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Present State of the Art
Re: Hormones and Diagnosis
A lot has been written on
breast cancer (BrCa) and
many women are savvy on the
disease and its diagnosis.
But there is a lot of
misinformation. In "1,000
words or less" here is the
latest update:
Who Gets It?
 Anyone
can. The average woman's
risk of getting breast
cancer (BrCa) before she
dies (usually of other
things) is 1:10. Most women
(80%) who get BrCa have no
"risk factors" (but
obviously, the other 20% of
BrCa sufferers come from a
much smaller segment of the
population).
What puts a woman at higher
risk: "First generation
relatives" (mother, sisters)
with the disease; very early
menarche and/or late
menopause (because of the
longer time exposed to the
higher estrogen milieu of
one's own ovaries); no (or
fewer) children--especially
if they weren't breastfed;
history of breast biopsies,
especially with "atypical"
findings. Also at higher
risk are women with a strong
family history of colon and
ovarian cancer.
There are dietary and other
predispositions: women with
diets high in fresh fruits,
veggies, grain and soy are
less likely targets compared
to their "fast
food/processed foods/meat'n'potatoes
counterparts. (Here again,
you are what you eat!)
Excess weight (releases more
estrogen), cigarette
smoking, alcohol excess and
physical inactivity are also
risk factors.
II. Types of Breast
Cancer
Luckily, most BrCa is very
slow growing (taking many
years from "first seed" to
distant spread), making
possible early diagnosis by
mammography and self
palpation and prompt therapy
before distant spread. A
couple of rare forms differ
from this norm (most notably
"inflammatory BrCa", which
can spread distantly in a
matter of months of its
first notice as a firm,
reddened area in the
breast).
Very interestingly, the type
of BrCa that may manifest
itself secondary to
post-menopausal hormone
stimulation is the most
benign and easy to cure.
III. Prevention
 It's
hard to argue with genes and
bad luck. That said, there
are a few things women can
do to level the playing
field:
Diets that are low in
processed foods and
saturated fats and high in
soy, grains, fresh fruits
and veggies are protective.
Breastfeeding (for at least
6 months) offers protection.
Whether this is secondary to
some physical or neuro-chemical
reason, or simply because
breast feeding lowers
internal estrogen levels for
a time is uncertain.
Not smoking or drinking
alcohol to excess is
protective. Although this is
not really prevention, you
can further even the odds by
early diagnosis, this is the
place for mammography and
frequent self examination.
Interestingly, taking
low-dose estrogen
supplementation for a short
(under 5 year) period of
time around or just after
menopause may offer a degree
of protection, especially
from the more virulent forms
of BrCa.
IV. Diagnosis
The operative word here is
EARLY.
Mammography, frequently
leading to directed biopsy,
picks up BrCa early,
frequently prior to
manifestation by palpation.
Conversely, however, if a
mass "feels disturbing" to a
qualified health care
examiner, a "negative"
mammogram should never delay
biopsy diagnosis.
 Coupled
with mammography, breast
ultrasound can help
distinguish cystic (usually
benign) from solid (more
worrisome) masses.
Most early BrCa's are picked
up by breast self-exam (BSE).
60% of masses picked up
relatively early are done so
by the woman herself; the
remaining 40% by health care
personnel. The ideal is a
"daily" shower or bath
palpation (to familiarize
oneself with the usual feel
of her breasts), plus a
periodic (every 1-2 months)
careful go-over and visual
inspection.
A new, available, and
scientifically proven
procedure called ductal
lavage can be added to the
diagnostic armamentarium for
high risk women. In this
procedure (which can only be
done in women who are able
to express a small amount of
milk or liquid from their
nipples with vigorous
self-expression), a tiny
catheter is threaded through
a duct in the nipple into
the breast, and actual cells
are rinsed out, frequently
leading to diagnosis in the
"precancerous" stage.
Who should be genetically
tested for BrCa? Women with
two first generation
relatives (or one first
generation relative plus
other high risk factors), or
women with strong family
histories of ovarian and
colon cancer may benefit
from the (expensive) testing
for BrCa-I and BrCa-II, the
genes which place their
"owners" at significantly
higher risk for breast
cancer.
A couple of different
"quasi-radiographic"
diagnostic procedures are in
the investigational pipeline
and may offer additional
hope for early
diagnosis--this remains to
be seen.
Hormones and Breast
Cancer
Traditional medical dictum
is that "hormones"
(estrogens) are a risk
factor for BrCa and that is
partially true. After a
woman's own ovaries and
comparatively high level of
estrogens they secrete (and
of course genetics) long
term and high dose estrogens
(via birth control pills or
traditional HRT at/after the
time a woman's own ovaries
cease functioning) are a
somewhat positive risk
factor for BrCa. The key
words are: a woman's own
ovaries, and "long
term--high dose."
It is now known (from meta
analyses of over 45 long
term studies involving more
than 750,000 women) that, as
a blanket statement,
estrogens do not cause BrCa.
In fact, if a woman with a
previous history of BrCa
("breast cancer survivor")
takes short-term (for sure 2
years or less and probably
less than 5 years) low dose
HRT (e.g., to help with
severe peri–menopausal
symptoms), she has a
decreased risk of dying from
both BrCa and cardiovascular
diseases than a woman who
does not take estrogens!
They key is: short-term, and
low dose. The key is
understanding and
individualization. The
hormones a woman's own
ovaries secrete are far
greater risk factors for
BrCa than short-term, low
dose estrogen
supplementation. But this
new knowledge will take a
while to "sink in." For a
woman who is truly worried
about a negative impact of
estrogen on her breasts, the
negative psychic stress
effect of a daily hormone
dose on her immune system
certainly may outweigh any
possible beneficial effects
of the hormone.
Certainly also, there is
great promise in SERM's
(Selective Estrogen
Receptive Modulators),
synthetic compounds which
certainly give the same bone
and cardiac protection as
estrogens and at the same
time significantly lower the
risk of BrCa. The problem
is, the presently available
SERM's (Raloxifen, Tamoxifen)
do not in any way help
menopausal symptoms--in
fact, they make them worse.
However...the whole ballgame
will soon be different with
FDA approval (expected in
1-2 years) of a new
generation of SERM's. One of
these, Tibolone, has been
used in Europe (under the
trade name Livial) for more
than a decade. Not only does
it have the same protection
as other SERM's, but it
helps with menopausal
symptoms as well.
It is certainly hoped the
FDA will approve it soon
(it's been in the "pipeline"
for years...)
Article courtesy of
Dr. Michael Goodman
www.caringforwomyn.com
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