As any woman going through perimenopause and menopause knows, estrogen seems to be a super hormone.
But hormone replacement seems to be a minefield, and the common teaching is that is bad for breast cancer. I am reading a book, “Estrogen Matters” by Dr. Bluming. On its cover it makes shocking claims. “Estrogen does not increase the risk of breast cancer.” (Which I agree with.) “Even breast cancer survivors may safely take HRT under a doctor’s supervision, and it will not increase their risk of recurrence.” (WHAT?! Then why do women go on Tamoxifen and other antiestrogens?)
This book came highly recommended to me. I am trying to read it with an analytical mind. I am interested because we plastic surgeons deal a lot with the breasts- breast reductions, breast lifts, breast augmentations, and breast reconstruction after cancer. As a woman who has to have yearly mammograms, with many friends my age already having had breast cancer, and the statistic 1:8 will get breast cancer, it is an important topic. And estrogen seems to have many good effects on the body- heart, bone, brain.
So can you, should you, do hormone replacement therapy?
What IS the risk for breasts?
This will be a multipart blog series. Clearly there are books upon books on the subject. I was surprised how this book tries to shake up the dogma I was taught in my training. Early in my career there was a giant study of women on hormone replacement, and the study was aborted as they found too many women having issues. So for the majority of my career, I have been taught hormone replacement is bad.
He starts the book with some interesting thoughts:
- The risk for a woman getting breast cancer in the next decade at age 30 is 0.4%, at 40 is 1.5%, at 50 is 2.4%, and 60 is 3.6%, and 70 is 4%. That is what gives the cumulative risk to 12%. He states that if you are 60 without being diagnosed with breast cancer, your risk is only 7.6% (12- the percentages for the prior decades that you are already passed.)
- If estrogen were a cause of breast cancer we would expect rates to decline after menopause
- Many women with estrogen receptor positive breast cancers “assume, understandably, that this means that estrogen is somehow feeding the kind of breast cancer they have.” He goes on to state that estrogen receptors usually means the breast cancer is growing slowly enough to have a normal cell and that in “most breast cancers estrogen receptor positive cells are not the ones proliferating.”
My thoughts?
I’m reading on. I am not sure I can agree with his stats on the rates of breast cancer risk. I hear him state that the risk is low. But I remember being with a bunch of friends from college and there were 8 of us. 8 women. Somehow we got to talking about health and did you get your mammogram? and I said don’t blow it off- statistically one of us will get breast cancer. The stats are 1 in 8. There were 8 of us. Within the next year one of us did get cancer. Two years later another did. So already we are past that statistic. Are we not a representative group? We did have kids later, or no kids at all. Are we just brainwashed to feel like breast cancer is lurking everywhere? Are my friends just unlucky?
I do not think estrogen causes breast cancer, but I did think it was like giving it miracle-grow if you had a cancer that was estrogen receptor positive. We TREAT breast cancer patients with Tamoxifen and other antiestrogens. The news that the estrogen receptor positive cells are not the rapidly growing part of the cancer is news to me, and I don’t know if that means the estrogen receptor positive cells aren’t cancer? Or are they a nicer gentler but still cancer?
More blogs to come.
But what I am gleaning from all my research is that this is not as black and white as I was once taught. Also on the book cover is that women on HRT live on average several years longer than those who did not take it, 7x as many women die of heart disease as die of breast cancer annually, and the same number of women die following hip fractures as die of breast cancer but HRT cuts this risk in half.