HORMONE THERAPY, HORMONE REPLACEMENT AND BREAST CANCER (Dr Burman)

This excellent Belgian/ INSERM  October 2007 review is explicitly about HORMONE THERAPY and breast cancer BRCA. and the risks of long-term (>15years) higher dose oral estrogenic THERAPY, and PROGESTIN,  and  ORAL androgen THERAPY,  for increasing the risk of BRCA  (but if anything reducing the risk of death from all causes including BRCA).

The review mentions  the safety of PROGESTERONE, but does not otherwise discuss either physiological human estrogen or androgen REPLACEMENT i.e. HRT.

           (Post) Menopause and Andropause (Androgen deficiency in men) are, like pituitary, hypothyroidism, adrenal, pancreas and parathyroid failure,  Hormone DEFICIENCY states, which have been uniformly treated for a century now with PHYSIOLOGICAL HORMONE REPLACEMENT i.e. HRT.

         For HORMONE DEFICIENCY STATES (excluding hormone resistance or other  eg collagen/allergic/ gynaecological diseases ),
We have always replaced approximately the normal daily hormone output by the most physiological route –
orally in the case of thyroid, cortisone   and melatonin, otherwise parenterally as with egg   SHR, insulin, HGH, vasopressin, erythropoeitin etc.

         Dozens of reputable clinics on all continents have used such physiological HRT including sex hormones (SHR) for hormone deficiency   for up to  40-60 years in many patients, and no-body of note  (in Canada, USA, UK, Europe, Australia, South America, South Africa, Asia) has ever  reported such physiological  systemic SHR to any pathology, let alone increased cancer.

           There is no paradox – disease is linked both to DEFICIENCY and to EXCESS of anything. As we have long discussed and Foidart ea repeat, Henderson ea since 1980 observed that the INCIDENCE (but not mortality) of breast cancer increases when HTs (oral estrogens)  are continued beyond about 15 years, ie exceeds about  5 grams of estradiol equivalent.

           It is common cause that  stilbestrol (DES)  (and Estinyl)  are vastly more potent than human estrogens, hence the marked increase in BRCA in the thousands of women given DES  for even just a few months of pregnancy in the  criminally infamous Chicago 1950 trial, let alone the increased breast and vaginal cancer in their daughters, and now problems in their granddaughters.

           That is why, on physiological  and safety grounds, we recommend only balanced human hormone replacement  HRT for chronic PREVENTION in hormone deficiency states.
We must keep asking ourselves: why treat postmenopause  hormone deficiency differently from men, when it has long been recognized that even men are best treated for gonadal deficiency with appropriate  physiological systemic  human testosterone?.
The commercially driven   North American tradition of convenient oral xenohormones (premarin, progestin) established by Wyeth et al by their buying the support of  the FDA, Masters, Wilson et al is no reason to go on forcing such xenotherapy on women, and blocking them (as the FDA is trying to do) from obtaining physiological HRT as is used for all other hormone deficiency states –  and sex hormone deficiency affects 100% of women from midlife. Unassailable evidence has been freely available for thirty years of the inferiority of xenohormones (including sex hormones) over physiological human hormones, but of course the New Drug Industry (apart fom Schering AG) and thus their front, the FDA, have done their  best to suppress this.

            This has little to do with PHARMACOLOGICAL THERAPY with eg corticosteroids for inflammatory disease, or HT (as traditional gynaecology uses)  for eg contraception or gynaecologic DISEASES.

               And this principle of physiological human hormone replacement HRT for all deficiency disease  does not gainsay that lower dose oral estrogen  HT eg appropriate estradiol 1mg/day for up to 10 years in the Oulu Trial (Heikkinen 2006) appears to greatly reduce all longterm disease, just as premarin in similar dose 0.625mg/day for up to 7 years reduced all diseases and mortality by 1/3  when started appropriately soon after menopause in the Womens’ Health Initiative, and the Nurses’ Study.  These studies do not disprove the Henderson  evidence  that  the threshold for promoting presentation of breast cancer  is a total cumulative  dose of about 5gm estradiol ie >3.4gm premarin.   It will take more than a  century   of systemic estraddiol at 50-70mcg/day use for a women to achieve such estrogen megadose  exposure.

              Given the evidence of uniform longterm preventative good from continuation of youthful  balanced  appropriate systemic estradiol-progesterone-testosterone  post menopause for up to and over 40 years in many women and men (eg Greenblatt; Greenblatt, Gambrell, Karpas; Schleyer-Saunders, Whitehead, Studd;; Nieschlag & Behre; Moller & Hansen;  Davis & Burger; Davey D  et al),  there is more physiological and observational data (in men, women and primates) to support the longterm use of appropriate balanced human SHR for multisystemic protection than there is for the use of oral xenoHT for even five years.

So we must at least give women the choice – of physiology-based evolutionary natural replacement, or (in Bill Masters’ words in 1957) convenience patent xenotherapy.  For the past century  (in fact millenia)  the evidence and thus Internists favour physiology. Random brain trephining, clitoridectomy, routine ulcer gastrectomy, hysterectomy, tonsillectomy, coronary artery stenting have come and gone. But appropriate hormone replacement- especially of sex hormones- will endure.

NDB  200711  Appropriate Hormone Replacement Group.

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