Archive for breast cancer

Oct
25

Are You Confused About Getting A Mammogram This Year?

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There are now new guidelines regarding the frequency of mammogram screening, and yes, this debate continues to go on!

These recommendations however, are backed by most professional medical organizations. The American Cancer Society agrees, and that carries a lot of weight.

These newest recommendation apply to women of low risk, and include starting age 45 instead of 40; and having a mammogram yearly until 55 yrs of age. At this point, women are recommended to have a mammogram every other year until within 10 yrs of life expectancy (when the average woman dies); then they can stop. The new recommendations recommend against monthly self breast exams, and against your medical provider doing breast exams.

If you are at high risk, ie have a family history of breast cancer or a personal history of cancer as well as some unhealthy life style practices; you are recommended to discuss your screening with your provider.

  • In other words, if you have had a sister, mother, daughter with breast cancer; you are at higher risk and need to be screened more regularly and start a little earlier.
  • If you have had any other cancer, you are considered at risk for future cancers from other sites; so you are at higher risk.
  • If you smoke, drink more that 10-14 alcoholic drinks a week (ie 12 oz beer, 5 oz wine, 1-1.5 oz liquor), are in the obese weight category, and are not active; you should get regular screening.

Many providers, myself included, do not agree with the lack of provider breast exams. I personally, will not give that up in my clinical practice. A lump is a lump and how are you going to know it is not cancer unless it is found and evaluated?

The reason for this shift in recommendations involve trying to minimize aggressive and fear inducing procedures and treatments for abnormalities that ultimately are benign or so slow growing they will not impact longevity. Cancer occurring in the 40′s and early 50′s are felt to be more aggressive and faster moving.

One major and important organization, the American Congress of Obstetricians and Gynecologists  do not agree with these new recommendations.

They feel screening should begin at age 40 and continue yearly, no end point specified. They still approve of self breast exams and yearly provider exams.

What do I, as a provider, recommend? Somewhere in the middle.

I do agree with yearly exams in the 40′s and 50′s. As stated above, if I see a woman for a yearly female exam, she is getting a breast exam. Self breast exams are fine every other month or so. It is probably ok to skip a year here and there with mammograms if someone is low risk. If a woman has no family history or personal history of cancer, but her healthy habits are not good; I will recommend yearly mammograms. I feel it is likely safe to stop screening in the late 70′s for most healthy women who expect to live well into their 80′s.

This is my take on the new recommendations. Let me know what your experiences, questions and thoughts are!

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Apr
25

Mammograms and Fear: is avoidance an option?

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Breast cancer is scary, no getting around it. It is especially scary when we know someone who has struggled with it.

Mammograms are painful, more painful for some of us than for others. Add pain to fear, and it is no surprise many of us avoid the ordeal all together.

The most current recommendations for mammogram screening recently published by the USPSTF call for women to have screenings begin at age 50 and occur every other year. Beginning screening at 40 is at the discretion of the individual, taking into account their concerns and risk factors. These recommendations are contrary to the American Cancer Society, and the American College of Obstreticians and Gynecologists(ACOG).

One in six women with develop breast cancer in their 40′s, and there has been a 35% drop in breast cancer death since the mid 1980′s. This coincides with the regular use of mammograms for breast cancer screening. It is no wonder the two most learned medical societies on the subject do not agree with these recent recommendations.

When you are at higher risk for breast cancer, avoiding your mammogram is not really a good option. Sure, it is your choice to not get a mammogram. If you are at risk though, and you cannot change that risk; doesn’t it make sense to be proactive? To catch something before it is a big problem?

Avoiding the problem will not make it go away, but it may make the problem more profound when it lands on your doorstep.

Sure, there is a lot of confusing information about the benefit of mammograms. Many screening tests can bring up abnormalities that need to be evaluated, and are found to be benign. So now we have pain, fear, and extended fear over a false positive mammogram finding. I understand the desire to avoid testing all together.

There are steps you can take however, to help avoid some of the pain and some of the fear.

1. If you are at high risk for breast cancer, talk to your provider about having an MRI performed instead of mammography. It is more accurate, and less painful; but unfortunately not always covered by insurance.

2. If you have dense breast tissue but do not qualify for MRI, get a 3D mammogram. It is more accurate in looking at abnormal appearing dense breast tissue.

3. Bring a friend to your screening test to give you emotional support.

4. Decrease your risk factors: cut down on alcohol, exercise and optimize your weight, stop smoking, reduce the consumption of toxins in your water and food.

It is often women with several family members with breast cancer that are most fearful, for good reason. If you know someone like this who avoids screening altogether, lend them your support. Encouraged them to get a mammogram, it could ultimately ease their minds!

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Oct
26

Ways to Reduce Your Risk of Cancer-Naturally

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October is Breast Cancer Awareness month; a time we women can think about our risks for breast cancer and how we can reduce them. A time to share our thoughts, knowledge and experiences with friends and loved ones.

According to experts, breast cancer is lower in countries with more of a plant based diet. The same experts state that diet is responsible for 30-40% of all cancers!

Researchers here in the US have not yet been able to link a higher fat diet with a higher rate of breast cancer. A study is ongoing however, the WHEL -Women’s Healthy Eating and Living study, looking at the effect of lifestyle and eating on the risk of breast cancer. This study will not be finished for a few more years. A similar study is ongoing in Europe, called EPIC-European Prospective Investigation into Cancer. It is involving over 500,000 people in 10 countries; and looking at the link between lifestyle and cancer.

We do know however, that being overweight and drinking alcohol heavily, and maybe even moderately; are 2 lifestyle habits that are associated with an increase risk of breast cancer. This HAS been shown in studies.

It is all about the immune system, and that IS how you can take control. Eating a healthy diet full of important nutrients, such as you get from fresh fruits and vegetables, gives your body what it needs to support a healthy immune system. A diet low in foods with added chemicals or pesticides, reduces the chance of unhealthy cell changes that may promote cancer. And maintaining a healthy weight with reduced fat, also reduces the amount of estrogen that fat cells are known to emit.

A recent study has suggested that women with healthy diets and weights prior to a diagnosis of ovarian cancer, had a better success rate with treatment and lower mortality in the years following diagnosis. This information was collated from data of the Women’s Health Initiative. It is felt this is related to a more vibrant immune system in women with healthier diets.

There are several simple steps you can take to improve your diet:

  • Buy one new vegetable every week you grocery shop, and experiment with different way to prepare, cooked or raw.
  • Add chopped vegetables to soups or spaghetti sauces, either home prepared or jarred.
  • Eat your fruits, don’t drink them. This gives you valuable fiber and reduces chance of unhealthy additives.
  • Trim fat and remove skin from meats and poultry to reduce unhealthy fats
  • Use less salad dressing. Even try some of the yoghurt bases salad dressing now in markets. I have tried several and they are very good, usually located in the produce part of the market, no the usual salad dressing isle.
  • Think of your plate divided into 1/3 section. Meat or protein on 1/3, vegetables on 1/3 and whole grains or beans on a third. Or, 2/3 s veggies, 1/3 protein.
  • Reduce your portion sizes of protein to total of 6 oz a day
  • Limit your alcohol. Alcohol is basically a sugar. Healthy limits are no more than 7 beverages a week for women, with a serving size of 4-5 oz of wine, or 1 0z of liquor, or one 12 oz beer (not IPA as the alcohol content is higher in many IPA beers) So MEASURE your wine glasses to know how much you are actually getting when you pour! A huge goblet filled to the top is not 1 serving.

Take this month of October to decide if you are serious about improving your immune system and sustaining your health for years and decades to come.

Start with one suggestion above and work on it. When you have integrated this into your routine, and you no longer need to think about it because it is automatic; start on the next item you feel you can, and need to change.

Making long lasting and important changes need not be done overnight. If you can, great!

Most of us however, have to start slowly and deliberately. I know you can change, I have seen it daily in my work in medicine. When the motivation is there, the power is there, and the will is there.

Find your power and motivation to make needed changes, and work to escape the risk of cancer.

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Oct
12

Know What You Need to Know-Breast Cancer

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Part of being smart about your medical care and problems, is knowing the drugs, and the studies that prove the drugs work.

There are numerous breast cancer treatments, and most university or major hospital systems will treat according the current guidelines, ensuring consistency in quality treatment. Studies are done to see what combinations of chemotherapy agents work best with a specific cancer cell types. Now, it is also possible to see if you are genetically suited to have a specific treatment work for you, tailoring this therapy even more specifically for you.

I hope you never have to get to know the names of these drugs, but if you do; it is important to become familiar with what is considered the standard effective therapy for your type of cancer. Studies continue to be ongoing as researchers are committed to finding a cure for the specific cancer they are studying. Many of these researchers have a personal stake in finding a cure, a relative or loved one with the very diagnosis they are researching. That is powerful motivation.

Powerful motivation also comes in the form of doing what it takes on the part of patients, to live another day, week, and even years. To someone looking from the outside in, some measures seem desperate; only giving a few months longer survival. Wondering if the pain of treatment is worth only a few months longer of survival.

Exciting news on exactly this issue came recently from Spain regarding a study looking at the combination of chemotherapy agents to treat a certain type of breast cancer. The use of Herceptin along with Perjeta increased survival by an additional 15 1/2 months! That is powerful if you are that patient, waiting for more and better treatment and cure.

The HERS2 positive breast cancers that responded to this treatment is a specific type occurring in roughly 1 of 5 breast cancers. It is a protein produced by the cancer cells due to a mutation, that promotes the growth of cancer cells.

I hear many people voice the opinion that if they ever got cancer, they would not want to subject themselves to harsh chemotherapy. They would try for quality of life. I understand that feeling, however those feelings often change when it is you getting that diagnosis. Most of us are truly not ready to give in and give up when we are in our 50′s, 60′s and even 70′s.

The cancer research community is truly bonded together to find the best treatments and cures. Most of these researchers know each other, speak to each other, are connected professionally. Be informed about what will help you . The American Cancer Society webpage is an excellent resource, as well as the National Institute of Health website that lists ongoing clinical trials.

Receiving a diagnosis of breast cancer is terrifying and shocking. Find some time to come to terms with this news, and talk to loved ones. You will need someone to travel this journey with you, get them on board early.

Read about your specific type of tumor and learn what is considered the standard diagnostic testing and treatment, and take notes along the way. Question your provider about your treatment plan, ensure they are holding to the standard of care.

Enlist people to help you understand the diagnosis, treatment and success of treatments. Have one of your smart computer savvy relatives do computer searches on the best treatments. Find out what research protocols the medical centers around you are enrolled in. Many will be lined up with other university and large research systems, sharing information on successes and failures.

Remember to take care of yourself with plenty of rest, healthy nutrition, and get some exercise. These life style habits have been shown to boost response to treatment and survival. Take charge of this where and when you can. It will help you feel in control.

 

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Jul
28

The Decision to Have a CPM

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Hopefully the decision whether to undergo a CPM is not a need or priority for you.

I am talking about a contra-lateral prophylactic mastectomy.

The diagnosis of breast cancer can be devastating for a woman and her family. The diagnosis carries with it the fear of dying a painful death, not living long enough to fulfill life’s dreams, all in addition to fear of disfigurement.

Treatment for breast cancer has advanced tremendously in the last several decades. Because of the ability to tailor effective treatment through genetic testing and hormonal receptor testing, women often have choices between undergoing a lumpectomy in place of a mastectomy. The difference between having a small amount of tissue removed, or the entire breast.

The staging of a woman’s breast cancer often dictates when a mastectomy is preferable over a lumpectomy. In some cases, with some factors contributing to the potential aggressiveness for recurrence, such as BRCA testing; removal of the non involved breast is recommended. But this is not the usual case.

It comes as some surprise to breast cancer experts that there is an increasing trend for contra-lateral prophylactic mastectomies in young women with early stage breast cancer. The reason is not known..

The fear of breast cancer can cause a women to desire surgery quickly, as in now. Many women immediately begin to consider having the non affected breast removed. CPM rates have almost tripled in recent years.

A recent study has looked at the benefit for contra-lateral prophylactic mastectomy (CPM), and benefits for the most part are few. Granted, researchers are looking at the end point of increased survival; which I guess is what it is all about. Will I live longer if my other breast is removed?

But what is the chance of cancer in the non-affected breast with a diagnosis of cancer? Between 3-9% of women with a non BRCA gene mutation breast cancer will go on the develop breast cancer in the healthy breast.

It is not the usual course, but it happens.

There are many types of breast cancer, and I review them extensively in this prior article. While having cancer of most any kind increases your risk of other cancers, one kind in particular is strongly associated with occurrence of other cancers. So strong that specialist strongly encourage women with the BRCA gene mutation to have a mastectomy of the non cancerous breast. While it is reassuring that this type of breast cancer is unusual and only accounts for 5-10% of breast cancer; the fear of recurrence in the healthy breast is a fear hard to dismiss if you have a diagnosis of breast cancer.

While many women will not get breast cancer, not screening is not an optimal way to avoid the issue.

Even if you are not at risk for breast cancer, I want you to do one thing for me.

Schedule your routine screening mammogram if it has been longer than a year. If you have dense breast tissue, talk to your provider about having a 3D mammogram for screening in place of routine mammogram. This is more sensitive and lessens false positive results, or abnormality scares.

And if you are at risk for breast cancer; definitely schedule a mammogram, probably a diagnostic or 3D mammogram for greater accuracy in screening.

Scary as it is, early detection decreases the chance of spread and perhaps invasiveness of disease through early treatment. We hope the early detection increases and lengthens survival, offering a cure.

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Jan
12

Escape the Code!

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Think it is impossible to escape your genetics? Are you destined and resigned to end up looking just like one of your parents, or Aunt Sally or Uncle Benny?

An interesting study looking at just that was recently released to the news. This research is centered on the genetic risk of breast cancer, and possible explanations for healthy members within clusters of families with strong histories of cancer.

Having a family history of  the BRCA1 and BRCA 2 gene mutation significantly increases a woman’s risk for developing breast cancer. This specific gene mutation is only responsible for some of the incidences of breast cancer. Researchers have been looking at other factors explaining this cluster of familial cancers. This has led to the exciting research regarding epigenetics!

It just may be possible to some degree, to escape your genetic code!

Genetic code is in all of our cells and it is the blueprint from which our cells, organs and bodies will work. Epigenetics is the machinery that actually turns on or turns off this blueprint. It can, and will determine what happens within your cells and your body.

Researchers and scientists are talking about something called methylation. This methylation process can prevent cancer from growing in certain situations, or help it to grow in other situations. It depends on the where in the body it is working, how much methylation is happening, and what is actually making it work.

It turns out that a decrease in the healthy methylation process may be responsible for aging. This decrease of healthy methylation can lead to hyper or hypomethlyation, which can then promote growth of cancer cells. This type of decrease is considered a somewhat natural process associated with normal aging. It then seems that certain life style habits can cause the wrong type of over methylation, leading to problems with glucose metabolism and also to cancer.

Getting back to the study I mentioned above. Unaffected women from high risk families with breast cancer were found to have different methylated blood cells when compared to affected family members. Researchers are not sure yet what this means, but it suggests a changed expression in the genetic code.

Another recent study regarding the incidence of breast cancer in British women revealed another surprising difference. White women residing in the UK were noted to have a higher incidence of breast cancer compared to South Asian women and black women, also residing in the UK. This difference was attributed to a higher consumption of alcohol and decreased amount of breast feeding by white women as compared to women of other ethnicity. When these habits were removed from the equation, the rate of breast cancer was equal throughout the different groups of women.

Diet has been shown to affect the expression of cells, specifically a diet low in folic acid is associated with gastrointestinal malignancies. Use of opiates, nicotine, and over use of alcohol have all shown  changes in cells leading to cancer through abnormal cell repair and DNA expression. This is the route believed to allow cancer cells to grow. Exercise has shown to elevated protective chemicals within our bodies which help prevent this abnormal methylation process.

Why are we talking about this? Researchers are beginning to identify the different affects healthy and unhealthy habits have on the incidence of disease. This empowers us to make decisions that allow us to take more control of our health and hopefully, longevity.

You may not be destined to develop diabetes or heart disease as you age, you may not be at risk for cancers. It may be possible to escape your genetic code by choosing certain habits that are beneficial to your epigenetics.

Think back on all the good advise from our mothers or fathers regarding healthy habits. Teachings such as eat your vegetables, get enough sleep, no drinking to excess or smoking at all; they were talking epigenetics!

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Jun
02

New Recommendations for HRT

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Hormone Replacement Therapy has been both embraced and vilified over the last decade and more. It was once considered the magic potion to keep women young, until the Women’s Health Initiative published some of its’ findings in 2002.

The WHI raised significant concerns regarding the safety of HRT in terms of breast cancer and cardiovascular health. This large study seemed to indicate an increase of breast cancer with HRT users, as well as an increase in stroke and heart attacks. Use of HRT has plummeted, and many women have suffered through the menopausal transition too afraid to ask for relief from their providers.

In a turn of attitude, new recommendations have been released in the UK. British researchers have re-analyzed much of the WHI data, as well as data from the Million Women’s Study; and found that some of the conclusions were possibly faulty. This has also been an increasing thought of researchers in the US.

To summarize possible misconceptions from the WHI, the slight increase risk of cardiovascular events with use of HRT was mostly confined to women who started HRT after the age of 60. HRT is felt to inflame cholesterol plaque which had formed in the years following menopause. Starting HRT at the time of menopause is not felt to increase risk of heart attacks or strokes in low risk patients.  A Danish study actually showed a lower risk of heart events when started early following menopause.

There still remains concerns shared by all menopausal researchers regarding the association between breast cancer and prolonged HRT use. A slight increased risk after 5 years of use of estrogen and progesterone has been seen in many studies. Use of estrogen alone has shown no increase in risk and in some instances a decreased risk. The problems with estrogen use alone is the increased risk of uterine cancer, a risk well known and studied extensively. Therefor, estrogen use alone for menopausal women is confined to women who have had a hysterectomy.

The current recommendations of the UK is to individualize the decision to take or not take HRT for your menopausal symptoms; rather than follow a blanket guideline recommendation. It is also recommended to consider HRT if your menopausal symptoms are significantly interfering with your life. The decision regarding HRT safety for you will depend on your personal history of cardiovascular health, as well as your family history of this and of cancer.

Here is how I think of HRT use. If should and can be considered if:

  • You are significantly impacted by menopausal symptoms in terms of mood swings, hot flashes, insomnia, muddled thinking and fatigue.
  • You are having difficulty with your work and daily chores because of these symptoms
  • You do not have a personal history of female cancers (breast, ovarian, uterine,vaginal), and possibly colon cancer (there is a genetic link)
  • You do not have a strong family history of any of these cancers ie. no mother, sister, daughter
  • No strong family history of heart disease ie. no family members had stroke, heart attacks, blood clots before the age of 50-55
  • You have never had a heart attack, stroke, blood clot of any kind and you had no problems with hormonal birth control use if ever used
  • Use of non equine estrogen (no premarin) and natural progesterone in low risk situations described above can usually be safely used for up to 5 yrs.
  • Use of estrogen patch and prometrium (natural progesterone) is felt to be safest combination, and I recommend tapering off in 3-5 years.
  • If you have had a hysterectomy for non cancerous reasons like fibroid, heavy menses; then estrogen patch alone is usually safe for 5-8 yrs but I recommend tapering off by 10 yrs.
  • If you are going to use HRT, I feel regular mammograms are a must. It is not the perfect screening tool but it is the best we have at this point. If you are going to do something that may increase your risk of developing a problem, you would be wise to screen for that problem and catch it early.

I am an advocate for HRT use in the safe and proper setting. I used it myself for 2 years at the onset of menopausal symptoms and it helped me cope with hot flashes, sleep deprivation and fatigue. My menopause came early, 45 yrs old, and took me completely by surprise! I tapered off when the findings of WHI came out because of the initial concerns this study raised; even though I am at low risk for cancer and cardiovascular illness. My own journey since then has focused on controlling symptoms though healthy diet and exercise, time for relaxation to promote sleep, and occasional use of herbs to help with sleep. After 10 yrs and more, I still get hot flashes but they are mild.

Every women’s journey through menopause is different. We have some similarity of symptoms, but the degree to which symptoms affect us are variable as is our ability to cope. Thus the need for an individualized approach!

 

 

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Nov
29

THERMOGRAPHY FOR BREAST CANCER SCREENING

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It seems that almost weekly, there is a new study or analysis of a study questioning or extolling the virtues of breast cancer screening. Several decades ago, the medical community was repeatedly encouraging women to get breast cancer screening, all in an effort to lower the death from breast cancer. Treatments were admittedly severe with total mastectomy, radiation therapy causing severe side effects, and harsh chemotherapy.

Breast cancer treatments have come a long way since then, and many women are successfully treated for breast cancer without disfiguring surgery or devastating radiation and chemotherapy. We may be tempted to attribute this improvement of treatment with earlier detection, and that may be the case for many women.

Many advancements include identifying specific cell types and tailoring treatment towards that cell type. This is where some of the controversy has arisen. There’s one type of cancer, called DCIS (ductal carcinoma in situ) that many women have been treated for and perhaps unnecessarily so.

Specialists initially felt this cancer type was as potentially life threatening as any type of breast cancer you may think of. It turns out however that this type is unlikely to ever progress beyond a localized tumor. This has caused many studies and data crunching to evaluate whether mammograms have actually lowered the breast cancer death rate.

It is clear that the final answer is not in yet. I suspect a more stratified evaluation guideline will eventually emerge regarding when and how often to get mammograms, and how having a higher risk for this disease will change that testing algorithm. For now however we are stuck with getting yearly or bi-yearly mammograms. I cannot help but believe that in many circumstances, a mammogram can discover a cancer earlier than it otherwise would have been discovered. In so doing, treatment would theoretically be kinder and gentler than the mastectomies and blasting radiation and chemotherapy of the 70′s and 80′s.

An interesting new study has introduced the use of a modality that is still somewhat controversial within the conventional medical community. It has been considered an alternative testing strategy, but this study raises its value.link to study***

Thermoscans have been around for a while and utilize the heat of blood flow to look for areas of growth within breast tissue. It does not use radiation, but an infrared technology. A growing cancer requires a blood supply that is otherwise not present to that degree in normal breast tissue. There for, an increased heat signal could indicate a growth. This will hopefully become a more accepted screening method within the medical community as it may give different information from standard mammograms.

Regardless of your personal feeling regarding breast cancer screening, it is wise to speak with your provider about your risk factors and determine a schedule and modality that is safe and effective for you.

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Nov
02

Mammograms and Breast Tissue Density

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Mammograms are part of most women’s health screening if they are over 40. Mammograms are never enjoyed, often feared for the information they may give forth; but usually endured on a regular basis. Woman are often relieved, if not happy; when they get their letter stating everything is fine for another year at least. Until now, most women were not routinely told if their breast tissue was dense and may limit the sensitivity of mammogram screening.

Mammograms detect a cancer by evaluating the density of normal breast tissue, and looking for an area of higher density which may represent an area of growth. Normal breast tissue is usually not all that dense by the time we are menopausal, and this is a normal changing associated with age.  Any area that appears more dense than most the surrounding tissue is then felt to be abnormal, perhaps suspicious for a cancer. This is one reason that mammograms in younger women are usually not very good at picking up a cancer, as the breast tissue in younger women is usually fairly dense.

There are some women that do maintain density in the breast tissue as they age. Estrogen is one of the causes of breast tissue density, so it stands to reason that late onset menopause can cause breast tissue to remain dense because of prolonged amounts of estrogen in the system. For the same reason taking HRT can also cause breast tissue density. This, in and of itself is not a problem; except for the fact that screening accuracy can be affected.

If you have dense breast tissue, and you are at increased risk for breast cancer; you may want to talk to your provider about different forms of breast cancer screening such as MRI or ultrasound of a specific lump or mass. It is now required in some states that a patient be informed if her breast tissue is dense enough to limit sensitivity of screening.

Mammograms continue to be a useful and sensitive screening tool for detection of breast cancer. Like anything though, it has its’ limitations. They may be painful and a dreaded event; and many specialist would point out the amount of over diagnosis that a false positive mammogram causes. It is up to you and your provider what you do for screening and how often this screening occurs.

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The North American Menopause Society, NAMS,  has recently released a new position paper on the use of hormone therapy during and following menopause. An analysis of several studies and data has shown that hormone therapy is not as dangerous or onerous as believed 10 years ago after the initial release of the Women’s Health Initiate study results.

The Women’s Health Initiative was designed to determine if HRT was cardioprotective; as well as to help determine if HRT caused an increase in breast cancer. This study was stopped prematurely due to an increase in cardiovascular events including stroke, heart attack and blood clots. Hormone therapy was quickly blamed for this increase in cardiovascular events, and consequently usage has plummeted.

You may be asking what is new about all this information?

Researchers have been continuing to analyze the data from this study, and have come to some conclusions which have helped guide NAM’s new position paper. This is what they have determined:

  1. Most cardiac events occurred in women over 60 who were placed on hormone therapy 10 or more years after menopause.
  2. Women who underwent hysterectomy and were placed on estrogen without progesterone had a lower rate of breast cancer, therefore taking estrogen for up to 7-8 yrs was not associated with increase risk of breast cancer.
  3. However, HRT started at time of menopause was associated with slightly higher risk of breast cancer than when started a few years post menopause.
  4. Women on estrogen therapy (ET) and estrogen/progesterone therapy(EPT) had lower rate of cardiovascular events when HRT was started at time of menopause, as opposed to several years post menopause.
  5. The types of estrogen and types of progesterone may influence risk of breast cancer and cardiac events.

What does this mean for you?

The recommendations suggest that you can expect the have your hormone therapy customized to your particular medical situation,  including consideration for your risk for breast disease and heart disease.

For those of you who have had a hysterectomy, you could reasonably take your estrogen therapy for up to 7 years without significantly increasing your risk of breast cancer.

For those of you who still have a uterus, you would want to limit your use of HT for 3-5 years. After this, your risk of breast cancer increases.

The type of progesterone therapy may affect the risk of cardiovascular events. A natural progesterone, such as Prometrium, may have significantly less risk than synthetic progesterone, for both cardiovascular events and possibly breast cancer.

The route of delivery of estrogen may lessen the risk of HT. Topical estrogen, or estrogen patches may have less risk of thrombotic events; than oral estrogen.

Estrogen is the most effective therapy for vulva and vaginal atrophy, with topical vaginal cream, ring and suppositories being superior to oral estrogen.

Compounded Bio-identical hormones should only be used if an allergy to a component of federally approved estrogen or progestin hormone therapy exists. These compounded hormones have not been tested and may contain levels of hormones or ingredients that are harmful. For this reason,  safety cannot be established as clinical trials proving safety have not been performed.

Hormone therapy can be very helpful when you are first experiencing menopausal symptoms. Now, with this statement paper, there is more guidance on safety of HRT use. Compounded Bio-identical Hormones are very popular, but their safety has not been establishes in the types of studies that this position paper discusses. There are many safe options for women that include patches, creams as well as pills; and this allows flexibility in dosing. This is is a form of customization.

This is information that you can use when you see your medical provider. Write in and share your own experience with HRT and whether or not it has helped, and even which preparation you used (your information is anonymous to our readers). It is through sharing information that we can enlighten one another about menopause and strategies to ease the common problems.

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