Data Collection And Follow
The clinical follow-up of each woman began on the date of primary BC surgery and continued until a first event or a maximum of 10 years, which was mandatory follow-up.
Diagnostic information was entered prospectively by Danish treatment units into the DBCG database on all women with early-stage BC at surgery. Subsequently, detailed clinical information concerning definitive surgery, radiotherapy, systemic treatment, and follow-up was consecutively registered in the database. From the DBCG database, we ascertained the following data for each patient: age, date and type of surgery, pathoanatomic features, adjuvant therapy , recurrence, second malignancy, and death, if any. A patient was classified as adherent following continuation of endocrine therapy for at least 4.5years in the absence of a BC event, or otherwise as nonadherent . Regarding adjuvant treatment, women who received both an AI and tamoxifen were categorized as AI users from the date of initiation of AI treatment.
For a complete follow-up on vital status, DBCG data were linked with the Danish Civil Registration System, thus recording death from any cause. Overall survival in the study cohort was determined from surgery until the date of death, emigration, or December 31, 2016, whichever came first. Each patients medical history registered in the Danish National Patient Registry for a period of 10 years before her BC diagnosis was summarized via the Charlson Comorbidity Index .
Are There Reasons Not To Take One Of These Drugs To Help Reduce Breast Cancer Risk
All drugs have risks and side effects that must be discussed when making the decision about chemoprevention.
Most experts agree that tamoxifen and raloxifene should not be used to reduce breast cancer risk in women who:
- Have a higher risk of serious blood clots*
- Are pregnant or planning to become pregnant
- Are breastfeeding
- Are taking estrogen
- Are taking an aromatase inhibitor
- Are younger than 35 years old
*Women who have a higher risk of serious blood clots include those who have ever had serious blood clots . Many doctors also feel that if youve had a stroke or heart attack, or if you smoke, are obese, or have high blood pressure or diabetes, you also have a higher risk of serious blood clots. Women with any of these conditions should ask their doctors if the benefits of taking one of these drugs would outweigh the risks.
A woman who has been diagnosed with any type of uterine cancer or atypical hyperplasia of the uterus should not take tamoxifen to help lower breast cancer risk.
Raloxifene has not been tested in pre-menopausal women, so it should only be used if you have gone through menopause.
Aromatase inhibitors are not useful for pre-menopausal women, so they should only be used if you have gone through menopause. These drugs can cause bone thinning , so theyre not likely to be a good option in women who already have thin or weakened bones.
Talk with your doctor about your total health picture to make the best possible choice for you.
Risks Of Hormone Replacement Therapy
Hormone therapy is a viable option for relatively young and healthy women up to age 59 or within ten years of menopause. Although, there are risks involved. Itâs critical to talk to your doctor about these risks before starting therapy.
The following risks are associated with HRT:
- Blood clots in the legs and lungs that could result in a stroke.
- Endometrial cancer if you are taking estrogen-only replacement therapy and you still have your uterus.
- Breast cancer if you are taking estrogen and progesterone combination therapy for five or more years. This risk decreases after hormone therapy is stopped and is not associated with estrogen-only therapy.
You are less likely to experience any issues if you follow these suggestions:
- Start treatment with the lowest dose that works for you for the shortest possible time.
- Have your doctor closely monitor your treatment and address any concerns you are having.
- Take progesterone and estrogen if you still have your uterus.
- Stay up-to-date with your doctor visits, mammograms, and pelvic exams.
- Stick to localized estrogen therapy if the only troublesome symptom youre experiencing is vaginal dryness or painful sex.
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Weighing The Pros And Cons
- Based on current research findings, it’s not advisable to take hormones as a preventive measure or over a long period of time.
- If you have severe menopause-related problems, it’s a good idea to carefully weigh the pros and cons of hormone therapy together with your doctor.
- If you decide to use hormones, the treatment should be as short as possible, using the lowest dose possible.
How Is Hormone Therapy Given
Hormone therapy is most often used to treat breast and prostate cancers. Research is being done to see if hormonal therapy could be used to treat other cancer types. Hormone therapy can be given in a few ways:
- Oral medication Taken by mouth.
- Injection Given by an injection under the skin or in the muscle .
- Surgical intervention Removal of the ovaries in women, or testicles in men, causes lower levels of hormones being made.
Hormone therapy is a systemic therapy, meaning that it travels throughout the body. Surgery and radiation therapy are local treatments.
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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 , orpostmenopausal 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.
Menopause: What Are The Benefits And Risks Of Long
Hormone therapy can help ease symptoms of menopause. But it is associated with a lot of serious risks if used over the long term. Although the treatment lowers the risk of bone fractures, it increases the risk of cardiovascular disease and breast cancer.
Womens hormone levels change during the time leading up to menopause . This can lead to hot flashes, sweats and mood swings. Some women have such severe symptoms that they start looking for treatments. One treatment option is hormone therapy with estrogen, or with a combination of estrogen and progestin. Combination drugs are generally used because estrogen can lead to growths in the lining of the womb when used alone. So estrogen-only medications are only suitable for women who have had a hysterectomy .
In the past it was thought that taking hormones for a long time after menopause can protect women from serious diseases. But this assumption turned out to be wrong. On the contrary: It is now clear that this treatment actually increases the risk of certain serious diseases. These include:
- Blood clots in the legs or in the lungs
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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 Taking Bioidentical Hormones For Weight Loss
Theres a new way to lose weight that doesnt involve counting calories or carbs, and it doesnt require you to give up your favorite foods. Bioidentical hormones can help you shed pounds without making any major changes to your lifestyle. But does BHRT work, and is it safe? Heres what you need to know about the pros and cons of taking bioidentical hormones for weight loss.
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What Are The Positive Effects Of Estrogens
The many positive functions of estrogens and their effects on health are often underestimated.
Estrogens are responsible for the development of reproductive tissues and female secondary sexual characteristics at puberty. They also maintain bone density and decrease the risk of osteoporosis, which can result in brittle bones that break easily. But the role estrogens play in womens health goes far beyond reproductive health and bone density.
Some of the most profound effects of estrogens are in the brain. For instance, hot flashes, which many women experience while going through menopause, are due to the loss of estrogens acting on brain areas involved in temperature regulation.
They can also influence cognitive function how we think, particularly verbal memory and fluency, which is the memory of words and how we express ourselves in language. And around the time of menopause in many women, they are believed to have an anti-depressive effect.
Sleep disturbances during menopause are believed to be caused by absence of the estrogens acting on sleep centers in the brain. The decreased actions of estrogens on the brain during menopause may also influence sexual desire.
And finally, estrogens may be protective in the brain. This has been demonstrated in nonhuman primates. In women, estrogens may decrease the incidence of Alzheimers disease if hormone replacement begins soon after menopause.
How High Does My Risk Need To Be
There is no single definition of a higher-than-average risk of breast cancer. But most major studies have used a 1.7% risk of developing breast cancer over the next 5 years as their cut-off point.
Some medical organizations recommend that doctors discuss the use of medicines to lower breast cancer risk in women at least 35 years old who have a 5-year risk of 1.7% or higher. Others might use different cutoff points.
The American Cancer Society does not have recommendations for using medicines to help lower the risk of breast cancer.
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What Risks Did The Study Show
The study showed that the risk for breast cancer was greater for:
- Women who took combined therapy-estrogen/progesterone rather than estrogen alone
- Women who are currently taking hormone therapy rather than past users
- Women who have used hormone therapy for a long duration of time.
Importantly, there was NO excess risk seen with women who have used vaginal estrogen.
The risk persisted for more than 10 years after stopping hormone therapy . However, these risks were VERY SMALL.
BENEFITS VS. RISKS OF HORMONE THERAPY IN MENOPAUSAL WOMEN
Roughly 6,000 women in the U.S. transition into menopause each day. For many women, this means experiencing hot flashes, night sweats, vaginal dryness and having difficulty sleeping, which can ultimately contribute to a decreased quality of life. Hormone therapy has been proven to be THE most effective treatment for vasomotor symptoms of menopause, while also decreasing the risk of postmenopausal bone loss and fractures. Postmenopausal women are also at an increased risk for cardiovascular disease, bone loss, and cognitive decline. One can argue that a woman’s overall well-being can be considerably affected by over generalization and misinterpretation of this data. For postmenopausal women, the decision to initiate hormone therapy should be individualized, weighing the pros and cons. A VERY SMALL INCREASED RISK FOR BREAST CANCER diagnosis possibly related to hormone therapy is only one part of the discussion of risks and benefits.
What Are The Benefits Of Hormone Therapy
If your major concerns with menopause are issues such as osteoporosis, heart disease, and urinary incontinence, hormone therapy may not be the initially recommended therapy to address these health issues. Dr. Bruner can offer other other medications, treatments, and lifestyle changes to help with these health concerns.
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Hormonal Therapies Slow Or Stop Breast Cancers Growth By Changing The Hormonal Milieu
For early stage cancer, these treatments include tamoxifen and a class of drugs called aromatase inhibitors . Three aromatase blocking drugs are available clinically. Anastrozole and letrozole work by reversibly blocking this enzyme, while exemestane binds to the enzyme and inactivates it permanently. Studies suggest that all three are equally effective. Women with metastatic breast cancer also have other hormone therapy options, including fulvesrant , megestrol acetate , and tormifene .
Am I At Higher Risk For Breast Cancer
A risk factor is anything that raises your risk of getting a disease. Your risk factors will need to be assessed to find out if you are at higher-than-average risk for breast cancer. But keep in mind that having risk factors does not mean that you will definitely develop breast cancer. In fact, most women who have one or more risk factors never develop breast cancer.
- Having a gene mutation linked to a family cancer syndrome
Some of these factors can increase your risk more than others.
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How Do I Know If Hormone Replacement Therapy Is Right For Me
Your doctor can help you weigh the pros and cons and suggest choices based on the severity of your symptoms and your medical history.
Here are some questions to ask:
- Based on my medical history, is there any reason I shouldnât use HRT?
- Do you think it could help my symptoms, especially hot flashes, sleep issues, and vaginal dryness?
- Are there other treatments I should consider?
- Do you think Iâll have side effects from HRT?
- Does my family medical history make me a good or bad candidate for HRT?
- What type of HRT might be best for me?
Proton Beam Radiation Therapy
Proton beam radiation uses beams of protons instead of X-rays. A proton is a particle with a positive electric charge that is in the nuclei of all atoms.
X-rays release energy both before and after they hit their target. But protons release their energy only after traveling a certain distance. So doctors think protons may be able to deliver more radiation directly to the treatment area while possibly doing less damage to nearby healthy tissue. But this is still being studied.
Right now, proton beam radiation is only being used in clinical trials to treat breast cancer. The machines needed to deliver protons are very expensive and are not widely available.
If youre interested in being treated with proton beam therapy, talk to your doctor to find a clinical trial that would be a good fit for your unique situation.
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Treatment Side Effects And Complications
Menopause-like symptoms can be difficult for young women being treated for breast cancer. Rather than the gradual onset of natural menopause, hot flashes and other symptoms tend to come on quickly and harshly soon after treatment starts.
Sexual side effects are common with lower estrogen levels, and these can be particularly bothersome for young women as well.
Breast Cancer Doctor Discussion Guide
Get our printable guide for your next doctors appointment to help you ask the right questions.
How Can Hormone Therapy Improve Concerns In Women
Hormonal imbalance in women can be caused by menopause, which includes three stages. Perimenopause is the stage directly before menopause. During this time, many of the classic symptoms of menopause appear as the body. These symptoms can include hot flashes, night sweats, sleeping problems, mood swings, and loss of interest in sex.
The next stage, menopause, also includes these symptoms, but they often begin to subside as the menstrual cycle ends and hormone fluctuations decrease. Postmenopause is the final stage and may include the development of hormone deficiency symptoms. Hormone therapy can help improve hormonal balance during and after menopause. The treatment process can help patients manage mood swings and decrease the frequency of hot flashes.
In addition, hormone therapy can aid in a smoother transition from perimenopause to postmenopause by regulating hormone levels. Once menopause is complete, therapy can prevent the development of hormone deficiency and its related symptoms, which can include weight gain, osteoporosis, and decreased libido.
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The Pros And Cons Of Hormone Therapy For Aging Transgender Women
An estimated 71% of transgender women use or intend to use gender-affirming hormone therapy . Although sample sizes are comparatively small, there are studies that demonstrate psychological advantages of GAHT, whereas others suggest added health risks. A presentation at The North American Menopause Society Annual Meeting in Atlanta, October 12-15, will address the differentiated pros and cons of hormones for transgender women.
Understanding the risks and benefits of GAHT for women in midlife and beyond is important because it’s estimated that nearly one-quarter of transgender women begin hormone therapy after the age of 40, with 12% beginning GAHT after age 50. Specific areas of focus include mental, cardiovascular, and breast health.
Multiple studies have confirmed improved mental health benefits and a feeling of overall well-being in transgender women using GAHT. Data collected from the National Transgender Discrimination Study examined qualify-of-life outcomes in transgender women aged older than 60 years and found that those who recently initiated GAHT reported statistically higher quality-of-life scores than their age-matched peers who had not initiated GAHT.
Dr. Sarah Pickle from the University of Cincinnati College of Medicine will present this information during the NAMS Annual Meeting and will discuss current GAHT recommendations and additional treatment considerations for transgender patients.