if youre taking estrogen-suppression medication after treatment for breast cancer, your estrogen levels will be low. Guard your bone health by understanding how estrogen affects your bones.

    Risk Factors You Cant Change

    Being a woman. Men can get breast cancer too, but itâs 100 times more likely to affect women.

    History of breast cancer. A woman who has had cancer in one breast, such as ductal carcinoma in situ or invasive breast cancer, is three to four times likelier to develop a new breast cancer, unrelated to the first one, in either the other breast or in another part of the same breast. This is different than a recurrence of the previous breast cancer.

    Age. Your risk goes up as you age. About 77% of women diagnosed with breast cancer each year are over 50, and more than 40% are 65 and older.

    In women ages 40 to 50, there is a 1 in 68 chance of developing breast cancer. From 50 to 60, that goes up to 1 in 42. From 60 to 70, its one in 28. And in women 70 and older, its 1 in 26.

    Direct family history. Having a mother, sister, or daughter with breast cancer puts a woman at higher risk. Its even greater if this relative developed breast cancer before 50 and had cancer in both breasts.

    Having one first-degree relative with breast cancer roughly doubles your risk, and having two first-degree relatives triples your risk. Having a male blood relative with breast cancer will also increase the risk.

    Dense breasts. Your breasts are a mix of fatty, fibrous, and glandular tissue. Dense breasts have more glandular and fibrous tissue and less fat. A woman with dense breasts is 1.5 to 2 times more likely to get breast cancer.

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