BREAST CANCER AND HORMONES; IS IT SAFE

In my experience, women associate breast cancer and hormones together. I understand one of the greatest concerns some women have is developing breast cancer during their life time. Breast cancer mortality is on the decline according to some studies and breast cancer awareness is everywhere with increasing utilization of mammograms and "the pink ribbon" with its own breast cancer awareness week every October.

The risk factors implicated in the development of breast cancer include:

Age . "old"

Family History affected mother or sister 2 to 3 relative risk, aunt or grandmother 1.5 relative risk, and affected mother AND sister 14.0 relative risk

Excessive alcohol intake - women who drink two to five drinks a day run a 41% greater risk of developing breast cancer than non drinkers

Obesity - post menopausal women who gain 11 to 22 pounds have an 18% higher risk of breast cancer than women who gain 4-5 lbs and in those who gain 44 to 55 pounds the risk jumps to 40%.

The breast cancer controversy began after the report of the Women's Health Initiative (WHI) sponsored by National Institutes of Health (NIH) raised concerns regarding the roles of hormones and breast cancer. This caused widespread discontinuation of the hormones and deprived women of the benefit of hormones. The study was discontinued in 1992, 3 years prematurely. Was planned for 8.5 years, still too short of an interval as it takes more than 8 years for the discovery of breast cancer from a single cell based on doubling times. Based on this, all of the 290 cases of breast cancer had malignant cells at the onset of the study (there were a total of 161,208 participants).

The trial of the estrogen/progestin was stopped due to minimal increase of hazard ratio of 1.26, which was only of borderline significance. The study of estrogen alone has not shown an increase in the risk of breast cancer at 7 years. There is confirming evidence from more than seventy studies that exogenous therapy, and even unopposed estrogens, do not increase the risk for breast cancer. There have been eleven studies, with none to the contrary, that have examined survival from breast cancer developing in estrogen users and have observed lower mortality. Long term progesterone deficiency has been shown to increase the risk of breast cancer. In one study in patients with stage IV metastatic breast cancer, estrogen with high dose progesterone was shown to be very effective. After giving the estrogen for seven days to enhance the progesterone receptors in metastatic cancer cells high dose medroxyprogesterone acetate (not my first choice) was given and the remission rate was 56% for up to six years.

The most consistently decreased risk of breast cancer in estrogen users has been those who also received progestogens (and it would be nice to see some studies using natural progesterone vs synthetic progestogens).

Breast cancer is being diagnosed in early stages, and the survival rates have not changed due to early diagnosis and treatment. Women may live for many years but with current methods for treating breast cancer are they happy, healthy and vibrant? We need to be given the opportunity to benefit from all available treatment. Estrogen replacement can be used for severe symptoms in breast cancer survivors after thorough explanation, and understanding, of benefits and risks.