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LE Magazine October 2004
What You Don't Know About Estrogen
What Women May Consider After Breast Cancer

“Stop taking estrogen” are usually the first words out of a doctor’s mouth after telling a woman that she has breast cancer. The estrogen that she is most likely to be taking is Premarin® or Prempro™—drugs associated with a 300% increased risk of breast cancer.88 Doctors equate Premarin® with estrogen, and estrogen with breast cancer. But hold on a minute—must a woman who has had breast cancer necessarily live the rest of her life in an estrogen-deficient state because one drug might have caused problems?

Not according to the research. In fact, a study from the Fred Hutchinson Cancer Research Center in Seattle showed a 50% reduction in the recurrence of breast cancer in women who used hormone replacement therapy, regardless of whether the therapy was oral, local, or both.89 Doctors at Chicago’s Rush-Presbyterian-St. Luke’s Medical Center have argued for a change in viewpoint on the subject. Researchers at the MD Anderson Cancer Center in Houston have been examining the question for more than a decade,90,91 and have found no compelling evidence against the use of hormone replacement therapy following breast cancer treatment.

In a study from the University of Texas Southwestern Medical Center in Dallas of 64 women with previous breast cancer—some of which was estrogen receptor positive—one case of recurrence and one case of new cancer in the other breast was reported after an average time on replacement therapy of 6 years and follow up of 12 years.92 Researchers concluded that the use of hormone replacement therapy is not associated with increased breast cancer.

No large, long-term studies have been conducted, but two reports on all the smaller studies both state that there is no increased risk of recurrence or new cancer in the opposite breast—receptor positive or negative.93,94

Premarin® and Prempro™ do not appear to have the same propensity to promote breast cancer following treatment. A report from the University of California, Irvine, found 13 recurrences in 145 women taking Prempro™ for an average of 2.5 years after treatment for breast cancer.95 Another report from South Africa had similar results. In 20 women taking Prempro™ and 4 taking tibolone (another hormone replacement drug), no recurrences were reported after three years of observation.96 This contrasts sharply with the more than four times increased risk for breast cancer in women taking tibolone, and almost three times increased risk in women taking Prempro™, reported for women who have never been treated for breast cancer.97

At this time, no compelling published evidence exists to suggest that taking hormone replacement therapy after treatment for breast cancer increases the risk of recurrence or new cancer in the other breast. Some caveats should be noted, however. Large, long-term studies have not been conducted, and until they are, nothing is definite. Second, important differences exist between hormone replacement therapies. For example, in one study, the drug Prempro™ caused significant breast density in 40% of women; by contrast, oral low-dose estrogen caused it in 6%, and transdermal estrogen in 2%.98  Breast density increases the chance that a mammogram can be misread.

Another overlooked factor in these studies is that when women survive breast cancer, they change their habits. In one study, 77% reduced their consumption of meat, and 72% increased their intake of fruit and vegetables.99 In another study, 64% started using dietary supplements, and almost all reported benefits.100 Women who have completed breast cancer treatment are seven times more likely to use alternative therapies, and if they are taking tamoxifen, they are even more likely to use alternative therapies to alleviate symptoms, with soy being a top choice.101

Might these changes in diet and lifestyle change a woman’s risk/estrogen profile so that a xenoestrogen such as a hormone replacement drug might behave differently in her body? It is very likely, in view of scientific studies showing how various dietary factors modulate estrogen. In addition, breast cancer treatment may permanently alter the genes that respond to estrogen. Contradicting this, however, are short-term studies showing that breast cancer patients who take estrogen-suppressing drugs (aromatase inhibitors) have a reduced risk of cancer recurrence. None of these studies, however, looks at lifestyle modifications that could skew the findings. In other words, the women whose breast cancer did not recur when taking aromatase inhibitors could have made significant improvements in their diets that were not accounted for in these studies. These dietary changes, and not the estrogen-suppressing drug, could be responsible for the cancer not recurring.


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