fresh from HealthSpan Life
A physician asks : What are people’s thoughts on bioidentical estrogen use in a woman who has recent history of breast cancer?
it is now common cause that the main trigger for activating dormant breast cancer nests is not estrogen but progestin:
in the premarin-only arm of the WHI (2004), there was 28% lower incidence of invasive BRCA in the women aged 50-69 at start (and 44% less CHD, 36% fewer deaths in the women starting under age 60y); so the feared major ADVERSE endpoints after HRT – athero/thrombosis, and breast cancer- are largely related to progestin, age of onset of HT, and dose..
Prof Fred Naftolin of NYU- former head of ObGyn and then professor in Biology at Yale – has a (surely not the) final word quoted below- in essence :
dont quibble over the type or route of estrogen for HT, or what has/ has not been “proven” by big medium-term trials- appropriate ERT is major benefit after treatment of breast cancer.
It is easy to see the wood and the trees:
There have been no long-term controlled trials of any drugs for any condition except metformin- the UKPDS for 20yrs, a mean of 13.5 years.
The million-year evolution of “beautiful young people” on parenteral human testosterone estradiol and progesterone, and 60 years’ careful observation of safe use of appropriate bioidentical and equine estrogen aside,
only oral estrogen has been proven (in >5year trials) to do wonders in reducing morbidity and mortality long-term, even from breast cancer (in the WHI 2004 paper on solo oral conjugated equine estrogen CEE when started appropriately from menopause; the 1990s Breast and Colon Cancer trial- Dr Bernard Fisher ea; and the Oulu trial 2006 with oral estradiol +- synthetic progestin). Similarly, physiological systemic testosterone replacement has shown if anything an antiproliferative effect on breast tissue in trials in both women (Zhou & Dimitrikakis); other primates (Clarkson; Zhou & Dimitrikakis); and rodents (von Schultz).
The landmark Wake University primate trials (Clarkson ea 1995-2007) show the CVD benefits of early postmenopausal (but not late) systemic estradiol plus progesterone, and oral CEE but not synthetic progestin; but adverse effect of oral CEE on breast proliferation.
Significant medium – and long-term benefit has not yet been shown in controlled trials in postmenopausal women for progestins including progesterone, nor for a single plant-sourced (phyto-)estrogen – and who is going to fund such a costly trial since both kava and black cohosh have killed when used for menopause symptoms.
The current KEEPS trial under way (Harman, Naftolin ea) will soon show what balance of benefit and harm there is between 450mcg a day oral premarin or 50mcg a day estradiol patch or placebo, (with or without parenteral progesterone) in young postmenopausal women. This trial, in women well under 60yrs, albeit (in comparison with the WHI) small and only for 5 years, will to a great extent largely resolve the unwarrantedly acrimonious secondary debate over oral vs parenteral and human bioidentical vs oral xenohormone ie horse estrogen. Unlike the obvious difference (seldom subtle) between good and bad, there are many good alternative routes to Rome or health, the differences being mostly superficial – like between man and woman.
ndb (Preventative, Gonadopause) Internist
—– Original Message —–
From: “Naftolin, Frederick” <Frederick.Naftolin@nyumc.org>
To: “Neil Burman”
Sent: Saturday, December 06, 2008 6:44 PM
RE: Bioidentical estrogen use with breast cancer?
Estrogen has an enviable record in treatment of the post-BRCA subject. Their prognosis is ~ the same as being one clinical stage lower.
Replacement hormones should not be used in women with active BRCA; rather the hormones should be part of an integrated program of treatment of the post-BRCA subject.
Professor of Obstetrics and Gynecology
Director, Reproductive Biology Research
Co-director Interdisciplinary program in Menopause Medicine
New York University School of Medicine