Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. October is Breast Cancer Awareness Month. We’ve all been affected by it one way or another, therefore it is critical that we keep our awareness up-to-date.
Let’s start with a few stats.
Breast Cancer Statistics
Each year in the United States 264,000 new cases of breast cancer are diagnosed. Each year 42,000 will die. Besides skin cancer, breast cancer is the most common cancer in women. It’s definitely the most serious, ranking number 2 in cancer deaths (right behind lung cancer).
Currently there are 4 million women living in the US with breast cancer. As a matter of fact, 1 out of 8 women will be diagnosed in their lifetime with breast cancer. These are astounding numbers! Out of the top 10 countries with the highest rates of breast cancer in women (2020), the United States is #10, Belgium is #1 (wcrf.org).
Risk factors for breast cancer include:
- Early menarche (before age 12)
- Late menopause (after age 55)
- Not having children
- First pregnancy after 30
- Too much alcohol
- Not breastfeeding
- Family history – if a first degree relative (mother or sister) has had breast cancer, you may have double the risk of having it in your lifetime.
- Being older (most breast cancer is found in women after age 50)
Most women with breast cancer have no family history of it. In fact, only 10% of women with breast cancer have a family history. There are a lot of women that I talk to about breast cancer, hormone replacement, etc., who are fearful because their aunt had it (the most common thing I hear), but actually most women who get breast cancer have no family history. It is a risk factor, but it’s overstated. However, there are strong genetic mutations like the BRCA gene in younger women (younger than 50).
Note: The more first degree relatives you have with breast cancer through the generations, the more you need to pay particular attention to that.
Breast Cancer Screenings
I like mammograms. Yes, they are controversial. Some European nations have even quit recommending them for the most part, saying the benefits may not outweigh the risks, i.e., unnecessary scary diagnosis (false positives), and ultimate outcomes.
I like the annual mammogram after age 40 (sooner, if you have a strong family history or symptoms). I’ve seen it save lives. I’ve seen many breast cancers found by the women themselves, through a self breast exam and mammography (finding early cancers).
If you’re worried about the radiation, which is a minor risk factor, you can get a thermogram. You have to do those at a place that does a lot of them, with an expert reading them. An MRI is usually cost prohibitive as a screening tool. An ultrasound alone is not good enough. Combining ultrasound with mammography is good for diagnostic tests.
Note: I’m a believer in prevention, so I do believe in screenings!
The reason I really want to talk about hormones and menopause is because there’s a lot of misunderstandings about it. I took note of a couple of nationally circulated articles this past week. One was talking about companies giving menopause benefits to women between the ages of 45-55, because 6,000 working age women enter menopause each day in the United States.
Female leaders are leaving the workforce at the highest rate in years. For every woman director getting promoted, two are choosing to leave. A lot of this is because of menopausal symptoms! It brings on a lot of anxiety, depression, and fatigue. There are many serious health problems that can result from this.
Note: We need to bring menopause out of the shadows and treat menopause.
Hormone Replacement and Breast Cancer
The WHI (Women’s Health Initiative) study in 2002 hurt many women by scaring patients and doctors off of hormone therapy, because of a false narrative of increased risk of breast cancer and heart disease. They actually terminated the study early for this.
What we’ve learned is the opposite. There is actually less breast cancer and heart disease in women when you’re doing hormone replacement correctly, using bioidentical hormones. Plus, the women feel much better and are much healthier.
The other article came out of the Wall Street Journal. It was about mood changes in women during perimenopause (the period right before full blown menopause occurs). This can go on for years! In a survey of medical residents, only 20% recieved ONE lecture on menopause, AND only 7% of doctors felt that they were prepared to treat menopausal symptoms. I’m sure they don’t realize the benefits either.
Note: Perimenopausal and menopausal symptoms can last for up to 10 years, which should be some of the most productive and enjoyable years of your life.
Women’s Health Initiative Study
Note: This section is for that flawed WHI study that scared everybody off of hormones back in 2002!
First of all, this study wasn’t even a study about menopause. It was a study about heart disease. In my opinion (and the opinion of many endocrine experts and menopause experts), an untold number of women are suffering right now with diseases that hormone replacement could have prevented. In fact, the WHI is probably the biggest screw up in the last 25 years in medicine.
Here are a few reasons why:
- The women in this study were way past menopause. On average they were 16 years past menopause. Thirty percent of them were smokers. Over fifty percent of them were obese and unhealthy. Who knows how many of them were alcoholics. These are the major risk factors for breast cancer.
- They didn’t study symptomatic women at all, and they used Premarin and Prempro. Before that study, those were the two most commonly prescribed medicines in the United States. Note: Premarin comes from horse urine estrogens.
- They also used medroxyprogesterone, which is a synthetic form of progesterone that can be very dangerous. It was the medroxyprogesterone arm of the study that caused the very slight increase in breast cancer, not the Premarin.
- The media came out with a headline that said the combination of estrogen and progesterone increased breast cancer by twenty-five percent. That was totally misleading when you look back at the studies.
Here’s what actually happened…
In the “Premarin only” study, breast cancer was actually decreased, not increased. In the Prempro (with medroxyprogesterone) added to the Premarin, the results went from 4 cases of breast cancer per 1000, to 5 cases per 1000. From 4 per 1000 to 5 per 1000 does not sound like a 25% increase to me.
They also said that synthetic hormones increase blood clots, and they actually did by a fractional number. But remember, these were oral and synthetic hormones. We don’t use oral hormones, and we don’t use synthetic hormones. We use bioidentical hormones that come from plants. We use them in creams and pellets. They bypass the liver, so they do not affect your clotting factors (even if you’re on a blood thinner).
I have a lot of people that come to me saying they can’t take bioidentical hormones because they’re on a blood thinner. Well, it’s not going to affect that with the creams or the pellets. In fact, there’s many studies that show that there’s a decreased risk of breast cancer and heart disease with bioidentical hormones. They’re very protective. We all know that hormones protect against osteoporosis. Also, women just feel so much better. There was also less colon cancer, even in the original WHI study.
Bioidentical Hormone Replacement Therapy (in women)
The thing about hormone therapy is that you really need to start it early. You need to get evaluated by age 40-45 to see where your hormones are. Women are more complex hormonally than men. They have four hormones to worry about, not just one, and they drop off at different rates. By the time you go into full blown menopause (defined as having no period in one year), you’ve been deficient in your other hormones (besides estrogen) for years. And those other hormones are very protective in every way.
Note: It’s a sad fact that as your hormones decline, you decline.
The problem is we’re living a long time. If you want to live a healthy and long life (healthspan), you need to think about hormone replacement therapy. It’s very safe in the hands of someone that knows what they’re doing. Unfortunately, medical school and residencies don’t teach about it, and you have to get these bioidentical hormones from a compounding pharmacy with a prescription. There are no drug reps out there peddling bioidentical hormones. They’ve been off patent for over 50 years, so there’s no money in it for pharmaceutical companies or the reps.
When you take bioidentical hormones you’re not only going to feel a lot better, you’re going to dramatically decrease your risk of heart disease. Why do you think women don’t have heart attacks before age 50 like men do? Because of protective estrogen. Why do you think they have osteoporosis way more than men? Because of protective estrogen.
Note: You need to start early.
Hormone therapy decreases the rate of dementia in women. You can almost call dementia a women’s disease. It’s 4:1 over men. There’s no doubt in my mind that bioidentical hormone therapy decreases rates of dementia in women.
And remember, women need testosterone just like men do. Just in a lot lower dose. In fact, they have more circulating testosterone in their systems than they do estrogen, if you do it on a per gram basis. Women need testosterone. They need progesterone. They need safe forms of estrogen replacement.
Note: The one hormone that women come in and thank me for the most is probably testosterone. It makes them feel the best. It helps them increase muscle, decrease fat, and increase energy. They have a lot better libido. They have a lot better memory.
Estrogen protects your bones, your skin, your hair, and your libido. It’s one of the main things that makes you female. You want natural progesterone, not medroxyprogesterone. Those are two vastly different chemical structures. Progesterone helps you sleep, protects your uterus, protects your breasts, and relaxes you. It balances out your estrogen.
In the later phases of your perimenopausal period (usually before you turn 50), you can have estrogen dominance. This is when you don’t have enough progesterone, but you have way too much estrogen. That’s why you need to take progesterone early. It brings your estrogen levels down to a safer level and decreases the risk of fibrocystic breast disease and uterine fibroids. Progesterone is very important. They’re all important! That’s why you need to balance these hormones.
Don’t Fear Bioidentical Hormones!
The WHI put unnecessary fear in doctors and patients about HRT. I am saying, don’t be afraid of bioidentical hormone therapy. Be afraid of NOT looking at your hormones and replacing them.
Note: I would never give estrogen to a woman who has had breast cancer. That’s why I emphasize mammograms. I don’t put women on BHRT without making sure they have a normal pap smear and a normal mammogram.
Before putting women on any form of HRT, I tell them to get mammograms. Prevention is what we’re after. We’re also looking for a better quality of life. Less heart disease. Less breast cancer. More muscle. Less fat. Better memory. Less dementia. Better bones. Better mood. Less anxiety. Better sleep.
In this month of October, go in and think about getting your hormone levels checked. Talk to your doctor about your mammogram, pap smears, your routine care, especially as you enter the 40’s and 50’s.
It’s not too late. Remember, the earlier the better. If you can get on hormone therapy in that perimenopausal period, it’s going to be much more effective than if you wait. BUT, it’s never too late!
I hope this helps! Get your screening tests done, ladies!