Where Do We Go From Here?

Key Points About Breast Cancer & Other Hormone Related Cancers

1. More deaths occur from heart disease than the next 16 causes of death combined including diabetes, all cancers, AIDS and accidents
2. A first pregnancy before age 25 protects against breast cancer
3. Dense breasts on mammography increase risk of breast cancer
4. Small breast cancers less than 2.1 cm (2.5 cm = 1 inch) have a lower mortality than large breast cancers
5. Positive family history occurs in only 15-20% of women with breast cancer but is an indication for closer monitoring and possible genetic testing
6. Bad estrogen” byproducts increase risk of breast cancer, ovarian cancer and uterine cancer
7. Good estrogen” byproducts lower risk of breast cancer, ovarian cancer, and uterine cancer and lower the risk of heart disease

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Screening: The Importance of Early Detection

Tumor size greatly affects mortality. The smaller the tumor, the more likely it is to be confined to the breast and therefore more responsive to treatment. In a study of 83,686 cases of women with primary breast cancer with tumor sizes ranging from 0.3 cm to 5 cm, and no lymph node involvement, the smallest tumors were associated with a mortality of 10% while the larger tumors were associated with a mortality of 25%. In women with tumor sizes ranging from 0.3 cm to 5 cm and positive lymph nodes, those with the smallest tumors had a 20% mortality and those with the larger tumors had a 40% mortality. Studies show improved mortality when breast cancer is detected as a small lesion, especially if it’s less than 2 cm.

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Risk Factors You Can Modify To Decrease Your Risk of Breast Cancer

Obesity

Obesity and weight gain during adult life increases risk of postmenopausal (but not premenopausal) breast cancer because fat tissue increases estrogen levels. The adverse effect of obesity on breast cancer is strongest in women who do not use HRT. In the Nurses’ Health study, women gaining 22 pounds or more after menopause increased their risk by 18% while losing at least 22 pounds lowered their breast cancer risk by 57%.

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DEDICATION

Breast cancer is the most feared health problem for women.  In a previous blog, I’ve pointed out that women experience more deaths each year from heart disease and strokes than breast cancer. I’ve given you specific data on the absolute risk of breast cancer.

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When a woman goes through menopause and her ovaries stop producing estrogen and progesterone, the pituitary responds by increasing FSH, a hormone from the pituitary gland that has regulated these hormones throughout her reproductive life. However, when all the eggs have been depleted, no further estrogen or progesterone can be produced. Nonetheless, the pituitary, which is “hard-wired” to respond to low estrogen, continues to make increasingly higher levels of FSH.

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“Outliving Your Ovaries” is a must read for every woman. Not only because it demystifies so many controversial and conflicting views in treating menopause, but mostly because one can put that book down and feel absolutely empowered! Women can now have the intelligent and informed conversation with their doctors about their bodies that so many of us have struggled to have.

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I am frequently asked the question, “How long can I safely stay on my hormone therapy? and I usually ask the woman, How long do you want to continue to feel well?” In all seriousness, there are no long-term studies that enable me to answer this question. Taking hormones less than five years seems to carry very little risk. However, the longer you take hormones the higher your risk.

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