Morning Rounds With Dr Economou
Left Image of hospital rounds courtesy of John Hopkins Nursing Magazine.
In Chicago in 1977, a Rush Hospital breast surgeon by the name of Steven Economou was making rounds with his house staff entourage of interns and residents. I was one of the interns in his group. Wearing long white coats and brandishing stethosopes, we followed Dr. Economou from room to room. Dr. Economous specialty was breast cancer surgery, and one of the surgical floors of Rush Hospital was filled with women either waiting for surgery or else recovering from their breast cancer operation.
Morning rounds with Steven Economou MD was a daily ritual, and as we bobbed in and out of hospital rooms, examining patients and reviewing charts, Dr Economou enjoyed stumping the house staff with difficult medical questions, as if they were small darts deftly thrown to an imaginary target on our foreheads. As if it was yesterday, I can remember one such question he asked me:Dr Dach, Does Estrogen cause breast cancer?
I had just finished medical school, and I really did not know. I did not even know if the answer was known. So, as was my usual custom in those days, I made up a plausible answer based on accepted knowledge.
I replied: Of course estrogen causes breast cancer. Estrogen stimulates growth of breast tissue, and any growth stimulation will cause cancer.
Dr Steven G. Economou passed away at the age of 84 in 2007.
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.
Estrogen Is Ok Medroxyprogesterone Is Not Ok
So, here we see an obvious conclusion, that Estrogen alone does not cause breast cancer and may even be protective, while adding a Synthetic chemically altered hormone, a progestin called medroxyprogesterone, DOES CAUSE breast cancer. Not only does medroxyprogesterone cause breast cancer, these cancers tend to be more aggressive and are deadlier.
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Promoted To Treat Vague Symptoms And Conditions Like Hormone Imbalance Custom
Only when Wierman did an in-depth history did the woman finally reveal that she and her husband had gone to an anti-aging clinic and been implanted with testosterone pellets. I watched her for over 12 months, as her testosterone slowly fell, says Wierman, who is professor in medicine, OBGYN, physiology, and biophysics at the University of Colorado School of Medicine and chief of endocrinology at the Rocky Mountain Regional Veterans Affairs Medical Center. The patient didnt know to mention the testosterone treatment to earlier providers, perhaps because she didnt actually know what she had gotten, Wierman says.
The patient had received a treatment known as bioidentical hormone replacement therapy that is being promoted on the internet, at anti-aging clinics, and by many practitioners. BHRT pellets are subcutaneous implants generally inserted into the hip area and used to treat everything from low libido to hair loss. Hormones may include various estrogens and prohormones such as DHEA or androstenedione, but the most commonly reported problems seem to stem from women given long-term supraphysiologic doses of testosterone, a treatment for which there is no generally accepted medical indication.
AT A GLANCE
Effect Of Castration On Tumor Development In Erko/wnt
As exogenous E2 increased tumor incidence and reduced latency, we reasoned that castration, by lowering endogenous E2, should also reduce tumor incidence from levels observed in intact ERKO/Wnt-1 animals. For these experiments, we compared intact and castrate ERKO/Wnt-1 animals. Castration delayed tumor onset from 12 to 23 months and reduced tumor incidence from 80% to 50% . Our working hypothesis is that both ER dependent and ER independent effects of estradiol are involved in carcinogenesis. This experiment also allowed verification of the expected ER dependent effect on the process of carcinogenesis. Tumors developed sooner in the ER+/+/Wnt-1 animals than in those lacking ER .
Since castration reduced tumor incidence in the intact ERKO animals, we reasoned that pharmacologic suppression of estrogen production should also exert similar effects. We had previously developed a regimen sufficient to block ovarian estrogen production to castrate levels in rodents with high-dose letrozole administration. Letrozole, given at a dosage of 20 lg/day for 5 days a week, increased 50% tumor incidence time from 12 to 18 months . The effect of letrozole was dose-dependent, since no difference in 50% incidence time point or overall incidence was observed in animals receiving a lower dose of AI versus vehicle .
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Reducing The Cancer Risks Of Hormone Therapy
If you and your doctor decide that MHT is the best way to treat symptoms or problems caused by menopause, keep in mind that it is medicine and like any other medicine its best to use it at the lowest dose needed for as short a time as possible. And just as you would if you were taking another type of medicine, you need to see your doctor regularly. Your doctor can see how well the treatment is working, monitor you for side effects, and let you know what other treatments are available for your symptoms.
All women should report any vaginal bleeding that happens after menopause to their doctors right away it may be a symptom of endometrial cancer. A woman who takes EPT does not have a higher risk of endometrial cancer, but she can still get it.
Women using vaginal cream, rings, or tablets containing only estrogen should talk to their doctors about follow-up and the possible need for progestin treatment.
For women who have had a hysterectomy , a progestin does not need to be a part of hormone therapy because theres no risk of endometrial cancer. Adding a progestin does raise the risk of breast cancer, so ET is a better option for women without a uterus.
Women should follow the American Cancer Society guidelines for cancer early detection, especially those for breast cancer. These guidelines can be found in Breast Cancer Early Detection.
Subcutaneous Implants The Evolution Of T Therapy In Clinical Practice And T With And Without E Implants
The T and E implants used at the Institute for Hormone Balance and its satellite offices are compounded by a 503b outsourcing pharmacy in Denton, Texas. They are composed of USP T and steric acid or USP E and steric acid . A proprietary Food and Drug Administration approved process compresses substrates into 3.1 mm cylinders, sealed in glass ampoules, and sterilized by E beam sterilization. Sterile implants are inserted into the subcutaneous tissue of the upper gluteal area or lower abdomen through a small anesthetized incision using a stainless-steel sterile trocar or a disposable trocar kit.
The IHB has been involved in bio-identical HRT over the past 24 years. Oral ET therapy and ET and/or T creams were used in majority of patients needing replacement through 2007. The practice augmented our armamentarium of HRT adding the use of subcutaneous hormone pellet therapy in 2008. From our experience, subcutaneous hormone pellet therapy provides improved relief of symptoms with fewer side effects than more traditional HRT therapies. The success of T implants in treating symptoms of pre- and post- menopausal patients was additionally shown by Glaser et al . The IHB developed a proprietary dosing computerized algorithm for pellet dosing based on patient demographics, symptoms, laboratory values, and medical co-morbidities.
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Study Uncovers Why Hormones Increase Breast Cancer Risk
EAST LANSING, Mich. Researchers have identified how the hormones progesterone and estrogen interact to increase cell growth in normal mammary cells and mammary cancers, a novel finding that may explain why postmenopausal women receiving hormone replacement therapy with estrogen plus progestin are at increased risk of breast cancer.
The discovery that both estrogen and progesterone must be present for the increased production of the protein amphiregulin, which binds to mammary cells and promotes cell growth, could lead to new treatment methods for the disease, said Sandra Haslam, director of Michigan State Universitys Breast Cancer and the Environment Research Center and lead researcher on the project.
The study, funded by the Department of Defenses Breast Cancer Research Program and published in Hormones and Cancer, looked at why progesterone combined with estrogen may contribute to increased breast cancer risk. In the study, researchers used both the native hormone, progesterone, and a synthetic compound, progestin obtaining the same results.
The finding might help explain earlier results from the groundbreaking Womens Health Initiative showing the risk of breast cancer is significantly greater for postmenopausal women who received hormone replacement therapy with combined estrogen plus progestin compared to women receiving estrogen alone.
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Estrogen Therapy And Cancer Risk
In women who still have a uterus, using systemic ET has been shown to increase the risk of endometrial cancer . The risk remains higher than average even after ET is no longer used. Although most studies that showed an increased risk were of women taking estrogen as a pill, women using a patch or high-dose vaginal ring can also expect to have an increased risk of endometrial cancer.
Because of this increased cancer risk, women who have gone through menopause and who still have a uterus are given a progestin along with estrogen. Studies have shown that EPT does not increase the risk for endometrial cancer.
Long-term use of vaginal creams, rings, or tablets containing topical estrogen doses may also increase the levels of estrogen in the body. Its not clear if this leads to health risks, but the amounts of hormone are much smaller than systemic therapies.
ET is not linked to a higher risk of breast cancer. In fact, certain groups of women taking ET, such as women who had no family history of breast cancer and those who had no history of benign breast disease, had a slightly lower risk of breast cancer.
The WHI study of ET did not report any results about ovarian cancer.
To put the risk into numbers, if 1,000 women who were 50 years old took estrogen for menopause for 5 years, one extra ovarian cancer would be expected to develop.
ET does not seem to have any effect on the risk of lung cancer.
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Why Estrogen Does Not Cause Breast Cancer
Estrogen therapy is a vital part of hormone replacement for women in menopause and beyond. Unfortunately, conventional wisdom of the past has tied it negatively to breast cancer. With over 2 million breast cancer survivors in the U.S., there has been enormous debate surrounding using hormone replacement therapy during and after breast cancer treatment.
Should there be concern? Does estrogen actually cause breast cancer? What is the research telling us? Were here to answer these questions, debunk some myths, and find the truth.
Family History Of Breast Cancer
The benefits of hormone replacement extend to women with a family history of breast cancer. A 1997 study in Iowa followed 41,800 women for 8 years. Those women using hormone replacement who had a history of breast cancer in a family member still had a 50% reduction in over all mortality compared to non-users. There was a slight increase in breast cancer in the hormone users in this observational study. However this was not statistically significant.
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Get The Relief You Seek With Blue Sky Md
If youre struggling with symptoms of menopause or at risk of breast cancer, pellets may be the ideal solution for you and your long-term health. Blue Sky MD have been at the forefront of hormone therapy practices in North Carolina for more than a decade. Weve treated thousands of patients and helped them on the path to better health and prevention.
Prevention: Breast Cancer And Hormone Therapy
Around the age of 40, women begin to lose testosterone through a normal decrease of production. Usually associated with sweaty teenage boys and muscle men, testosterone is very important for women, too. Healthy levels of testosterone prevent cell overgrowth in the breasts. So, when these levels drop and are not addressed it puts you at risk of breast cancer. In fact, one long term study found testosterone pellet therapy such as BioTE® pellet therapy reduced the risk of breast cancer in pre and post-menopausal women.
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Confirmed: A Link Between Breast Cancer And Hormone Therapy
Breast cancer incidence parallels estrogen-progestin use among menopausal and postmenopausal women
Researchers at the Kaiser Permanente Center for Health Research in Portland, Ore., concluded there is definitely a link between breast cancer and the use of menopausal hormone therapy, particularly estrogen-progestin treatment combinations. Since 1990, “breast cancer rates dropped in parallel with hormone use just as it rose in parallel to it,” says oncologist Andrew Glass, lead author of the study published in the Journal of the National Cancer Institute.
Glass and his colleagues reviewed the medical histories of 7,386 women diagnosed with invasive breast cancer between 1980 and 2006. They found that breast cancer incidence rose 25 percent from the early 1980s to the early 1990sa period when an increasing number of women were getting mammograms and also undergoing hormone therapy to control menopause symptoms and prevent chronic disease. Glass acknowledges that the jump in breast cancer could be attributed to more women getting mammograms, because the test can find cancers that might otherwise go undetected until the disease has progressed.
“It’s not exact cause and effect, but it’s as close as you can be in epidemiology,” Glass says. “There is no other explanation for what we’ve found.”
Brca1 And Brca2 Mutations
There are several genetic mutations that increase the risk of developing breast cancer. Probably the most well known and reported on are the mutations of the proteins BRCA1 and BRCA2. These proteins, like the metabolite 2-OH estrone, are involved in DNA repair. When either of these genes is mutated, or altered, such that its protein product is not made or does not function correctly, DNA damage may not be repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer.
Women without the BRCA mutation have a 12% lifetime risk of developing breast cancer, and the average age for developing breast cancer in the BRAC women is 61 years old . With a mutation in the BRCA gene, the incidence of breast cancer increases to 60-80% and the average age of development decreases to 42 years old . Patients with BRCA 1 and BRCA 2 mutations also have a 20- 40% chance of developing cancer in the same or contralateral breast in the years following diagnosis .
The USPSTF recommends genetic screening for patients who have a significant family history such as: breast cancer diagnosis prior to age 50, cancer in bilateral breasts, family history of both breast and ovarian cancer, multiple family breast cancers, two or more primary BRCA1 or BRCA2 related cancers in same family member, male breast cancer, and Ashkenazi Jewish ethnicity . Breast cancers in patients with BRCA1 mutation tend to be triple negative.
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Therapy: Subcutaneous Testosterone And Testosterone Combined With Anastrozole Implants
Subcutaneous implants are composed of non-micronized USP testosterone and stearic acid in a geometric ratio of 20:1, or non-micronized USP T, stearic acid and USP anastrozole in a geometric ratio of 15:1:1. Implants are placed in sealed glass vials and autoclaved for sterility and heat fusion. The sterile implants are inserted into the subcutaneous tissue of the upper gluteal area or lower abdomen through a 5mm incision using local anesthesia and a disposable trocar kit.
Combined Hrt And Breast Cancer
Combined estrogen and progesterone may have the highest risk factor of any type of HRT. According to BreastCancer.org, the risk of developing breast cancer increases by 75% for those taking combined HRT.
The organization also noted that combined HRT increases the chance that a healthcare professional may diagnose a persons breast cancer at a more advanced stage, which increases the likelihood of mortality.
According to the , the risk of breast cancer increases the longer a person takes HRT. However, it also decreases significantly after a person discontinues HRT.
The American Cancer Society states that the risk of breast cancer returns to average 3 years after a person discontinues combined HRT.
However, the researchers for the 2020 study found that risk reduced after 5 years for medroxyprogesterone, and 10 years for levonorgestrel, which are types of progesterone.
Combined HRT is also linked to breast density, which can make it harder to locate cancer on a mammogram. Breast density is a term to describe the amount of dense tissue compared to fatty tissue in a persons breast. Dense tissue is more fibrous than fatty tissue.
HRT containing estrogen alone can also increase the risk of a person developing breast cancer. However, it may only increase the risk after 10 years of continued use.
A person who has had or has breast cancer should not take HRT. Instead, they should speak with a doctor about alternative options.
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How Is Hormone Therapy Used To Treat Breast Cancer
There are three main ways that hormone therapy is used to treat hormone-sensitive breast cancer:
Adjuvant therapy for early-stage breast cancer:Tamoxifen is FDA approved for adjuvant hormone treatment of premenopausal and postmenopausal women with ER-positive early-stage breast cancer, and the aromatase inhibitorsanastrozole, letrozole, and exemestane are approved for this use in postmenopausal women.
Research has shown that women who receive at least 5 years of adjuvant therapy with tamoxifen after having surgery for early-stage ER-positive breast cancer have reduced risks of breast cancer recurrence, including a new breast cancer in the other breast, and reduced risk of death at 15 years .
Until recently, most women who received adjuvant hormone therapy to reduce the chance of a breast cancer recurrence took tamoxifen every day for 5 years. However, with the introduction of newer hormone therapies , some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common .
Some premenopausal women with early-stage ER-positive breast cancer may have ovarian suppression plus an aromatase inhibitor, which was found to have higher rates of freedom from recurrence than ovarian suppression plus tamoxifen or tamoxifen alone .
Men with early-stage ER-positive breast cancer who receive adjuvant therapy are usually treated first with tamoxifen. Those treated with an aromatase inhibitor usually also take a GnRH agonist.