Breast Cancer and Hormone Replacement Therapy

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Dr. Maupin answers questions about hormone replacement in patients with breast cancer, or high risk of getting breast cancer.

At BioBalance we have been treating women who have had ER positive breast cancer with Testosterone Pellets for 20 years Testosterone pellets improve their quality of life and actually decreases their risk of recurrence.  This fact has been proven not only by research but by our experience.  We believe that quality of life after cancer is very important and we not only believe that testosterone replacement is helpful to improve sex drive, muscle mass, skin texture, and other symptoms of aging, but also treats the symptoms of estrogen deficiency safely.

The first thing patients have to deal with when told that they have Breast cancer is how to treat it.  There are many opinions about what treatment is the best and how much treatment is needed.  In my 39 years of diagnosing and following the treatment of breast cancer patients, the history was that doctors started by throwing the kitchen sink at even the earliest smallest cancer and not only prescribed either radiation or radical surgery, and chemotherapy.  We have been working our treatment path away from these radical therapies to an individualized therapy based on the aggressive nature of the cancer and severity or spread of the cancer.  We should have done this long ago and we would have helped more women regain their sexuality and their self-esteem, but this is how the practice of medicine works.

I always have to go through the process of putting myself in the shoes of the patient I am talking to and ask myself what I would do if this was me with this disease. I have had a love hate relationship with chemotherapy for Breast cancer unless the cancer had metastasized and chemo would improve life expectancy at least 50% over other treatments. In many cases, Chemotherapy is lifesaving, but it also caused so many side effects and impaired the immune system which can cause a second or third cancer somewhere else down the line.  I would make sure if I had the cancer that before I took the advice of a surgeon or a medical oncologist, I would weigh the effectiveness AND the side effects of each treatment mode for my stage of cancer.

In addition to knowing the numbers of the effectiveness of a breast cancer therapy, and weighing the real risks, I would want to know the risk of long-term damage to my immune system and how much disfigurement I would have to endure afterwards.

Many women make the decision for which treatment they receive when they are in shock over their diagnosis. They don’t hear or can’t think through the fact that removing your breasts without provision for reconstruction, or radiation damages the skin so much that no reconstruction is possible after the fact. I can’t tell you how upset my patients have been when they have chosen a treatment that is more radical than their cancer justified, based on the emotion of fear, without understanding the side effects until it was too late.  A woman’s breasts are extremely important to her self-esteem therefore preserving them and or reconstructing them after mastectomy is extremely important. It is because of this issue, that in 2001-2002 I sponsored a bill with our new Governor Holden who passed it into law by executive order.  This new law required insurance companies to pay for the reconstruction of breasts that have to be removed to treat breast cancer.  In Missouri, the passing of that bill made all the difference to women who have been disfigured with mastectomies to treat their cancer, and many states followed our state’s law.

I can tell you that my logical plan to treat estrogen positive breast cancer would be to have the following treatment If I developed breast cancer: I would have a biopsy to confirm the type and the spread of my cancer, allowing the biopsy of one axillary node, to avoid the side effect of lymphedema in that arm that comes with removing many nodes.  Then, if necessary, I would have a mastectomy with nipple sparing surgery and reconstruction at the time of mastectomy.  If I had ductal breast cancer, I would have a bilateral mastectomy because it is often bilateral, even if it is not visible at the time of the first surgery.  I don’t want to worry about breast cancer in my remaining the rest of my life!  If it was contained in the breast tissue that was removed, I’d be able to lead a normal life and take Testosterone and Anastrazole to block the testosterone from converting into estrogen.

Chemotherapy has been recommended for patients who have low grade, and stage or early breast cancers to improve a patient’s survival as little as .1%!  Because taking chemo increases your risk of other diseases and cancers it should give you an appreciable survival advantage to take that risk.  Always ask your oncologist how much your survival will be improved by taking chemo.  You will have your own number to accept chemo…I would have to have 33% improvement in my survival to take traditional chemo.  Taking aromatase inhibitors which is oral chemo-like therapy, is often recommended and has very few side effects if you take testosterone pellets with it.

Another treatment for breast cancer is radiation. It is often disfiguring and the damage to the skin can’t be fixed with plastic surgery, so I would only do that if there was spread to the lymph nodes, or for a recurrent cancer.   Chemotherapy should be reserved for those women who have metastasized and need it to save their lives. The question you should ask your oncologist is what % will chemotherapy increase my survival? If it is minimal, I would think twice before going forward.

In the NE Journal of Medicine December 16, 2021 they agree with me about the course of treatment not requiring chemotherapy if certain criteria are met: If a woman has ER positive Breast cancer and has 0-3 axillary nodes positive and a recurrence score < or = to 25 they can forgo chemotherapy without a negative impact on disease free survival.

 This solves the Cancer treatment portion of the equation, but what should you do about those symptoms of estrogen deficiency that women experience after menopause? The answer for my patients is NOT nothing, because if you do nothing you are making a choice! Try testosterone pellets and minimal estrogen cream to the vagina for lubrication. The small amount used on the vagina will not be absorbed into the body enough to stimulate the estrogen receptors of cancer cells.

Testosterone pellets have been found to address the symptoms of menopause, and to improve the number and function of the immune cells called T cells (cancer killing blood cells), and stimulate T cell activity to kill cancer cells of all kinds.

If you have been given the advice that you cannot take T after you have ER + breast cancer, then get another opinion…the cancer doctor’s goal is only to keep you cancer free but they usually have no concern about your quality of life, and the research they read is not about improving your symptoms of estrogen and testosterone deficiency.  The relief of these symptoms is not on their radar, but it is definitely worth trying T to relieve your symptoms of menopause.

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author. 993-0963.

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