New information about estrogen replacement and breast cancer.
For decades OBGYNs and oncologists have been denying estrogen replacement to women who have had ER positive Breast Cancer because they believed that estrogen would increase the risk of breast cancer recurrence…As of July of 2022, The National Cancer Institute has reversed the previous position that estrogen in local form for bladder and vaginal atrophic symptoms, and for the systemic form of estrogen would increase the risk of recurrence and death. Now the findings of the most recent study are that the replacement of estradiol in any form to postmenopausal women who are symptomatic (vaginal dryness, bladder infections and bladder irritability and urinary incontinence), as well as ERT for hot flashes, and depression in postmenopausal ER + breast cancer patients reveal that the risk of death and breast cancer recurrence is no higher among women who take ERT compared to women who take nothing!
In my OBGYNB residency and for my ACOG boards, I was taught that Estrogen replacement was dangerous for women who have had a positive family history of breast cancer, for women who have + ER, + Breast cancer in the past, and for women who are at high risk for breast cancer. The latest study repeals that belief!
This study finally does an “about face” to the previous belief that Estrogen Replacement Causes recurrence or a shortened life span. The newest study proves what I have seen in my gyn practice: patients taking ERT after non-metastatic breast cancer were safe and had the same rate of recurrence as women who took no estrogen.
In the latest study by the National Cancer Center found that estradiol benefitted women in general and was safe. The biggest difference between those women who did take estrogen after breast cancer and those who didn’t take estradiol was that women on estrogen had a normal sex life and lived a healthy quality of life, and those without estradiol did not. This finding is the same conclusion I came to by watching my patients with and without Breast Cancer, who took estrogen because of severe menopausal symptoms after non-metastatic ER+ breast cancer. Recurrence of breast cancer in my 29 years of GYN practice and in the 20 years of BioBalance Health® medical practice was no more common in those who took E2 replacement than women who took no estrogens after cancer!
Finally, research reveals, and I hope medical practice guidelines will soon include the OK to give estradiol of women at risk for Breast Cancer and those who have been successfully treated. The refusal of doctors to give women what they need after menopause and successful treatment for breast cancer has damaged many women’s lives…Doctors need to realize that quality of life is important and fear of non-documented beliefs just hampers the health and quality of life of their patients.
The article follows.
Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study
Søren Cold, MD, Frederik Cold, MD, Maj-Britt Jensen, MSc, Deirdre Cronin-Fenton, PhD, Peer Christiansen, MD, Bent Ejlertsen, MD
JNCI: Journal of the National Cancer Institute, djac112, https://doi.org/10.1093/jnci/djac112
Abstract
Background
Women treated for breast cancer (BC) often suffer genitourinary syndrome of menopause. These symptoms may be alleviated by vaginal estrogen therapy (VET) or menopausal hormone therapy (MHT). However, there are concerns of risks of recurrence of BC and death following treatment.
Methods
Our study included longitudinal data from a national cohort of postmenopausal women, diagnosed 1997-2004 with early-stage invasive estrogen receptor–positive nonmetastatic BC, who received no treatment or 5 years of adjuvant endocrine therapy. We ascertained prescription data on hormone therapy, VET or MHT, from a national prescription registry. We evaluated mortality and risk of recurrence associated with use of VET and MHT vs non-use using multivariable models adjusted for potential confounders.
Results
Among 8461 women who had not received VET or MHT before BC diagnosis, 1957 and 133 used VET and MHT, respectively, after diagnosis. Median follow-up was 9.8 years for recurrence and 15.2 years for mortality. The adjusted relative risk of recurrence was 1.08 (95% confidence interval [CI] = 0.89 to 1.32) for VET (1.39 [95% CI = 1.04 to 1.85 in the subgroup receiving adjuvant aromatase inhibitors]) and 1.05 (95% CI = 0.62 to 1.78) for MHT. The adjusted hazard ratios for overall mortality were 0.78 (95% CI = 0.71 to 0.87) and 0.94 (95% CI = 0.70 to 1.26) for VET and MHT, respectively.
Conclusions
In postmenopausal women treated for early-stage estrogen receptor–positive BC, neither VET nor MHT was associated with increased risk of recurrence or mortality. A subgroup analysis revealed an increased risk of recurrence, but not mortality, in patients receiving VET with adjuvant aromatase inhibitors.
Issue Section:
Breast cancer (BC) survivors often experience symptoms of declining estrogen levels. Adjuvant endocrine therapy, in particular aromatase inhibitors (AIs), may aggravate these symptoms (1,2). The urogenital system is particularly sensitive to estrogen deprivation, and genitourinary syndrome of menopause (GSM) often develops, including vaginal dryness, itchiness, burning, overactive bladder, and urinary incontinence (3). The American Endocrine Society concluded that level A evidence exists regarding the effectiveness of systemic or local hormone therapy in GSM (4). Vaginal estrogen therapy (VET) is well-tolerated and indicated for isolated GSM among healthy women (5). The use of menopausal hormone therapy (MHT) has been cautioned in BC survivors following demonstration of an increased risk of recurrence in the HABITS (Hormonal Replacement After Breast Cancer – is it Safe?) trial (6) and in the Livial Intervention following Breast cancer: Efficacy, Recurrence, And Tolerability Endpoints trial (7), though this association was not reproduced in the results published from the Stockholm trial (8). A small cohort study and a nested case-control study including a total of 340 women with early BC investigated the risk of BC recurrence associated with the use of VET (9,10). Neither showed an increased risk. However, the studies had several limitations, including small sample size and short follow-up. Therefore, it remains unclear whether VET or MHT is safe in women treated for BC (11,12).
Among women without a history of BC, a meta-analysis from the Collaborative Group on Hormonal Factors in Breast Cancer reported increased risk of primary BC among women treated with MHT compared with never-users, whereas VET was not associated with an increased risk of BC (13,14).
The objective of this observational cohort study was to determine the association of use of hormonal treatment (VET and MHT) with the risk of BC recurrence and mortality in a large population-based cohort of Danish postmenopausal women treated for early-stage estrogen receptor–positive (ER+) BC.
This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author. www.BioBalanceHealth.com • (314) 993-0963. Please subscribe to our YouTube channel and please check “ Like “. Follow us on Facebook and Instagram at BioBalanceHealth.
