Past History of Breast Cancer
Patients with past history of breast cancer should not have estradiol or estrone recommended for estrogen supplementation. These estrogens play a role in causing breast cancer by damaging DNA. Estriol is the protective estrogen that is high during pregnancy. It does not activate the estrogen receptor, but occupies the receptor sites so that it is not available for estradiol. Hormone balance is important, and testing of hormone levels is recommended prior to supplementing. For post breast cancer patients, many medical practitioners do not recommend hormone supplementation, except for progesterone, unless hormone levels are well below normal and symptoms are severe. Use of hormones should be carefully tracked by both patient and doctor.
Here's what we suggest:
- Estriol should be recommended (2 mg twice a day)
and is thought to reduce the risk of breast cancer recurrence. For atrophy
of vaginal tissues and urethral problems in post breast cancer patients,
a compounded estriol cream (.5 mg/gram applied topically 2 - 3 times
a week) is considered safe.
- Progesterone has the effect of down regulation
of estrogen receptors in breast and uterine tissue.
- Testosterone has been reported in some studies
to have an anti-carcinogenic effect on breast cancer cells and in clinical
studies has demonstrated increased survival rates for patients receiving
testosterone vs. those who did not.
- Arimidex prevents aromatization of testosterone to estradiol and
aromatization of androstenedione to estrone. The ATAC study has documented
Arimidex as better than tamoxifen or placebo for early-stage, hormone-receptor-positive
breast cancer. The early ATAC results do suggest that Arimidex might
have benefits over tamoxifen, but the decision to start taking Arimidex
instead of tamoxifen is not clear-cut at this point.
Two things we know about Arimidex:
- Arimidex and tamoxifen should not be taken together. There
appears to be no proven advantage to the combination over tamoxifen
or Arimidex alone, and you may have side effects from both drugs.
- Aromatase inhibitors have no proven role in pre-menopausal
women diagnosed with breast cancer.
- Indole-3-Carbinol prevents conversion of 2-hydroxyestrone to the
carcinogenic 16-hydroxyestrone and 4-hydroxyestrone.
Drug therapy recommendations:
- Estriol 2.5 mg + Progesterone 100 mg + Testosterone 1.25 mg. Take
one sublingual tablet twice a day.
- Arimidex (anastazole) 1 mg tablets. Take one everyday.
- Indole-3-carbinol 400 mg. Take one capsule daily.
Certainly a person with an estrogen-receptor-positive tumor is at much
higher risk with estradiol treatment than an estrogen-receptor-negative
tumor. However, both types of tumors have an elevated risk of recurrence
with estradiol treatment.
My thoughts are that a patient with a history of estrogen-receptor-positive
tumor should DEFINITELY be on Arimidex for life! She also should not receive
estradiol, of course. The other hormones (except DHEA) are fine. The downside
for women at risk of breast cancer is that DHEA can convert to estrogen
and has a stimulatory effect on breast cells, particularly when estrogen
is low. Close watch on overall hormone balance levels is required, and
testing is recommended every 6 months. In terms of estrogen receptor negative,
I would say that Arimidex is probably not a must.
High Risk for Breast Cancer
A patient with a high risk (based on the Gail Model) for breast cancer
would benefit from supplementation of estrogen and progesterone with human
identical hormones in ratios similar to those in the human body.
Progesterone is recommended for benefits of fluid balance and protection
against cancer. Progesterone has the effect of down regulation of estrogen
receptors in the breast.
Patients are also likely to benefit from estriol with its potential
for protection against breast cancer recurrence due to its low estrogenic
activity, which possibly results in binding to estrogen receptors without
stimulation of receptor. This is recommended in a higher ratio of estriol
to estradiol than the typical ratio seen in Biest (80%/20%). For patients
with a higher risk for breast cancer, we recommend 90%/10% estriol/estradiol.
We also recommend Indole-3-Carbinol to prevent conversion of 2-hydroxyestrone
to the carcinogenic 16-hydroxyestrone and 4-hydroxyestrone. This will
provide additional protection against breast cancer and should be considered
in the patient with positive family history.
Drug Therapy Recommendations:
- 90% estriol/10% estradiol sublingual tablet. Take one under the tongue
twice a day.
- Progesterone 100 mg sublingual tablets. Take one under the tongue
twice a day.
- Indole-3 Carbinol (Cervaplexx I3-C) 400 mg. Take one every day.
In response to the book "The Sexy Years" by Suzanne Somers,
we have not found in the last 12 years any significant increase in insulin
resistance with continuous therapy. I do not feel it is necessary to cycle
therapy if you have been in post-menopause for over one year.
Lastly, in most instances it will be rather difficult for patients to
find an endocrinologist in their area to work with them and natural hormone
therapy. My suggestion for women would be to use your regular OB-GYN and
contact us if the patient needs assistance.
- Hoover R. Gray LA Cole P. et al: Menopausal estrogens and breast
cancer. N Engl J Med 295:401-405, 1976.
- Smith LH, Gordon GS Medical staff conference: Postmenopausal osteoporosis.
West J Med 125:137-142, 1976.
- Halberstam MJ: If estrogens retard osteoporosis, are they worth the
cancer risk? Mod Med 45:9, 15, 1977.
- Speroff L: The breast as an endocrine target organ.Contemp Obstet
Gynec 9:69-72, 1977.
- Gold JJ: Figure 5-7 in Gold JJ (ed). Gynecologic Endocrinology, ed
2. New York. Harper & Row Publishers Inc. 1975, p.67.
- Ryan KJ: Biosynthesis of ovarian steroids, in Danforth DN (ed): Textbook
of Obstetrics and Gynecology, ed 2. New York. Harper & Row Publishers
Inc. 1971, pp131-134.
- Yen SSC, Martin PL, Burnier NM, et al: Circulating estradiol, estrone
and gonadotropin levels following the administration of orally active
17 b-estradiol in postmenopausal women. J Clin Endocrinol Metab 40:518-521,
- Thijssen JHH, Poortman J, Schwarz F, et al: Post-menopausal estrogen
production with special reference to patients with mammary carcinoma.
Front Horm Res 3:45-62, 1975.
- Lauritzen C: The female climacteric syndrome: Significance, problems,
treatment, Acta Obstet Gynecol Scand 51 (suppl): 49-61, 1976.
- Lauritzen C: The management of the pre-menopausal and the post menopausal
patient. Front Horm Res 2: 2-21, 1973.
- Bulbrook P.D, Swain MC, Wang DY, et al: Breast cancer in Britain
and Japan: Plasma oestradiol-17b, oestrone and progesterone and their
urinary metabolites in normal British and Japanese women. Eur J Cancer
- breastcancer.org - A non-profit organization for breast cancer education
discusses Arimidex (ATAC Trial). http://www.breastcancer.org/research_hormonal_120001a.html
- AstraZeneca Oncology - Breast Cancer Healthcare Professional summarizes
the Arimdex (anastrozole); ATAC Trial http://www.breastcancerprofessionalinfo.com/atac-study.htm
- Medscape: ATAC trial: Aromatase Inhibitors in the Adjuvant Setting:
Available Data. http://www.medscape.com/viewarticle/424077_5
- Lemon HM: Estriol prevention of mammary carcinoma induced by 7, 12-dimethylbenzanthracene
and procarbazine, Cancer Res 35:1341-1353, 1975.
- Gail MH, Brinton LA, Byar DP, Corle DK, Green SB, Schairer C, Mulvihill
JJ. Projecting individualized probabilities of developing breast cancer
for white females who are being examined annually. J Natl Cancer Inst
- Costantino JP, Gail MH, Pee D, Anderson S, Redmond CK, Benichou J,
Wieand HS. Validation studies for models projecting the risk of invasive
and total breast cancer incidence. J Natl Cancer Inst 1999;91:1541-1548.
- Indole-3-carbinol(13c) and Dindolylmethane (DIM) abstracts: http://www.integratedhealth.com/infoabstract/i3cab.html
Read more questions and answers about natural hormones in the Ask The Pharmacist area of the site, or E.mail Pete Hueseman directly. A toll-free number is provided on the resources page.
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