This is NOT medical advice. I am a plastic surgeon, not an oncologist. But as I do a lot of breast surgery, including breast reconstruction, and as I am seeing friends my age (50s) getting breast cancer, the question is can you give hormone replacement to women who have had breast cancer?
The even asking of the question seems blasphemous.
We routinely give breast cancer survivors Tamoxifen and other anti estrogens to reduce their recurrence of breast cancer. But I am reading this book Estrogen Matters, and in it the author cites many facts and studies which challenge the idea of you cannot give estrogen to breast cancer survivors.
He brings up the point that most women survive their breast cancer. Health professionsals need to figure out how to improve their symptoms of menopause and general health.
Some interesting points:
- Removing ovaries in women with premenopausal breast cancer did not affect recurrence.
- Women who have pregnancies (high hormone levels) after breast cancer do not have higher rates of recurrence.
- There was a study done where women with cancer were assigned to estrogen, tamoxifen, or placebo. The estrogen and tamoxifen arms were protective about equally, and both were better against recurrence than placebo.
- He goes on to cite 10 studies all over the world which show HRT and estrogen do not increase breast cancer recurrence.
So what did show a risk? Why are we so focused on anti-estrogens?
The WHI study (which had many issues. please read my blog), a ton of lawsuits fueled by “mass media, not good science,” and the HABITS study led to the anti-hormone replacement view.
The HABITS study was in Sweden. A prospective double armed study: HRT vs. not. After 2 years, with 434 enrollees, it was stopped. 26 women in the HRT group had a breast cancer recurrence, where only 7 in the nonHRT group did. There was no difference in metastasis or risk of death. In 2008 they repeated the study. Again, it showed HRT with higher breast cancer rates: 39 vs. 17. There were no recurrences seen in women who had positive lymph nodes, no difference in distant mets, or risk of death. NO new breast cancers were seen in women taking estrogen alone.
They only saw it in women on HRT who were ALSO on Tamoxifen.
So there is dissent within medicine. “Of the 20 studies published between 1980 and 2008, only the HABITS study found an increase in breast cancers among women on HRT, and ONLY if they were also on Tamoxifen.”
Conclusion?
This is a contentious point still in medicine. There are many benefits to estrogen- skin, heart, brain, bone. There are studies indicating no increased risk of recurrence, some which actually show a decreased rate of recurrence, and a few studies and the oft repeated dogma of “hormone replacement therapy for a breast cancer patient in malpractice.”
Hormone replacement has benefits. And it has risks.
I guess what I have learned from my research is that the issue is not so black and white. What seemed like a crazy notion- giving hormone replacement to a woman who has had breast cancer?!? is perhaps not so crazy.
You are the one who lives with the ramifications good and bad. You need to make the choice.