It’s October, better known in women’s health as Breast Cancer Awareness Month. There is a lot of public awareness that goes towards cancer research, prevention, and treatment. All of which is so important. Just this week I have had multiple patients who are receiving bioidentical hormone replacement tell me that they were warned not to take estrogen because it can lead to breast cancer. One was told by a local obgyn and another by a friend who works for an obgyn in Dallas. I could understand if this misinformation was coming from a non-medical professional but when it comes from an ob/gyn…
Just this month, Menopause, a prominent journal in women’s health, published a study that looked at whether oral versus transdermal estrogen differed in lowering the risk of breast cancer. The researchers had already concluded from the WHI Study (a very large multicenter prospective cohort study-this type of study is the best type of design for a research study) that “women on estrogen therapy had a significantly lower breast cancer risk compared to those with placebo. Furthermore, in women who developed breast cancer, the risk of dying was lower in women who took estrogen compared with those on placebo.”
This study wanted to see if women who took oral estrogen versus transdermal estrogen had a difference in lowering the risk of breast cancer. They found that women who used transdermal estrogen did have even a lower risk of breast cancer compared to those that took oral estrogen. Now, this doesn’t change anything in the clinical setting. I already almost always use estrogen in a non-oral route. My patients are given it via a cream or pellet. I have been using this route for years because estrogen taken orally has to go through the liver for metabolism. When it goes through the liver for metabolism it does increase the risk of blood clots and stroke. Although a minimal increase, why even take the chance when you can totally avoid it by using it on the skin or under the skin bypassing liver metabolism. It also increases the level of a bad form of estrogen called estrone (a whole different topic to discuss later).
So to conclude, women should NOT be concerned about estrogen increasing their risk of breast cancer because it actually lowers their risk of breast cancer. If they were to get breast cancer, they have a lower risk of dying if they were taking estrogen. When you take estrogen you should take it either in a patch, cream or pellet. If your doctor or friend scares you that estrogen increases your risk of breast cancer, tell them they need to catch up on the published hormone literature over the last 10 years.
I will be posting more information in the future about why women should not take Provera (synthetic progestin) for menopause symptoms. Why Provera increases risk of breast cancer. Why all women 40 years and older should take DIM. Hint…DIM lowers Estrone (bad estrogen) made predominantly in fatty tissue or when women take oral estrogen.
Finally, our prayers are with all women who are battling breast cancer right now. May you have the strength to get through your treatments and perseverance to overcome!