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Life Extension Magazine

LE Magazine October 2004
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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.

References

1. Saphner T, Tormey DC, Gray R. Venous and arterial thrombosis in patients who received adjuvant therapy for breast cancer. J Clin Oncol. 1991 Feb;9(2):286-94.

2. Love RR, Barden HS, Mazess RB, Epstein S, Chappell RJ. Effect of tamoxifen on lumbar spine bone mineral density in post- menopausal women after 5 years. Arch Intern Med. 1994 Nov 28;154(22):2585-8.

3. Jelinsky SA, Harris HA, Brown EL, et al. Global transcription profiling of estrogen activity: estrogen receptor alpha regulates gene expression in the kidney. Endocrinology. 2003 Feb;144(2):701-10.

4. Toran-Allerand CD. Minireview: a plethora of estrogen receptors in the brain: where will it end? Endocrinology. 2004 Mar;145(3):1069-74.

5. Wilkinson HA, Dahlund J, Liu H, et al. Identification and characterization of a functionally distinct form of human estrogen receptor beta. Endocrinology. 2002 Apr;143(4):1558-61.

6. Horard B, Vanacker JM. Estrogen receptor-related receptors: orphan receptors desperately seeking a ligand. J Mol Endocrinol. 2003 Dec;31(3):349-57.

7. Greschik H, Wurtz JM, Sanglier S, et al. Structural and functional evidence for ligand-independent transcriptional activation by the estrogen-related receptor 3. Mol Cell. 2002 Feb;9(2):303-13.

8. Tremblay GB, Bergeron D, Giguere V. 4- hydroxytamoxifen is an isoform-specific inhibitor of orphan estrogen-receptor-related (ERR) nuclear receptors beta and gamma. Endocrinology. 2001 Oct;142(10):4572-5.

9. Yang C, Chen S. Two organochlorine pesticides, toxaphene and chlordane, are antagonists for estrogen-related receptor alpha-1 orphan receptor. Cancer Res. 1999 Sep 15;59(18):4519-24.

10. Osipo C, Gajdos C, Liu H, Chen B, Jordan VC. Paradoxical action of fulvestrant in estradiol-induced regression of tamoxifen-stimulated breast cancer. J Natl Cancer Inst. 2003 Nov 5;95(21):1597-08.

11. Stoll BA. Palliation by castration or by hormone administration. In: Stoll BA, ed. Breast Cancer Management. London: William Heineman; 1977:133-46.

12. Stoll BA. Overprolonged adjuvant tamoxifen therapy in breast cancer. Ann Oncol. 1991 Jun;2(6):401-3.

13. Howell A, Dodwell DJ, Anderson H, Redford J. Response after withdrawal of tamoxifen and preogestogens in advanced breast cancer. Ann Oncol. 1992 Sep;3(8):611-7.

14. Schafer JM, Lee ES, O’Regan RM, Yao K, Jordan VC. Rapid development of tamoxifen-stimulated mutant p53 breast tumors (T47D) in athymic mice. Clin Cancer Res. 2000 Nov;6(11):4373-80.

15. Coward P, Lee D, Hull MV, Lehman JM. 4- Hydroxytamoxifen binds to and deactivates the estrogen-related receptor gamma. Proc Natl Acad Sci. 2001Jul 17;98(15):8880-4.

16. McDonnell DP, Vegeto E, O’Malley BW. Identification of a negative regulatory func- tion for steroid receptors. Proc Natl Acad Sci. 1992 Nov 15;89(22):10563-67.

17. Takahashi K, Okada M, Ozaki T, et al. Safety and efficacy of oestriol for symptoms of natural or surgically induced menopause. Hum Reprod. 2000 May;15(5):1028-36.

18. Iosif CS. Effects of protracted administration of estriol on the lower genito urinary tract in postmenopausal women. Arch Gynecol Obstet. 1992;251(3):115-20.

19. Head KA. Estriol: safety and efficacy. Altern Med Rev. 1998 Apr;3(2):101-13.

20. Bhavnani BR. Estrogens and menopause: pharmacology of conjugated equine estro- gens and their potntial role in the prevention of neurodegenerative diseases such as Alzheimer’s. J Steroid Biochem Mol Biol. 2003 Jun;85(2-5):473-82.

21. Wakatsuki A, Okatani Y, Ikenoue N, Fukaya T. Different effects of oral conjugated equine estrogen and transdermal estrogen replacement therapy on size and oxidative suscepti- bility of low-density lipoprotein particles in postmenopausal women. Circulation. 2002 Oct 1;106(14):1771-6.

22. Vongpatanasin W, Tuncel M, Wang Z, Arbique D, Mehrad B, Jialal I. Differential effects of oral versus transdermal estrogen replacement therapy on C-reactive protein in postmenopausal women. J Am Coll Cardiol. 2003 Apr 16;41(8):1358-63.

23. Sanada M, Tsuda M, Kodama I, Sakashita T, Nakagawa H, Ohama K. Substitution of transdermal estradiol during oral estrogen- progestin therapy in postmenopausal women: effects on hypertriglyceridemia. Menopause. 2004 May;11(3):331-6.

24. Akkad AA, Halligan AW, Abrams K, al Azzawi F. Differing responses in blood pressure over 24 hours in normotensive women receiving oral or transdermal estrogen replacement therapy. Obstet Gynecol. 1997 Jan;89(1):97-03.

25. Shimizu H, Ross RK, Bernstein L, et al. Serum oestrogen levels in postmenopausal women: comparison of American whites and Japanese in Japan. Br J Cancer. 1990;62(3):451-3.

26. Hill P, Chan P, Cohen L, Wynder E, Kuno K. Diet and endocrine-related cancer. Cancer. 1977 Apr; 39(4 Suppl):1820-6.

27. Dickinson LE, Macmahon B, Cole P, Brown JB. Estrogen profiles of Oriental and Caucasian women in Hawaii. N Engl J Med. 1974 Dec 5;291(23):1211-3.

28. Lawson JS, Field AS, Tran DD, et al. Breast cancer incidence and estrogen receptor alpha in normal mammary tissue–an epi- demiologic study among Japanese women in Japan and Hawaii. Int J Cancer. 2002 Feb 10;97(5):685-7.

29. de Visser SJ, Uchida N, Vliet- Daskalopoulou E, et al. Pharmacokinetic differences between Caucasian and Japanese subjects after single and multiple doses of a potential combined oral contraceptive (Org 30659 and EE). Contraception. 2003 Sep;68(3):195-02.

30. Punnonen R, Lukola A, Kudo R. Cytoplasmic estrogen receptor concentrations in the endometrium of Finnish and Japanese women. Eur J Obstet Gynecol Reprod Biol.1984 Jul;17(5):321-5.

31. Moore JW, Clark GM, Takatani O, Wakabayashi Y, Hayward JL, Bulbrook RD. Distribution of 17 beta-estradiol in the sera of normal British and Japanese women. J Natl Cancer Inst. 1983 Oct;71(4):749-54.

32. Nagata C, Takatsuka N, Inaba S, Kawakami N, Shimizu H. Effect of soymilk consumption on serum estrogen concentrations in premenopausal Japanese women. J Natl Cancer Inst. 1998 Dec 2;90(23):1830-5.

33. Lu LJ, Anderson KE, Grady JJ, Nagamani M. Effects of an isoflavone-free soy diet on ovarian hormones in premenopausal women. J Clin Encodrinol Metab. 2001 Jul;86(7):3045-52.

34. Lu LJ, Cree M, Josyula S, Nagamani M, Grady JJ, Anderson KE. Increased urinary excretion of 2-hydroxyestrone but not 16alpha-hydroxyestrone in premenopausal women during a soya diet containing isoflavones. Cancer Res. 2000 Mar 1;60(5):1299-05.

35. Zhou JR, Yu L, Mai Z, Blackburn GL. Combined inhibition of estrogen dependent human breast carcinoma by soy and tea bioactive components in mice. Int J Cancer. 2004 Jan 1;108(1):8-14.

36. Kumar NB, Cantor A, Allen K, Riccardi D, Cox CE. The specific role of isoflavones on estrogen metabolism in premenopausal women. Cancer. 2002 Feb 15;94(4):1166-74.

37. Wood CE, Cline JM, Anthony MS, Register TC, Kaplan JR. Adrenocortical effects of oral estrogens and soy isoflavones in female monkeys. J Clin Endocrinol Metab. 2004 May;89(5):2319-25.

38. Shao ZM, Shen ZZ, Fontana JA, Barsky SH. Genistein’s “ER-dependent and independent” actions are mediated through ER pathways in ER-positive breast carcinoma cell lines. Anticancer Res. 2000 Jul;20(4):2409-16.

39. Verma SP, Goldin BR. Copper modulates activities of genistein, nitric oxide, and cur- cumin in breast tumor cells. Biochem Ciophys Res Commun. 2003 Oct 10;310(1):104-8.

40. Han DH, Denision MS, Yamada K. Relationship between estrogen receptor- binding and estrogenic activities of environmental estrogens and suppression by flavi- noids. Biosci Biotechnol Biochem. 2002 Jul;66(7):1479-87.

41. Wood CE, Register TC, Anthony MS, Kock ND, Cline JM. Breast and uterine effects of soy isoflavones and conjugated equine estro- gens in postmenopausal female monkeys. J Clin Endocrinol Metab. 2004 Jul;89(7):3462- 8.

42. Diel P, Geis R-B, Caldarelli A, et al. The differential ability of the phytoestrogen genis- tein and of estradiol to induce uterine weight and proliferatin in the rat is associated with a substance specific modulation of uterine gene expression. Mol Cell Endocrin. 2004 Jun 30;221(1-2):21-32.

43. Peterson G, Barnes S. Genistein inhibits both estrogen and growth factor-stimulated proliferation of human breast cancer cells. Cell Growth Differ. 1996 Oct;7(10):1345-51.

44. Ju YH, Doerge DR, Allred KF, Alfred CD, Helferich WG. Dietary genistein negates the inhibitory effect of tamoxifen on growth of estrogen-dependent human breast cancer (MCF-7) cells implanted in athymic mice. Cancer Res. 2002 May 1;62(9):2474-7.

45. Bang OY, Hong HS, Kim DH, et al. Neuroprotective effect of genistein against beta amyloid-induced neurotoxicity. Neurobiol Dis. 2004 Jun;16(1):21-8.

46. Shumaker SA, Legault C, Kuller L, et al. Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women’s Health Initiative Memory Study. JAMA. 2004 Jun 23;291(24):2947-58.

47. Djuric Z, Depper JB, Uhley V, Smith D, Lababidi S, Martino S, Heilbrun LK. Oxidative DNA damage levels in blood from women at high risk for breast cancer are associated with dietary intakes of meats, veetables, and fruits. J Am Diet Assoc. 1998 May;98(5):524-8.

48. Dos Santos SI, Mangtani P, McCormack V, et al. Lifelong vegetarianism and risk of breast cancer: a population-based case-control study among South Asian migrant women living in England. Int J Cancer 2002; 99:238-44.

49. Hecht SS, Carmella SG, Kenney PM, Low SH, Arakawa K, Yu MC. Effects of cruciferous vegetable consumption on urinary metabolites of the tobacco-specific lung carcinogen 4-(methylnitrosamino)-1-(3- pyridyl)-1-butanone in Singapore Chinese. Cancer Epidemiol Bio Prev. 2004 JuN;13(6):997-04.

50. Michnovicz JJ, Adlercreutz H, Bradlow HL. Changes in levels of urinary estrogen metabolites after oral indole-3-carbinol treatment in humans. J Natl Cancer Inst. 1997 May 21;89(10):718-23.

51. Bradlow HL, Telang NT, Sepkovic DW, Osborne MP. 2-hydroxyestrone: the ‘good’ estrogen. J Endocrinol. 1996 Sep;150 Suppl:S259-65.

52. Auborn KJ, Fan S, Rosen EM, et al. Indole-3-carbinol is a negative regulator of estrogen. J Nutr. 2003 Jul;133(7 Suppl):2407S-75.

53. Parkin DR, Malejka-Giganti D. Differences in the hepatic P450-dependent metabolism of estrogen and tamoxifen in response to treatment of rats with 3,3’diindolylmethane and its parent compound indole-3-carbinol. Cancer Detect Prev.2004 ;28(1):72-9.

54. Gao X, Petroff BK, Oluola O, Georg G, Terranova PF, Rozman KK. Endocrine disruption by indole-3-carbinol and Tamoxifen: blockage of ovulation. Toxic App Pharmacol. 2002 Sep 15;183(3):179-88.

55. Girgert R, Bartsch C, Hill SM, Kreienberg R, Hanf V. Tracking the elusive antiestrogenic effect of melatonin: a new methodological approach. Neuro Endocrinol Lett. 2003 Dec;24(6):440-4.

56. Rato AG, Pedrero AG, Martinez MA, del Rio B, Lazo PS, Ramos S. Melatonin blocks the activation of estrogen receptor for DNA binding. FASEB J. 1999 May;13(8):857-68.

57. Luboshitzky R, Here P, Shen-Orr Z. Urinary 6-sulfaoxymelatonin excretion in hyperan drogenic women: the effect of cyproterone acetate-ethinyl estradiol treatment. Exp Clin Endocrinol Diabetes. 2004 Feb;112(2):102-7.

58. Anisimov VN, Alimova IN, Baturin DA, et al. The effect of melatonin treatment regimen on mammary adenocarcinoma development in HER-2/neu transgenic mice. Int J Cancer. 2003 Jan 20;103(3):300-5.

59. De Jonage-Canonico MB, Lenoir V, Martin A, Scholler R, Kerdelhue B. Long term inhibition by estradiol or progesterone of mela- tonin secretion after administration of a mammary carcinogen, the dimethyl benz(a)anthracene, in Sprague-Dawley female rat; inhibitory effect of melatonin on mammary carcinogenesis. Breast Cancer Res Treat. 2003 Jun;79(3):365-77.

60. Travis RC, Allen DS, Fentiman IS, Key TJ. Melatonin and breast cancer: a prospective study. J Natl Cancer Inst. 2004 Mar 17;96(6):475-82.

61. Tan DX, Manchester LC, Reiter RJ, Qi WB, Karbownik M, Calvo JR. Significance of melatonin in antioxidative defense system: reactions and products. Biol Signals Recept. 2000 May;9(3-4):137-59.

62. Chuang YY, Chen Y, Gadisetti, et al. Gene expression after treatment with hydrogen-peroxide, menadione, or t-butyl hydroperoxide in breast cancer cells. Cancer Res. 2002 Nov 1;62(21):6246-54.

63. Torres-Farfan C, Richter HG, Rojas-Garcia P, et al. Mt1 melatonin receptor in the primate adrenal gland: inhibition of adrenocorti-cotropin-stimulated cortisol production by melatonin. J Clin Endocrinol Metab. 2003 Jan;88(1):450-8.

64. Cagnacci A, Soldani R, Yen SS. Melatonin enhances cortisol levels in aged but not young women. Eur J Endocrinol. 1995 Dec;133(6):691-5.

65. Stewart DE, Cheung AM, Duff S, et al. Attributions of cause and recurrence in long-term breast cancer survivors. Psychooncology. 2001 Mar;10(2):179-83.

66. Pawlikowski M, Kolomecka M, Wojtczak A, Karasek M. Effects of six months melatonin treatment on sleep quality and serum concentrations of estradiol, cortisol, dehydroepiandrosterone sulfate, and somatomedin C in elderly women. Neuro Endocrinol Lett. 2002 Apr;23 Suppl 1:17-19.

67. Available at: http://www.OurStolenFuture.org. Accessed August 9, 2004.

68. No authors. Oral-contraceptive use and the risk of breast cancer. The Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. N Engl J Med. 1986 Aug 14;315(7):405-11.

69. Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999 Jan 14;340(2):77-84.

70. Chang-Claude U. Inherited genetic suscep tibility to breast cancer. IARC Sci Publ. 2001;154:177-90.

71. Houlston RS, Tomlinson IP. Modifier genes in humans: strategies for identification. Eur J Hum Genet. 1998 Jan;6(1):80-8.

72. Houlston RS, Tomlinson IP. Detecting low penetrance genes in cancer: the way ahead. J Med Genet. 2000 Mar;37(3):161-7.

73. Brandt B, Hermann S, Straif K, Tidow N, Buerger H, Chang-Claude J. Modification of breast cancer risk in young women by a polymorphic sequence in the egfr gene. Cancer Res. 2004 Jan 1;64(1):7-12.

74. Shannon J, Cook LS, Stanford JL. Dietary intake and risk of postmenopausal breast cancer (United States). Cancer Causes Control. 2003 Feb;14(1):19-27.

75. Lee HP, Gourley L, Duffy SW, Esteve J, Lee J, Day NE. Dietary effects on breast cancer risk in Singapore. Lancet. 1991 May 18;337(8751):1197-1200.

76. Dos Santos SI, Mangtani P, McCormack V, et al. Lifelong vegetarianism and risk of breast cancer: a population-based case-control study among South Asian migrant women living in England. Int J Cancer. 2002; 99:238-44.

77. Toniolo P, Riboli E, Shore RE, Pasternack BS. Consumption of meat, animal products, protein, and fat and risk of breast cancer: a prospective cohort study in New York. Epidemiology. 1994 Jul;5(4):391-7.

78. Cho E, Spiegelman D, Hunter DJ, et al. Premenopausal fat intake and risk of breast cancer. J Natl Cancer Inst. 2003 Jul 16;95(14):1079-85.

79. Le MG, Moulton LH, Hill C, Kramar A. Consumption of dairy produce and alcohol in a case-control study of breast cancer. J Natl Cancer Inst. 1986 Sep;77(3):633-6.

80. Djuric Z, Depper JB, Uhley V, Smith D, Lababidi S, Martino S, Heilbrun LK. Oxidative DNA damage levels in blood from women at high risk for breast cancer are associated with dietary intakes of meats, veg- etables, and fruits. J Am Diet Assoc. 1998 May;98(5):524-8.

81. Available at: http://www.thebreastcancer fund.org. Accessed August 9, 2004.

82. Available at: http://www-dep.iarc.fr/globo can/globocan.html. Accessed August 9, 2004.

83. Available at: http://www.ianr.unl.edu/pubs/ Feef/g1324.htm. Accessed August 9, 2004.

84. Maume D, Deceuninck Y, Pouponneau K, Paris A, LeBizec B, Andre F. Assessment of estradiol and its metabolites in meat. APMIS. 2001 Jan;109(1):32-8.

85. Reyes N, Iatropoulos M, Mittelman A, Geliebter J. Microarray analysis of diet-induced alterations in gene expression in the ACI rat prostate. Eur J Cancer Prev. 2002 Aug;11 Suppl 2:S37-42.

86. Lu LJ, Cree M, Josyula S, Nagamani M, Grady JJ, Anderson KE. Increased urinary excretion of 2-hydroxyestrone but not 16alpha-hydroxyestrone in premenopausal women during a soya diet containing isoflavones. Cancer Res. 2000 Mar 1;60(5):1299-05.

87. Liu S, Kulp SK, Sugimoto Y, Jiang J, Chang HL, Lin YC. Involvement of breast epithe- lial-stromal interactions in the regulation of protein tyrosine phosphatase-gamma (PTPgamma) mRNA expression by estrogenically active agents. Breast Can Res Treat. 2002 Jan;71(1):21-35.

88. Chen CL, Weiss NS, Newcomb P, Barlow W, White E. Hormone replacement therapy in relation to breast cancer. JAMA. 2002 Feb 13;287(6):734-41.

89. O’Meara ES, Rossing MA, Daling JR, Elmore JG, Barlow WE, Weiss NS. Hormone replacement therapy after a diagnosis of breast cancer in relation to recurrence and mortality. J Natl Cancer Inst. 2001 May 16;93(10):754-62.

90. Cobleigh MA, Berris RF, Bush T, et al. Estrogen replacement therapy in breast can- cer survivors. A time for change. Breast Cancer Committees of the Eastern Cooperative Oncology Group. JAMA. 1994 Aug 17;272(7):540-5.

91. Vassilopoulou-Sellin R, Cohen DS, Hortobagyi GN, et al. Estrogen replacement therapy for menopausal women with a history of breast carcinoma. Results of a 5-year, prospective study. Cancer. 2002 Nov 1;95(9):1817-26.

92. Peters GN, Fodera T, Sabol J, et al. Estrogen replacement therapy after breast cancer: a 12-year follow-up. Ann Surg Oncol. 2001 Dec;8(10):828-32.

93. Col NF, Hirota Lk, Orr RK, Erban JK, Wong JB, Lau J. Hormone replacement therapy after breast cancer: a systematic review and quantitative assessment of risk. J Clin Oncol. 2001 Apr 15;19(8):2357-63.

94. Meurer LN, Lena S. Cancer recurrence and mortality in women using hormone replacement therapy: meta-analysis. J Fam Pract. 2002 Dec;51(12):1056-62.

95. Brewster WR, SiSaia PJ, Grosen EA, Mc Gonigle KF, Kuykendall JL, Creasman WT. An experience with estrogen replacement therapy in breast cancer survivors. Int J Fertil Womens Med. 1999 Jun;44(4):186-92.

96. Guidozzi F. Estrogen replacement therapy in breast cancer survivors. Int J Gynaecol Obstet. 1999 Jan;64(1):59-63.

97. Stahlberg C, Pedersen AT, Lynge E, et al. Increased risk of breast cancer following different regimens of hormone replacement therapy frequently used in Europe. Int J Cancer. 2004 May 1;109(5):721-7.

98. Lundstrom E, Wilczek B, von Palffy Z, Soderqvist G, von Schoultz B. Mammographic breast density during hormone replacement therapy: effects of continuous combination, unopposed transder-mal and low-potency estrogen regimens. Climacteric. 2001 Mar;4(1):42-8.

99. Maunsell E, Drolet M, Brisson J, Robert J, Deschenes L. Dietary change after breast cancer: extent, predictors, and relation with psychological distress. J Clin Oncol. 2002 Feb 15;20(4):1017-25.

100. Patterson RE, Neuhouser ML, Hedderson MM, et al. Types of alternative medicine used by patients with breast, colon, or prostate cancer: predictors, motives, and costs. J Altern Complement Med. 2002 Aug;8(4):477-85.

101. Harris PF, Remington PL, Trentham-Dietz A, Allen CI, Newcomb PA. Prevalence and treatment of menopausal symptoms among breast cancer survivors. J Pain Symptom Manage. 2002 Jun;23(6):501-9.