Estrogen matters: Who Killed HRT?
Does estrogen cause breast cancer? What do you think?
The Women’s Health Initiative told us that there were more cases of breast cancer in the women who took estrogen in the study, but then, the 17-year follow-up data did not demonstrate an increase in mortality for breast cancer or any other cancer in the women who were on the hormone arm of the study.
Most women fear breast cancer more than almost any other disease. So, how do we make a decision about whether taking hormones in menopause is the correct decision for any particular patient?
Having practiced hormones for more than 40 years, I remember prescribing much higher doses of estrogen back in the 80’s and 90’s. The WHI remarkably changed how we think about the benefits of hormones, and many doctors and patients will not touch estrogen with a ten-foot pole.
I picked up a book lately titled “Estrogen Matters”. It was published in 2018 and was written by an oncologist and a PhD, Avrum Bluming, MD, and Carol Tavris, PhD. Dr. Bluming is a medical oncologist and the majority of his practice deals with breast cancer patients. HIs wife developed breast cancer at age 45. HIs wife survived her breast cancer, but the chemotherapy she took put her into an early menopause and she was miserable with hot flashes, night sweats, insomnia, vaginal dryness, painful intercourse, decreased sex drive, and changes in cognitive function to include inability to concentrate and fuzzy thinking. Dr. Bluming had many other patients with similar concerns and began to study estrogen’s effects on the breast to understand if it was reasonable to consider estrogen in women who have been treated for breast cancer.
By the 1990’s, data had been accumulated that demonstrated a 40-50% decrease in atherosclerotic heart disease in women who took hormones. This is extremely important since 8 times more women die of heart disease than breast cancer. Estrogen reduced hip fractures by 50%, and as many die of complications of hip fractures as die from breast cancer! Studies determine that there were 50% less cases of colon cancer and deaths from colon cancer in women who took hormones, and 35% less Alzheimer’s disease. In the 90’s, data demonstrated that women who took hormones did not have an increase in breast cancer when they took hormones for 10-15 years, and also, women who took hormones lived, on average, 3 years longer than women who did not.
In 1995, Dr. Bernadine Healy, the first and only female director of the NIH, published a book that stated that the health benefits of hormone replacement were compelling, and the benefits to quality of life were compelling as well.
In 1994, the NIH began the WHI study, spending 1 billion dollars of taxpayer money to study the effects of diet and hormone replacement on the cardiovascular, musculoskeletal, gastrointestinal systems to name a few. Drs. Bluming and Tavris believe that the data from the WHI led to some conclusions that were misleading, exaggerated, or completely wrong.
Their book is meant to refute many of the claims made by the investigators in the WHI, and I am eager to delve into the data they present, because, in my practice, I believe that much of the fear of hormones is largely exaggerated.
Here are some facts about breast cancer that are interesting:
- The rates of breast cancer increase in each decade of life, as estrogen levels fall. The risk of breast cancer in your 30’s is .4%, in your 40’s it is 1.5%, in your 50’s it is 2.4%, in your 60’s 3.6%, and over 70 the risk is 4%.
2. High doses of HRT have been used to treat metastatic breast cancer.
3. Women who were taking hormones when their breast cancer was diagnosed have a better prognosis.
4. We know that some breast cancer cells are estrogen receptor positive, but the more aggressive breast cancers are estrogen receptor negative. They refute the thought that because a cell has an estrogen receptor, that estrogen “feeds” that cell.
5. Women who get breast cancer when they are pregnant, when the estrogen level is about 10 times higher than in the non-pregnant state, have a similar prognosis by stage, and terminating the pregnancy has no survival benefit.
Dr. Tarvis is a psychologist and has studied gender bias in healthcare and bias in research.
She had no particular interest in menopause when she joined Dr. Bluming in his quest to understand the conclusions of the WHI. They concluded that the data in the WHI was manipulated and much of it incorrect. They began go publish articles in medical journals but found little support, so they wrote this book that I will review for you.
As I review chapters of this book, that we can look at the totality of data about the benefits and risks of hormone therapy, and you can make a better-informed decision about your own health.
Marilyn C. Jerome, MD
Foxhall OB-Gyn Associates
Estrogen Matters, Avrum Bluming, MD, Carol Tavris, PhD, 2018