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Shae's avatar
Shae
Member
3 months ago

Hormone Replacement Therapy?

Hi all — I’ve been reading a recent research- esp. from the US, including the book Estrogen Matters, which questions the idea that women with breast cancer should automatically avoid Hormone Replacement Therapy (HRT), and how it can help with longevity etc. 

I’m planning to speak with my doctor about it, but I’m curious — has anyone here looked into this or discussed HRT after breast cancer with their team?

Would love to hear your experiences or any studies/resources you found helpful.

7 Replies

  • Hi Neets, thank you so much for your wonderful response; not only for the benefit of Shae and I, but also for all the other women who will not feel so alone in what is generally characterised by oncologists as an extreme position. Of course making out it’s an extreme decision (not to take Tamoxifen or aromatase inhibitors) as opposed to an informed and entirely appropriate life choice is a good device. It allows specialists to avoid answering the questions of the (“greater unwashed”) who don’t possess a medical degree and therefore have no place questioning current medical orthodoxy. Professional arrogance is alive and well.

    As you mention, we need to ask questions and advocate for ourselves. However It’s not always as easy as it sounds. I was supporting my father through palliative care while going through BC treatment. Normally capable of questioning and pushing back I felt diminished, rushed and intimidated in my short, sharp, and perfunctory oncology appointments. Having BC is a vulnerable time for us all and understandably there’s a desire to just place yourself in the hands of the team (of complete strangers) and trust them entirely.

    My oncologist was always running more than an hour late and I even felt pressured by the knowledge that there was a waiting room full of other women behind me looking at their watches and worrying about getting back to work, childcare etc. I did a fair bit of preparation to ready myself not to merely accept the Tamoxifen prescription and to ask questions. Yet the specialist made me wait in glacial silence for a response to the simple question of “what is the statistical likelihood of recurrence in my specific case. Finally as I walked towards the door his tone changed and he said almost jovially that I’d made a perfectly reasonable decision. 

    The medical profession, particularly specialists have a knack of being entirely certain about many things that actually have no evidentiary basis. History amply demonstrates that doctors are often highly resistant to evidence that their deeply entrenched beliefs about medicine are wrong. A stark case in point being mid 19th century surgeons ignoring germ theory, offended by the notion that they themselves could be causing deadly infections in their patients. Bloody aprons were a status symbol of an experienced surgeon, rather than a sign of poor hygiene. The surgery mortality rate remained high throughout the 130 years that surgeons actively resisted washing their hands. 

    So we come to the question of why we are still stuck with breast crushing machines called mammograms, grotesque biopsies and harrowing hook wire procedures. It’s easy (and convenient) to blithely discredit new technology and let’s face it, there’s huge costs involved in introducing it. There does however need to be more public open discussion and major patient representation about it. Let’s speak up for progress, get behind the Doctors Reform Society (DRS) and other such reform bodies; unless of course you personally feel adequately represented by the AMA. 

  • Hi Shae, Sorry that I’m late into the thread. I am also a reader of Estrogen Matters and my BC was found to be ER/Pr+. After Mastectomy my oncologist strongly recommended I take Tamoxifen but after querying the benefit I was advised it would improve my likely recurrence in 15 years by 3%. So no way was I going to compromise my quality of life for the next 5 years+ for 3% “insurance.” 

    I stopped taking HRT as advised but unfortunately the horrible menopause symptoms came back. The hot flushes, sweats and sleeplessness began to take their toll and the last straw was the very low mood. Normally an early bird who exercises 4 mornings a week, I found myself waking up crying, drenched in a sense of hopeless. 

    I decided to go back on HRT. I feel great now and am very happy with my decision.

    What does my oncologist think of my decision? Well, my review is next week so I’ll let you know after that. I’ll try to get an estimate of what my increased ‘perceived’ risk is. I say perceived because there is no research on the matter. I’ve now met two other women who went back on HRT after ER/Pr+ BC and neither of them were ‘game’ enough to admit that to their oncologist. I totally understand that as no-one enjoys getting a ‘dressing down’ from someone who doesn’t live in their body or have any apparent empathy for their day to day suffering. 

    I’m not here advocating HRT for people with ER/Pr+ BC. I’m happy to offer myself and my specific case to science to be tracked over time to aid evidence based information. If the medical fraternity tracked women choosing this path rather than shaming them, we might get some actual information to base our decisions on.

     

    • Neets's avatar
      Neets
      Member

      Hi FlatNina & Shae

      I am pleased to hear that you too asked about the benefit, if any, of taking Hormone Therapy for ER/PR+ I did also, and was told via a Predict test/survey that my Oncologist I saw for that appt did, taking in the details of my 2 early breast cancers ILC right breast & IDC left breast  & advised from the data & research, the benefit would be 1% for the next 10 years! Why would I do it? I would not have been told this, nor you, I believe had we not asked about the perceived benefit, which is very concerning & disappointing. I can only imagine the number of women taking Hormone Blocking Therapy and suffering the many side effects some short term but others much longer and quite debilitating & long lasting for very small gains if any, and if they would have chosen to take it if they were told of possibly a very small % of benefit, for their particular circumstances for their cancer.

      I have not read the book Estrogen Matters but have listened to many Oncologists including its author and Hormone specialists mostly in the US on all matters to do with Estrogen & Progesterone. There are different types of Estrogens & how they play out in the body are different, with 1 type actually being cancer preventing! I have not taken HRT, I am 55 and was diagnosed with early breast cancers at 54, about 13-14 months after my last period. Menopause has been challenging mostly with the insomnia and 10-12kg weight gain, I would trade to have more hot flushes, unpleasant as they are instead of the insomnia & weight gain. Lately however, I have been considering some form of hormone treatment for my insomnia because I know what damage not having enough restorative sleep has on the body long term & most likely linked to why I cant shift the weight. I will need to do a lot of research to find the right open minded and well researched specialist for this, because like most new & evolving information and research, it takes time to be recognised and implemented, when typically the "establishments" that want to do what they have always done or are told to do by those who control and benefit from the status quo.

      Which brings me to my next point.....this new campaign "Know Yourself Feel Yourself " is or all very well & very important but pretty much rehashed info about self checking. My cancers could not be "felt" by 2 different surgeons after diagnosis even when they knew exactly where they were in my breasts. I was fortunate because they were small, also I was told that Lobular cancer does not form like a lump it spreads flat, much harder to feel. The cancer found in my right breast after my very 1st mammogram at the age of 54 which I had been putting off because of the concern of radiation exposure under compression. The left one was only found because of the contrast MRI I was having to stage the right breast cancer. So, after 2 biopsies, a number of Ultrasounds and 4 Mammograms within a very short time span of about 6 weeks (3 which were 3D, so more radiation) I ended up having lumpectomies in both breasts, followed by radiation treatment (15 sessions) and I passed up on the recommended Hormone therapy because of the lack of benefit it would give me, as previously mentioned. My journey now is to monitor, feeling my breasts now is a total waste of time, because after the lumpectomies & corrective surgery for an excessive lump I was left with after my initial surgery they feel like nothing they did before & with all the scar tissue and sensations I now get from nerves, nothing feels normal for me now. So I am left with the option of having annual contrast Mammograms because of my dense breasts, which I must say I don't feel too comfortable about & have very limited alternatives for effective monitoring with minimal risks. 

      Now, what if there was a new imaging technique that was all benefit & no harm. No squashing/compression of your breasts, no radiation, no contrast (heavy metal retention) from MRI's (which I was not told about when having one) and possibly more & concise accurate results especially for dense breasts and safe to have repeatably over & over again and possibly minimising the need for unnecessary biopsies. How amazing would that be! I have listened to breast surgeons & other specialists, predominately in the US talking about &  already using this imaging in the US for a few years now. It is called QT Imaging (Ultrasound) and uses advanced forms of Ultrasound within water and is completely safe and far cheaper than a MRI & can even be used simultaneously with chemo to track if it is having any benefit in real time. Now I am no expert & have no training in these fields, but what I have read and seen by the extensive research already available, and what I am able to understand of it, I am surprised that no-one in Australia is shouting this from the roof tops yet, or at the very least looking into its potential or checking its credibility to see it "its too good to be true" as was a surgeons response at my last appointment when I was discussing my concerns over having regular/yearly 3D mammos with contrast because of my dense breasts, regular mammos isn't gonna cut it, since it failed to detect the cancer in my left breast. I was initially going to pay to have MRI's to monitor moving forward but with further research after having the one I had to have, Id rather not have a serve of heavy metal Gadolinium that is in the contrast and has been known to be retained in the body, predominately in brain tissue, than was originally thought.....hello dementia anyone? QT Imagery is not some crazy pseudo tech being pushed by some wellness influencer wanker but created & designed by a doctor (Dr John Klock) who was also partly responsible for the design and implementation of CT calcium score testing for heart disease risk, commonly used for some time now all over the world. 

      I have emailed Imaging clinics in Melbourne, Sydney & Brisbane to find if any one has heard or even looked into this, but unfortunately not. There is a clinic in Brisbane that has had a little media exposure about an imaging they do (Cone Beam Breast CT) but unfortunately, even though there's no compression of the breasts, somewhat beneficial, and is better for dense breasts with more clearer and more extensive imaging, it is still relying on CT scan which is still radiation exposure. I have emailed BCNA about QT Imagery asking if its on their radar, but......no response. 

      With so much talk & campaigning about the importance of early detection and ways of doing that, and helping to minimise the fear, anxiety, stress etc etc that comes with screening, diagnosing, treating & then monitoring, something that could be a complete game changer and a far better alternative is not even being considered, seems just crazy to me. What harm is there for the people responsible, capable and educated in this domain to just look into it and see if it really is "to good to be true" If the science stacks up, why not go for it?

      My experience with early breast cancer has taught me, you can never ever ask enough questions & then some & if the responses you get are a bit dismissive or vague, do your own research, or just do more research generally. Understand that your breast/s are not separate to your body but a part of your body, so treatment should be for the whole body & not just your breast/s. Weighing up risk to benefit from screening to monitoring can only be done with accurate up to date information & a healthy dose of trust your gut. The only reason I finally had my 1st mammogram at the age of 54 was simply the 1 in 7 women statistic, no matter how healthy you are, there are no guarantees & I did not think of myself as special to fall on either side of that statistic. I am weighing up which option to go for until a better alternative is made available here, if ever. The Cone Beam CT scan no compression clearer imaging for dense breasts but radiation still, paid for out of my pocket (few hundred $$) with a trip to Brisbane from Melbourne, or the contrast Mammogram with more radiation than a standard one, free with breast screen Victoria? I have more research to do to find out which one exposes me to the least amount of radiation. Or pay for a MRI with contrast which I know is just as accurate if not more that a contrast Mammo but is the Gadolinium in the contrast more of a risk than the radiation, unfortunately I believe that comparison research has not been done. BUT if QT Imagery was here already my choice would be very easy & a no brainer. I would love to hear if anyone else has come across this  information or knows of someone who has probably had it done in the US or Canada & what their experience was like.

      Cheers.

       

  • Hi Shae​ 

    Just finished Estrogen Matters and am also going to raise this with my Onc. Wondering if you did and if so how you went.

  • Daina_BCNA's avatar
    Daina_BCNA
    Community Manager

    Hi Shae​, Thanks for raising such an important topic. In addition to Arpie's comments, we thought you may also find the below info helpful to discuss with your oncologist.

    HRT is generally not recommended for people with or who’ve had hormone receptor-positive breast cancer, due to the link between estrogen and cancer growth. Systemic (delivered throughout the body) HRT, in particular, has been associated with a higher risk of recurrence. A 2021 analysis found a 46% increase in risk for those who used it. Because of this, current guidelines advise against systemic HRT for anyone with a history of breast cancer.

    That said, topical HRT options like low-dose vaginal estrogen creams, tablets, or rings may be considered safer, as they tend to stay localised and don’t significantly raise hormone levels in the body.

    It’s definitely a complex and sometimes confusing area, with limited research available, so it’s great that you’re planning to explore it further with your treating team. 

    🔗 HRT and breast cancer recurrence risk – breastcancer.org
    🔗 Topical vs systemic HRT – breastcancer.org
    🔗 HRT and breast cancer risk overview – breastcancer.org

    • HardDecisions's avatar
      HardDecisions
      Member

      HiDaina_BCNA​ 

      LikeShae​ i too am incredibly interested in the research findings shared in Oestrogen Matters book (coauthored by Dr Amens) not least because it inspires some hope - quality of life appears to be completely disregarded by the majority of Oncologists so it’s beyond refreshing to hear Dr Amens, an oncologist in the US, has been advocating for HRT because our sanity, heart, brain, skin & sexual health matters! 

      Interested which 2021 you are referring to “A 2021 analysis found a 46% increase in risk for those who used it”? In the book, there was ONE out of 26 studies since the mid 90s that found an increase in recurrence and that was the HABITS study, subsequently deemed as deeply flawed. 

      HRT changed my life, am just disappointed I was only on it for 6 months before my diagnosis. Which I had to advocate to get to the bottom on breast pain for far too long. It was NOT caused by HRT, presented to Drs 18 months before that. I am ER & PR positive and it’s such a cruel blow. 

      3 days of tamoxifen and there is no way I’m continuing with it with the instant and severe toxic side effects. Too debilitating and frankly dangerous for an active mum.

      Hunting for a way to assess recurrence risk - has anyone seen this? Peri rage has come back with full force and the best way to direct it is to see how we can support women who have already been through enough!! 

  • Check your Biopsy results, Shae​  ..... if your diagnosis was ER/Pr+ ... that means your Breast Cancer was being 'fed' by Oestrogen & Progesterone (the hormones that are in HRT.)

    This is why Hormone Suppressing meds (AIs) are suggested after surgery.

    I was on HRT when I had my FIRST  Mammogram 'call back'.  It had made my breast VERY lumpy and they had difficulty reading the Mammogram.  As a result of that experience, I stopped taking it. 

    About 10 years later, I was diagnosed with Breast Cancer.  It was missed by BreastScreen NSW - & only picked up by my GP when she did a random 'boob check' on me & she felt it. (It was just months after the 'clear' BreastScreen mammogram.)

    Ask your Oncs about it this week when you see them.  Be guided by them

    take care & all the best