Estrogen replacement is now safe for breast cancer patients with ER+ breast cancer
Channel: BioBalance Healthcast
Date: 2022-09-19

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog/
For decades OBGYNs and oncologists have been denying estrogen replacement to women who have had ER positive Breast Cancer because they believed that estrogen would increase the risk of breast cancer recurrence…As of July of 2022, The National Cancer Institute has reversed the previous position that estrogen in local form for bladder and vaginal atrophic symptoms, and for the systemic form of estrogen would increase the risk of recurrence and death.  Now the findings of the most recent study are that the replacement of estradiol in any form to postmenopausal women who are symptomatic (vaginal dryness, bladder infections and bladder irritability and urinary incontinence), as well as ERT for hot flashes, and depression in postmenopausal ER + breast cancer patients reveal that the risk of death and breast cancer recurrence is no higher among women who take ERT compared to women who take nothing!

In my OBGYNB residency and for my ACOG boards, I was taught that Estrogen replacement was dangerous for women who have had a positive family history of breast cancer, for women who have + ER, + Breast cancer in the past, and for women who are at high risk for breast cancer. The latest study repeals that belief!

This study finally does an “about face” to the previous belief that Estrogen Replacement Causes recurrence or a shortened life span.  The newest study proves what I have seen in my gyn practice: patients taking ERT after non-metastatic breast cancer were safe and had the same rate of recurrence as women who took no estrogen.

In the latest study by the National Cancer Center found that estradiol benefitted women in general and was safe.  The biggest difference between those women who did take estrogen after breast cancer and those who didn’t take estradiol was that women on estrogen had a normal sex life and lived a healthy quality of life, and those without estradiol did not. This finding is the same conclusion I came to by watching my patients with and without Breast Cancer, who took estrogen because of severe menopausal symptoms after non-metastatic ER+ breast cancer.  Recurrence of breast cancer in my 29 years of GYN practice and in the 20 years of BioBalance Health® medical practice was no more common in those who took E2 replacement than women who took no estrogens after cancer!

Finally, research reveals, and I hope medical practice guidelines will soon include the OK to give estradiol of women at risk for Breast Cancer and those who have been successfully treated.   The refusal of doctors to give women what they need after menopause and successful treatment for breast cancer has damaged many women’s lives…Doctors need to realize that quality of life is important and fear of non-documented beliefs just hampers the health and quality of life of their patients.

 

The article follows.

Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study 

Søren Cold, MD, Frederik Cold, MD, Maj-Britt Jensen, MSc, Deirdre Cronin-Fenton, PhD, Peer Christiansen, MD, Bent Ejlertsen, MD

JNCI: Journal of the National Cancer Institute, djac112, https://doi.org/10.1093/jnci/djac112

 

Abstract

Background

Women treated for breast cancer (BC) often suffer genitourinary syndrome of menopause. These symptoms may be alleviated by vaginal estrogen therapy (VET) or menopausal hormone therapy (MHT). However, there are concerns of risks of recurrence of BC and death following treatment.

Methods

Our study included longitudinal data from a national cohort of postmenopausal women, diagnosed 1997-2004 with early-stage invasive estrogen receptor–positive nonmetastatic BC, who received no treatment or 5 years of adjuvant endocrine therapy. We ascertained prescription data on hormone therapy, VET or MHT, from a national prescription registry. We evaluated mortality and risk of recurrence associated with use of VET and MHT vs non-use using multivariable models adjusted for potential confounders.

Results

Among 8461 women who had not received VET or MHT before BC diagnosis, 1957 and 133 used VET and MHT, respectively, after diagnosis. Median follow-up was 9.8 years for recurrence and 15.2 years for mortality. The adjusted relative risk of recurrence was 1.08 (95% confidence interval [CI] = 0.89 to 1.32) for VET (1.39 [95% CI = 1.04 to 1.85 in the subgroup receiving adjuvant aromatase inhibitors]) and 1.05 (95% CI = 0.62 to 1.78) for MHT. The adjusted hazard ratios for overall mortality were 0.78 (95% CI = 0.71 to 0.87) and 0.94 (95% CI = 0.70 to 1.26) for VET and MHT, respectively.

Conclusions

In postmenopausal women treated for early-stage estrogen receptor–positive BC, neither VET nor MHT was associated with increased risk of recurrence or mortality. A subgroup analysis revealed an increased risk of recurrence, but not mortality, in patients receiving VET with adjuvant aromatase inhibitors.