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HRT, Controversal issue
One thing I have found during my journey through breast cancer is how many controversal issues there are.
Hormal replacement therapy is just one of them. I did some reading on it because I have chemo induced menopause. The medical onc said he would work closely with my medical doctor about what I was allowed to have for the hot flashes. The sweating is to the point that I cannot keep up with fluid intake, especially when at work. Since my onc and I have not agreed on other controversal issues, I went to my gyne. Since I am er- pr- he let me have year supply of estrogen.
There is a study going on that is giving women that are hormone - hormones because it is easier to treat if they can convert them. Some have attributed the decline in death rate from breast cancer to better screening and insurance companies being mandated to cover mammograms and not appling the deductible. Others have said it is because they stopped letting women have HRT.
Myself, I am looking forward to returning to a little of normalcy.
Before one takes any hormones, please study about it first. It says on the papers that came with the medicine that it can cause breast cancer.
Hormal replacement therapy is just one of them. I did some reading on it because I have chemo induced menopause. The medical onc said he would work closely with my medical doctor about what I was allowed to have for the hot flashes. The sweating is to the point that I cannot keep up with fluid intake, especially when at work. Since my onc and I have not agreed on other controversal issues, I went to my gyne. Since I am er- pr- he let me have year supply of estrogen.
There is a study going on that is giving women that are hormone - hormones because it is easier to treat if they can convert them. Some have attributed the decline in death rate from breast cancer to better screening and insurance companies being mandated to cover mammograms and not appling the deductible. Others have said it is because they stopped letting women have HRT.
Myself, I am looking forward to returning to a little of normalcy.
Before one takes any hormones, please study about it first. It says on the papers that came with the medicine that it can cause breast cancer.
Each woman should make the decision about initiating or continuing HRT after doing a complete personal risk assessment in conjunction with her doctor(s).
However, BC survivors and other women particularly concerned about breast cancer should consider the following reports:
January 2008, Cancer Epidemiology, Biomarkers and Prevention, Post-menopausal women on combined HRT have higher risk of rare type of Breast Cancer.
March, 2008, Journal of the National Cancer Institute, HRT may increase disease recurrence in breast cancer survivors.
April 2008, JAMA, Women have a slightly increased cancer risk for three years after stopping HRT.
.
However, BC survivors and other women particularly concerned about breast cancer should consider the following reports:
January 2008, Cancer Epidemiology, Biomarkers and Prevention, Post-menopausal women on combined HRT have higher risk of rare type of Breast Cancer.
March, 2008, Journal of the National Cancer Institute, HRT may increase disease recurrence in breast cancer survivors.
April 2008, JAMA, Women have a slightly increased cancer risk for three years after stopping HRT.
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Endocrine Society Issues Position Statement on Menopausal Hormone Therapy
Laurie Barclay, MD
Authors and Disclosures
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FDA Approved Treatment for Postmenopausal Osteoporosis
Get important product information on another FDA approved postmenopausal osteoporosis medication.
Click here June 29, 2010 — A new Endocrine Society scientific statement published in the July 2010 issue of the Journal of Clinical Endocrinology & Metabolism evaluates benefits and risks for postmenopausal hormone replacement therapy (HRT), now known as menopausal hormone therapy (MHT). The statement, entitled "Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement," was also posted online ahead of print on June 21 and presented in San Diego, California, at ENDO 2010: The 92nd Annual Meeting & Expo.
Although MHT was in widespread use in the 1990s in hopes of lowering cardiovascular disease risk as well as to treat menopausal symptoms, the Women's Health Initiative (WHI) Study showed that MHT was actually associated with an increased risk for heart disease, stroke, and breast cancer. However, recent evidence suggests that these risks may be affected by time after onset of menopause when MHT was started, a factor not considered in the WHI assessment of MHT safety and efficacy.
"Before the WHI, MHT was believed to prevent heart disease, fractures, memory loss and dementia in addition to relieving uncomfortable menopausal symptoms," said task force chair Richard J. Santen, MD, professor of medicine at the University of Virginia in Charlottesville, in a news release. "Following the WHI reports of increased health risks associated with MHT, MHT use declined by 80%. New data however [show] that these health risks may not apply to all women using MHT, and that MHT may in fact be very beneficial to some women."
Controversy regarding WHI's applicability to women just entering menopause stems from the fact that the average age of participants was 63 years, and only 3.5% of the women were aged 50 to 54 years, which is the age range when women typically decide whether to start MHT. Furthermore, the WHI did not address menopausal symptom relief. Therefore, this scientific statement considered new data from later studies evaluating the effects of MHT in women aged 50 to 55 years.
Compared with women who begin MHT after age 60 years, those who begin MHT a short time after onset of menopause at ages 50 to 59 years appear to benefit. According to recent evidence, women in the short-time group using MHT for 5 years had a 30% to 40% reduction in mortality risk and no increased cardiovascular disease risk. In addition, they had a 90% decrease in hot flashes, overactive bladder, or other menopausal symptoms.
"Some women in the short-time group still developed breast cancer but only with the combination of estrogen plus a progestogen, not with estrogen alone," Dr. Santen said. "This may be due to the stimulation and uncovering of very small, undiagnosed breast cancers, rather than causing these cancers de novo."
Conclusions Reached
Evaluation of the new data along with WHI evidence led the task force to reach the following conclusions, with level of evidence A:
•"Standard-dose" estrogen used with or without a progestogen is associated with marked reduction in frequency and severity of hot flashes. For many women, lower doses of estrogen are also effective.
•An alternative hormonal therapy for postmenopausal vasomotor symptoms is tibolone, which is widely available worldwide, but not in the United States.
•For symptoms of vaginal atrophy, very low doses of vaginal estradiol are effective.
•Symptoms of overactive bladder may be reduced by estrogen given vaginally or systemically.
•Vaginal estrogen is associated with lower rates of recurrent urinary tract infections.
•Tibolone improves urogenital atrophy.
•For women in late postmenopause, estrogen given with or without a progestogen is as effective as bisphosphonate therapy for preventing early postmenopausal bone loss and increasing bone mass.
•Use of estrogen alone and estrogen plus a progestogen is associated with a lower incidence of hip and vertebral fractures.
•For osteoporotic women older than 60 years, tibolone is associated with significantly lower rates of vertebral and nonvertebral fractures.
•Treatment with the selective estrogen receptor modulator raloxifene is associated with increased bone mineral density and lower rates of vertebral, but not hip, fractures.
•Use of MHT containing estrogen plus a progestogen is linked to a lower risk for colon cancer.
•Raloxifene is associated with a lower risk for breast cancer.
•Mammographic density is increased in women taking estrogen alone or with a progestogen.
•Use of tibolone is associated with a greater risk for breast cancer recurrence.
•Sexual function is improved by physiologic amounts of transdermal testosterone, but not by dehydroepiandrosterone.
•Risk for venothrombotic episodes is approximately doubled in women using MHT, and this risk is multiplicative with baseline risk factors such as age, increased body mass index, thrombophilias, surgery, and immobilization.
•Use of raloxifene is associated with an increased incidence of venothrombotic episodes.
•In older, but not younger, women, tibolone is associated with an increased risk for stroke.
•Raloxifene is not associated with any increase in stroke risk.
•In older women with preexisting vascular disease, hormone use does not reduce stroke incidence.
•Although continuous estrogen plus a progestogen does not cause endometrial cancer, estrogen alone without a progestogen is associated with an increased incidence in endometrial cancer.
•Tibolone is not associated with an increased incidence of endometrial hyperplasia or carcinoma.
•Risk for gallbladder disease is increased in women using estrogen alone or with a progestogen.
•MHT started after age 60 years does not improve memory.
"It is important to remember that most women considering MHT are between the ages of 50 and 55 and in this group MHT may have many benefits," Dr. Santen concluded. "Physicians and their patients need to re-think the use of [MHT] based on data pertinent to the 50-55 year old and therapy should be individualized based on symptoms and underlying risks of breast cancer and heart disease."
J Clin Endocrinol Metab. Published online June 21, 2010. Abstract
[CLOSE WINDOW]Authors and DisclosuresJournalistLaurie Barclay, MDFreelance writer and reviewer, Medscape, LLC
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
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Following menopause, some women experience vaginal dryness and atrophic vaginitis, also known as vaginal atrophy, to such a severe degree that intercourse becomes painful or even impossible (even with the use of vaginal lubricants), due to the vaginal irritation and even tearing that may result.
About a year ago, the well-known author and breast cancer specialist, Dr. Susan Love, on her Web site, Dr. Susan Love Research Foundation, wrote that because of the very low systemic absorption of estrogen from two very low-dose locally (vaginally) applied estogen products, oncologists have become more comfortable having women who have had breast cancer use either Vagifem or Estring.
At that time Vagifem came in a 25mcg dose. In 12/09, the FDA approved the even lower-dose Vagifem 10 mcg. (This is the product which is being used in the third clinical trial mentioned in my June 16th, 5:33 p.m. post, above.)
Women struggling with this very real quality-of-life issue may want to discuss it with their oncologists.
About a year ago, the well-known author and breast cancer specialist, Dr. Susan Love, on her Web site, Dr. Susan Love Research Foundation, wrote that because of the very low systemic absorption of estrogen from two very low-dose locally (vaginally) applied estogen products, oncologists have become more comfortable having women who have had breast cancer use either Vagifem or Estring.
At that time Vagifem came in a 25mcg dose. In 12/09, the FDA approved the even lower-dose Vagifem 10 mcg. (This is the product which is being used in the third clinical trial mentioned in my June 16th, 5:33 p.m. post, above.)
Women struggling with this very real quality-of-life issue may want to discuss it with their oncologists.
Thank you for your thorough research on HRT and BC. I would be extremely reluctant to use HRT now that I have had BC.
Another consideration in regard to HRT:
Two studies reported in April at the American Assn. for Cancer Research 101st Annual Meeting 2010 found that if a woman's breast density changes, so does her risk of breast cancer — if density goes up, so does risk, and vice versa.
One of the studies used data from the 2002 Women's Health Initiative trial that found postmenopausal women using hormone replacement therapy (estrogen and progestin) had a greater risk of breast cancer than women taking a placebo. In the new study, researchers found that in mammograms done a year apart, breast density went up for 85% of the women in the replacement group, and this increase in density could explain the increased cancer risk in that group.
These findings suggest that knowledge about breast density could be important to a woman deciding whether to use hormone replacement therapy for relief of hot flashes or other menopausal symptoms, for example, says Celia Byrne, assistant professor of oncology at the Lombardi Comprehensive Cancer Center at Georgetown University and lead researcher on the study. "If she has dense breasts, she might consider not taking hormones."
Evidence shows that for women with extremely dense breasts, the cancer risk can be four to six times higher than for women whose breasts are not dense. By comparison, a family history of breast cancer — long considered an important risk factor — usually only doubles the risk.
Two studies reported in April at the American Assn. for Cancer Research 101st Annual Meeting 2010 found that if a woman's breast density changes, so does her risk of breast cancer — if density goes up, so does risk, and vice versa.
One of the studies used data from the 2002 Women's Health Initiative trial that found postmenopausal women using hormone replacement therapy (estrogen and progestin) had a greater risk of breast cancer than women taking a placebo. In the new study, researchers found that in mammograms done a year apart, breast density went up for 85% of the women in the replacement group, and this increase in density could explain the increased cancer risk in that group.
These findings suggest that knowledge about breast density could be important to a woman deciding whether to use hormone replacement therapy for relief of hot flashes or other menopausal symptoms, for example, says Celia Byrne, assistant professor of oncology at the Lombardi Comprehensive Cancer Center at Georgetown University and lead researcher on the study. "If she has dense breasts, she might consider not taking hormones."
Evidence shows that for women with extremely dense breasts, the cancer risk can be four to six times higher than for women whose breasts are not dense. By comparison, a family history of breast cancer — long considered an important risk factor — usually only doubles the risk.
Thank you bb, for this all important information.
My sister and I, both had IDC two years ago because we both had taken HRT for some years.We didn't know then, that this hormone could have caused our breast cancer.Both our ER was positive, 95 to 99% receptive.
I hope that women will consider carefully before being advised to take HRT.My own family Doctor said to me that had he known,many years ago what he knows now about HRT,he would have never prescribed Premarin for my hot flashes.
Thank you again bb. :)
My sister and I, both had IDC two years ago because we both had taken HRT for some years.We didn't know then, that this hormone could have caused our breast cancer.Both our ER was positive, 95 to 99% receptive.
I hope that women will consider carefully before being advised to take HRT.My own family Doctor said to me that had he known,many years ago what he knows now about HRT,he would have never prescribed Premarin for my hot flashes.
Thank you again bb. :)
The association between HRT and BC was scientifically established in 2002.
For a related post, click on this link:
http://www.medhelp.org/posts/Breast-Cancer/HRT-and-Breast-Cancer-Compensatory-and-punitive-damage-awards-against-drug-makers-upheld-/show/1272474
For a related post, click on this link:
http://www.medhelp.org/posts/Breast-Cancer/HRT-and-Breast-Cancer-Compensatory-and-punitive-damage-awards-against-drug-makers-upheld-/show/1272474
Gyne's are now prescribing HRT to breast cancer patients and I think people can safetly consider it. Ask you gyne.
Some things that have not been researched;
Using BP cuff and blood draws on affected lymphedema arm.
The reason for the decrease in breast cancer deaths, is it better screening, more awareness, more drugs and treatment or no HRT?
Some things that have not been researched;
Using BP cuff and blood draws on affected lymphedema arm.
The reason for the decrease in breast cancer deaths, is it better screening, more awareness, more drugs and treatment or no HRT?
No reason to be sorry. (Except for the fact you are having computer problems! :-( )
Just keeping people up to date on the search for this elusive study.
Hope you are having a good day, aside from the misbehaving computer.
Regards,
bb
Just keeping people up to date on the search for this elusive study.
Hope you are having a good day, aside from the misbehaving computer.
Regards,
bb
Re your last post: Good coverage of the issue of use of ERT or combined HRT!
Re your next-to-the- last post: I still have not found any mention of a study using ESTROGEN to re-convert ERneg BC to ERpos BC.
The first one you cited uses a chemo. drug, vorinostat (Suberoylanilide hydroxamic acid) to produce the reconversion (similar to the studies using Herceptin for that purpose.)
The second one you cited is the one I mentioned above, using short-duration estrogen just before each chemo cycle, to try to increase the effectiveness of the chemo.
bb
Re your next-to-the- last post: I still have not found any mention of a study using ESTROGEN to re-convert ERneg BC to ERpos BC.
The first one you cited uses a chemo. drug, vorinostat (Suberoylanilide hydroxamic acid) to produce the reconversion (similar to the studies using Herceptin for that purpose.)
The second one you cited is the one I mentioned above, using short-duration estrogen just before each chemo cycle, to try to increase the effectiveness of the chemo.
bb
ERT: The use of estrogen alone after menopause does not appear to increase the risk of developing breast cancer significantly, if at all. But when used long term (for more than 10 years), ERT has been found to increase the risk of ovarian and breast cancer in some studies.
At this time there appear to be few strong reasons to use post-menopausal hormone therapy (combined PHT or ERT), other than possibly for the short-term relief of menopausal symptoms. Along with the increased risk of breast cancer, combined PHT also appears to increase the risk of heart disease, blood clots, and strokes. It does lower the risk of colorectal cancer and osteoporosis, but this must be weighed against possible harm, and it should be noted that there are other effective ways to prevent osteoporosis. Although ERT does not seem to have much effect on breast cancer risk, it does increase the risk of stroke. The increased risk of hormone replacement therapy is the same for "bioidentical" and "natural" hormones as it is for synthetic hormones.
The decision to use PHT should be made by a woman and her doctor after weighing the possible risks and benefits (including the severity of her menopausal symptoms), and considering her other risk factors for heart disease, breast cancer, and osteoporosis. If a woman and her doctor decide to try PHT for symptoms of menopause, it is usually best to use it at the lowest dose that works for her and for as short a time as possible.
http://www.cancer.org/docroot/cri/content/cri_2_4_2x_what_are_the_risk_factors_for_breast_cancer_5.asp
At this time there appear to be few strong reasons to use post-menopausal hormone therapy (combined PHT or ERT), other than possibly for the short-term relief of menopausal symptoms. Along with the increased risk of breast cancer, combined PHT also appears to increase the risk of heart disease, blood clots, and strokes. It does lower the risk of colorectal cancer and osteoporosis, but this must be weighed against possible harm, and it should be noted that there are other effective ways to prevent osteoporosis. Although ERT does not seem to have much effect on breast cancer risk, it does increase the risk of stroke. The increased risk of hormone replacement therapy is the same for "bioidentical" and "natural" hormones as it is for synthetic hormones.
The decision to use PHT should be made by a woman and her doctor after weighing the possible risks and benefits (including the severity of her menopausal symptoms), and considering her other risk factors for heart disease, breast cancer, and osteoporosis. If a woman and her doctor decide to try PHT for symptoms of menopause, it is usually best to use it at the lowest dose that works for her and for as short a time as possible.
http://www.cancer.org/docroot/cri/content/cri_2_4_2x_what_are_the_risk_factors_for_breast_cancer_5.asp
http://www.hopkinskimmelcancercenter.org/index.cfm/cid/1254
http://clinicaltrials.gov/ct2/show/NCT00193726?term=estrogen++breast+cancer&rank=4
These are not the ones I remember reading, however they explain the point.
http://clinicaltrials.gov/ct2/show/NCT00193726?term=estrogen++breast+cancer&rank=4
These are not the ones I remember reading, however they explain the point.
More re clinicaltrials.gov:
I neglected to list one study that is planning to try high-dose estrogen to treat metastatic triple negative breast cancer (TNBC)
I neglected to list one study that is planning to try high-dose estrogen to treat metastatic triple negative breast cancer (TNBC)
pps. I also found a more recent study in Italy, in which 3 of 10 subjects with advanced ER neg BC converted to ER pos status after treatment with Herception and chemo.
p.s. In a general Internet search, I did find some references to ER neg. BC cells converting to ER pos. cells, but this was in cells in a laboratory, not in human beings, and it was after exposure to Herceptin, not to estrogen...
At clinical trials.gov I found:
1. A couple of studies in regard to trying estrogen as a treatment for metatastic ER+ BC that had failed previous hormone-blocking therapy.
2. One study trying short-duration estrogen just before each cycle of adjuvant chemotherapy to see if it would increase the effectiveness of the chemo
3. A study testing the safety of vaginal estrogen (Vagifem) for vaginal atrophy/dryness in woman on estrogen-blocking drugs such as tamoxifen
4. A study testing the safety of low dose estrogen to treat hot flahes and vaginal dryness in women on AIs
However, a search for estrogen as a treatment for ERneg BC turned up no results.
If you come across the study you referred to again, I'd really appreciate a reference or link to the information...
Thanks,
bb
1. A couple of studies in regard to trying estrogen as a treatment for metatastic ER+ BC that had failed previous hormone-blocking therapy.
2. One study trying short-duration estrogen just before each cycle of adjuvant chemotherapy to see if it would increase the effectiveness of the chemo
3. A study testing the safety of vaginal estrogen (Vagifem) for vaginal atrophy/dryness in woman on estrogen-blocking drugs such as tamoxifen
4. A study testing the safety of low dose estrogen to treat hot flahes and vaginal dryness in women on AIs
However, a search for estrogen as a treatment for ERneg BC turned up no results.
If you come across the study you referred to again, I'd really appreciate a reference or link to the information...
Thanks,
bb
I don't think you can change your ER negative cancer to ER positive cancer because of taking hormones. You can get another cancer or a recurrence of cancer that could be ER positive that could be caused by hormones. That's a big risk to take. I understand just how bad the hot flashes can be. I've often complained that I'm being COOKED and have had hot flashes that las well over an hour. As much as I need estrogen to control this that is like putting fire to lighter fluid.... and I don't want to get burned.
If you have a study that proves that to be something else I'd like to see it as well.
Best wishes.
If you have a study that proves that to be something else I'd like to see it as well.
Best wishes.
Could you provide us a reference in regard to the study you cited?
Thanks,
bluebutterfly
Thanks,
bluebutterfly
They are giving women that are er - hormones to try to convert them to er+. Tamoxifin would than work for them.
er+ has a better overall survival.
er+ has a better overall survival.
Ma, before I can best respond to you, I wanted to ask you to explain the following statement as I am not sure I understand it.
'There is a study going on that is giving women that are hormone - hormones because it is easier to treat if they can convert them.'
What do you mean when you say it is this way easier to convert them? Their estrogen and progesterone status re: negative to positive? Ir from feeling absolutely miserable to better? other?
I would really like to understand! Kat
I
'There is a study going on that is giving women that are hormone - hormones because it is easier to treat if they can convert them.'
What do you mean when you say it is this way easier to convert them? Their estrogen and progesterone status re: negative to positive? Ir from feeling absolutely miserable to better? other?
I would really like to understand! Kat
I
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