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Can you take estrogen
if you have had breast cancer? I
receive a lot of mail from women who have had breast
cancer. They want to know what they can do to relieve disturbing hot flashes
and other perimenopausal symptoms.
A very common problem is a women who has had breast cancer successfully treated with
surgery and/or radiation therapy or possible chemotherapy. If such a woman suffers
perimenopausal symptoms such as hotflashes,
many physicians are reluctant to prescribe estrogen.
(see interview on the use
of Effexor for hotflashes)
 Sue:
Is there any scientific evidence to support this practice or can all or some subset of
these women receive estrogen and/or progesterone supplements?
 Dr. Goldstein:
Sue, You have touched on a very complex although increasingly common problem.
Premenopausal women with breast cancer successfully treated who then go through a natural perimenopause/menopause can have
very disquieting symptoms. Traditionally such patients and most physicians have absolutely
felt that estrogen was contraindicated. Increasingly, there are some observational studies
that suggest that the use of estrogen for short term relief of symptoms in such patients
is not associated with an increased rate of recurrence or death.
Case by Case Basis:
My feeling is that each patient must be taken on an individual case by case
basis. Certainly length of time since the tumor was diagnosed and treated is an important
consideration. Recently I had a patient who was 5 years since her breast cancer diagnosis
and treatment. She was having transitional symptoms which were so disturbing to her life
function that low dose estrogen for a short period of time was absolutely appropriate. If
such a patient had been simply 12 or 18 months since successful treatment, one would not
have had such a comfort level.
I pointed out to her that although breast cancer can recur
after 5 years the majority of patients who do poorly will do so in the first 5 years.
After 5 years although one is never "cured" from breast cancer one has to begin
to make plans for the rest of ones life. It not only includes health benefits but often
relief of symptoms that are quite disruptive to normal day to day life.
Sue:
If estrogen/progesterone preparations can be used in these women, then how does the
following affect the recommendation? Does estrogen/progesterone receptor status (positive
or negative) of the tumor affect the answer? What about people who are node positive
vs. node negative on their axillary node dissections? What if they have metastatic disease
e.g. cancer spreading to the bones?
Dr. Goldstein:
Although there is not abundant scientific evidence good medical judgment and
common sense would dictate that if the tumor were estrogen receptor negative one has a
greater comfort level taking estrogen (although not totally) and if there were no positive
nodes as opposed to positive nodes one also has a slightly greater comfort level using
estrogen as outlined above.
In the case of a patient with metastatic disease for an
instance to bone it becomes much more problematic. Certainly metastatic disease is a poor
prognostic sign for long term survival. One must weigh the quality of life that one is
experiencing on a day to day basis with the ultimate odds of survival. This relates to my
initial and loudest advice, that is, this must be done on a case by case basis.
Sue , its great talking to you.
Taking Estrogen & Breast Cancer
Question:
My friend is a cancer survivor, double mastectomy. She is hormone receptor positive and
wants to know if she can take the Cenestin
without harmful effects to her under her current situation?
Right now she is cancer free.
Dr. Goldstein:
Answer: "There is no data to support doing or not doing it. If she is
very symptomatic (hot flashes,
etc.) and she has had both breasts removed, it might be appropriate. If she is
asymptomatic and only concerned about health benefits (bones, heart, etc.), Raloxifene is a better choice."
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HotFlash FAQ:
HotFlashes and Breast Cancer
What if you
can't take estrogen?
 
For women with breast cancer with hotflashes, taking estrogen
is not an acceptable form of therapy, because it can make the cancer worse. Loprinzi has
found Effexor to be the best non-hormonal therapy for women with hot flashes and breast
cancer. Not only did the participants in the study have less flashes, but they also
had a better sense of well-being and sleep better.
Find out more
 Estrogen
& Breast Cancer
Stephanie Bender, MA, the author of Power
of Perimenopause says about the risk of breast cancer in women taking estrogen,
"We consider how the woman is feeling and what her risk of developing long term
disease is- like osteoporosis
and heart disease. There are many
estrogen products and they can be used in very small doses to give women good
results."
 Estrogen & Cancer?
Dr. Susan Love's
Breast Book
by Susan M. Love, Karen Lindsey, Marcia Williams
 
see ou
interview with Dr.Love
hosted by Sue Spataro
This fully revised edition of Dr. Love's important book reflects every major new
development in breast care, screening, diagnosis, treatment, and research. 
Every chapter has been brought up to date to include the newest information on silicone
implants, the reliability of mammograms, genetic risk factors, environmental hazards,
diet, hormone use, and more.
 newly revised for 2000!
Could It
Be...Perimenopause?
by Steven R.
Goldstein, Laurie
Ashner
 
 see the interview with Dr
Goldstein
In clear, supportive prose, Goldstein offers no-baloney advice. "Today's
perimenopausal women has neither the time nor the patience to go through four to fifteen
years of symptoms without relief," he says. He fully delineates the roles of various
hormones, how to determine if you're in perimenopause or not, as well as how to treat the
various symptoms to gain control over your life.
The Estrogen Alternative:
What Every Woman Needs to Know About Hormone
Replacement Therapy and Serms, the New Estrogen Substitutes
by Steven R. Goldstein,
Laurie Ashner
Most women know the benefits of estrogen replacement after menopause: It reduces the risk
of osteoporosis, heart disease, even Alzheimer's disease. Many are still reluctant to take
it, because it increases the incidence of breast and uterine cancer. Find out more. |
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