From The Doctor’s Desk: Hormone Imbalance A Contributing Factor In Breast Cancer

Hormone Replacement Therapy (HRT) increases breast cancer. Have you read headlines like that? Or perhaps you were told that HRT caused someone’s breast cancer.

Do hormones really cause or lead to breast cancer? Think about this: every women continues to produce hormones, even after menopause. So, it cannot be that hormones in and of themselves cause cancer. Scientific evidence indicates that synthetic hormones and hormone imbalance do contribute to breast cancer.

The ABC’s of Estrogen.

Estrogen’s effects in the body are regulated through two different kinds of receptors: alpha and beta receptors. Estrogen-alpha receptors stimulate breast cell growth. Estrogen-beta receptors inhibit breast cell growth.

• Estradiol, the most potent estrogen, equally stimulates alpha and beta receptors = growth stable
• Estrone, the second most potent estrogen, stimulates alpha receptors 5:1 over beta receptors = pro growth
• Estriol, the weakest variety of estrogen, actually stimulates beta receptors 3:1 = growth inhibitory

The key element here is balance of hormones. Higher levels of estrone present in your body (produced by fat cells) result in more breast stimulation. Higher levels of estriol present in your body results in less breast cell stimulation and, therefore, breast protection. Estriol = Good. Estrone = Bad. If you have heard of someone developing breast cancer after starting Premarin, there’s a logical explanation for that. Guess what Premarin is loaded with? Premarin contains (48%) estrone (estrone = bad = breast cell stimulation).

Here are some more ugly facts about Premarin, also know as conjugated equine estrogen. Premarin actually decreases estrogen beta receptors. So, if you take Premarin, then you are taking high doses of estrone (estrone = bad) and decreasing your estrogen receptors that inhibit breast cell growth. In a nutshell: you are taking more of the bad estrogen and decreasing your amount of the good estrogen. This equates to a prime set up for breast cancer.  Don’t take my word for it. See the wonderful article by Kent Holtorf.

Progesterone: The Growth-Inhibitor Hormone

The confusion out there about estrogen and breast cancer is bad enough, but the confusion is even greater on the subject of progesterone.

Pregesterone is the key hormone in the second half of a woman’s cycle. Estrogen is the dominant hormone in the first half of your cycle (estrogen = growth = growth of the uterine lining to support implantation of an egg). The counteractive hormone to this growth phase is progesterone (progesterone = no growth = sloughing off of the uterine lining). It’s the amazing and fascinating way that woman was created.

Synthetic progestins, often prescribed, are NOT the same as the progesterone your body produces. Just look at the structure and you see that they are not. The one thing they do have in common is they both protect the lining of the uterus against excessive estrogen growth. But, that is where the similarities end.

While there are many differences between the two, our focus here will be on the difference in breast cancer potential. Simply stated, synthetic progestins are pro-breast cancer and bioidentical progesterone is breast protective. The Women’s Health Initiative (link) revealed a 26% increase in breast cancer as a result of taking synthetic progestin. The Nurse’s Health Study (link) found that synthetic progestins tripled breast cancer risk over that of estrogen only. The use of Provera, a synthetic progestin and component of Prempro, has been shown to increase the risk of breast cancer by 800%!

The statistics for bioidentical progesterone are the opposite. Bioidentical progesterone has many positive breast benefits:

• Progesterone decreases estrogen production
• Progesterone moves estradiol to weaker estrone
• Progesterone moves estrone to inactive (sulfated) form
• Progesterone moves estrone to weakest/safest estriol
• Progesterone down-regulates estrogen receptors all together
• Progesterone activates the cancer protection gene, p53

The idea that progesterone is a safer alternative to synthetic progestins is not new at all.  As early as the early 80’s, there has been a call for safer progesterone over synthetic progestin counterparts. In 1981, nearly 30 years ago, L.D. Cowan showed that just having low progesterone levels increases the risk of premenopausal breast cancer risk 5.4 times.

Unfortunately, progesterone-deficient states, (or estrogen dominance) are very common in women today as a result of many factors: being overweight, PCOS, environmental xenoestrogens, excessive estrogen therapy, and perimenopause. Another study, showed progesterone to have a 400% decreased breast growth rate.

The Scientific Evidence Is Clear.

The evidence in the scientific literature is clear with regards to estrogens, progesterone, and hormone balance.

Bioidentical and synthetic hormones should NOT be used interchangeably. They are not equal. They have very different physiologic effects on the breast:  synthetic progestins (Provera notably) increase breast cancer (800%) and bioidentical progesterone protects against breast cancer (400% decrease breast growth rate).

Estrogen therapy is not for everybody and is definitely not a panacea drug; in fact estrogen dominance is a major contributor to breast cancer risk. But if estrogen therapy is needed, then estriol (Estriol = good) is the best.

Hormone balance is the key. Without estrogen and progesterone balance, a women’s cycles are irregular, and infertility can be a big problem.

You know, once we understand hormones and the balancing cycle between estrogen and progesterone, it makes perfect sense that imbalance would cause breast problems. And the scientific evidence indicates just that. In honor of Breast Cancer Awareness Month, it’s time make sure your hormones are balanced and protect yourself from breast cancer.

From the Doctor’s Desk: Think Pink — It’s Breast Cancer Awareness Month!

I love the change of seasons. I particularly love fall in the South. The oppressive heat of summer gives way to crisp, cool mornings, green leaves give way to brilliant colors, and college football returns.  But, October is even more special than that. October brings attention to one of the greatest fears of women — breast cancer.  October is Breast Cancer Awareness month.

There is much to be excited about in the arena of breast cancer treatment. Earlier detection, minimally invasive surgery, and high survival rates head the list. Credit needs to be given to the great work of many organizations like the Susan G. Komen Foundation and many researchers and physicians around the world.

But, breast cancer has not given up.

Let’s look specifically at the most current statistics of breast cancer. The lifetime probability of women developing breast cancer (2003-2005) is 1 in 8.  That amounts to about 185,000 women annually. Breast cancer accounts for 27% of all cancers in women. Breast cancer accounts for 15% of all cancer deaths in women and is the second leading cause of death due to cancer in women — only surpassed by lung cancer.  

The statistics are not all bad. Breast cancer has decreased by 27% from 1990 to 2005. Five-year breast cancer survival rates are improving — 91% for Caucasian women and 78% for African-American women.

Weight contributes to breast cancer risk. Since 1960, the percentage of obesity has risen from 16% to 36% (2006). That means that 1/3 of the female population is obese. What a disturbing trend! And even worse, the trend of breast cancer has paralleled the obesity trend in women.

Here are the current Screening Guidelines:

• Yearly mammograms starting at age 40
• Clinical breast exam every 3 years for women in their 20’s and 30’s; annually after 40
• Self breast exams should begin in early 20’s

The focus in breast cancer today is on early detection and treatment.  At Seasons, we want to focus on prevention. Why ever let the cancer develop in the first place. Follow us over the next couple of weeks as we focus on how.

From the Doctor’s Desk: Research Shows Vitamin D Insufficiency Linked To Cancer

Inadequate sunlight exposure has been linked to many cancers. (Click here for article.)

• Breast
• Colon
• Ovary
• Prostate
• Bladder
• Esophagus
• Kidney
• Lung
• Pancreas
• Rectum
• Stomach
• Uterus
• Non-Hodgkins Lymphoma

Recent research suggests that vitamin D therapy can prevent cancer.  Another article suggested that Vitamin D levels greater than 55 ng/ml would prevent 60,000 cases of colorectal cancer and 85,000 cases of breast cancer in North America. The same article projected that 250,000 cases of colorectal cancer and 350,000 cases of breast cancer world wide would be prevented each year.  In fact, the American Journal of Clinical Nutrition recently showed a 77% reduction in breast, ovarian, colorectal cancers as well as lymphoma and leukemia just by normalizing the amount of Vitamin D in a patient’s body.

Vitamin D Therapy Another Cog In The Wheel of Wellness.

I practice Integrative and Functional Medicine and this research supports my approach. By replacing exactly what the body needs, in this case Vitamin D, my patients can improve their bone health, improve symptoms in a myriad of other conditions, and possibly even prevent cancer in their bodies. No anti-depressants, no relaxants, no harmful medications, and no side effects. Our focus is treating the cause of symptoms and, as a result, providing true health and wellness.

Related articles by Zemanta and others:

• How Much Vitamin D Should You Be Taking? (health.usnews.com)
• http://www.womentowomen.com/healthynutrition/vitamind.aspx
• Why Black People Need More Vitamin D
• 5 Ways Vitamin D Could Save Your Life (abcnews.go.com)

All Estrogens Are Not Created Equal

There is a lot of confusion in the medical and non-medical communities regarding estrogens. Many today think there is only one estrogen. Many today think bioidentical estrogens and synthetic estrogens are identical in structure and function. Many today think estrogen production stops after menopause or after a total hysterectomy. However, this couldn’t be further from the truth.

The body never stops producing estrogens. The body, in fact, produces 3 types of estrogens: estradiol, estrone, and estriol. These are the natural estrogens native to the body and the foundation of bioidentical hormone replacement of estrogen.

A woman’s body produces estrogens in various places. Most people knows that ovaries produce estrogens. But did you know that the adrenal glands and fat cells produce estrogens, too? Think about that for a minute. This explains why women of all ages continue produce estrogen. Our adrenal glands don’t disappear at menopause. And fat cells certainly don’t. So how do we know if a woman needs estrogen?

Let’s look more closely at the 3 main estrogens produced in the body.

• estradiol
• estrone
• estriol

Estriol is a good place to start. Estriol is the weakest of all Estrogens. A woman’s placenta produces very large amounts of estriol during pregnancy. However, estriol is not confined to pregnancy. The liver produces small amounts, too. Estriol primarily affects a woman’s hair, nails, skin, and her vaginal lining. Studies also suggest estriol has potential in breast cancer prevention because estriol binds to specific receptors (beta-receptors) in the breast that inhibit breast cell growth. All other estrogens would be expected to increase breast cell growth (which can lead to cancer) through activity with alpha-receptors.

Estrone is the second most potent estrogen. Estrone is predominately produced in fat cells after menopause. Overweight women have high circulating estrone levels. Unfortunately, 63% of American women are overweight or obese, so many women have high estrone levels. Estrone levels rise even more after menopause, and estrone has been implicated in breast tumors in animal studies. (Scientists say this because estrone has a 5:1 affinity for alpha breast receptors, but that’s pretty technical.) Just remember that alpha-receptors increase breast cell growth. You could say estrone encourages breast cell growth, and that can lead to uncontrolled breast cell growth. We call that breast cancer.

Estradiol is the most potent estrogen. Estradiol is produced predominately from the ovaries. This means a woman will have less estriadiol after menopause because her ovaries are producing less. Estradiol is the main stimulus for growth of the lining of the uterus in the first 2 weeks of the monthly cycle, and it helps in triggering ovulation. Like estrone, estradiol has been implicated in breast tumors. It has a 3:1 affinity for alpha-receptors in the breasts, which promote breast cell growth and can lead to cancer.

That’s a lot of information for one blog post, I know. But remember the overall point. Bioidentical hormone therapy is much more than the use of bioidentical estrogen. It is about which estrogens your body needs to maximize efficacy, reduce side effects, and prevent disease.

Related articles by Zemanta

• Bioidentical Hormones: A User’s Guide (health.usnews.com)
• Bioidentical Hormones: Safer For Hot Flashes Than HRT? (health.usnews.com)
• Marcia Stefanick: Continue Hormone Replacement Therapy? (health.usnews.com)
• Should I take hormones or not? (cnn.com)

Bioidentical Hormones: What Does The Scientific And Medical Evidence Say?

A young lady came into my office the other day to discuss hormones. She was a breast cancer survivor. Her concern, and rightly so, was her risk of getting breast cancer again. Since she lived in the south (our main office is in Ruston, Louisiana), she had experienced the women’s ritely passage of menopause: “the hysterectomy ceremony.”

Her question to me was: can she take hormones? Years ago, her cancer doctor had placed her on premarin, telling her that it was safe. She also was told that because she had a hysterectomy, progesterone was not necessary. Her gynecologist, in contrast, told her she couldn’t take premarin. Different doctors, different opinions.

I’m not trying to offer a third opinion here. I just want to stay focused on the evidence. That is what evidence-based medicine is all about. Unfortunately, market forces are clouding evidence-based medicine today.

In earlier posts, I’ve talked about progesterone, synthetic progestins and their polar opposite effects on a woman’s breasts. Progesterone lowers risks. Progestin increases risks. I want to get a little more specific today with some information from an outstanding review of the evidence. In Dr. Kent Holtorf January 2009 article, the Bioidentical Hormone Debate, he exhaustively reviewed 196 research articles. (If you aren’t up to reading the full article, you can read an abstract of the review.)

Here is my summary of the risks associated with synthetic progestins:

• increased breast cell growth
• increased conversion of weaker estrogens into more potent estrogens
• promoted the formation of toxic estrogen metabolites (16-hydroxyestrone)
• stimulated the conversion of inactive estrogen to active estrogen (estrone sulfate to estrone)
• had anti-apoptotic effects. (Apoptosis is programmed cell death: which is a way to control cancer growth. Anti-apoptosis means your body lacks this method of controlling cancer growth.).

Contrast this with the benefits of the natural bioidentical hormone progesterone.

• reduced breast cell growth by 400%
• downregulated estrogen receptors in the breast
• induced cancer cell apoptosis (programmed cell death that helps control cancer growth)
• reduced breast cell division and growth
• and in some studies, progesterone actually arrested human breast cancer cells.

After looking at nearly 200 independent studies, Dr. Kent Holtorf concluded that “Both physiological and clinical data have indicated that progesterone is associated with a diminished risk for breast cancer, compared with the increased risk associated with synthetic progestins.” Studies have shown that synthetic progestins increase the risk of breast cancer:

1. by approximately by 25% for each 5 years of use
2. by triple the risk (67%) of breast cancer when added to estrogen therapy
3. double the risk to 4% per year when compared to estrogen therapy alone.

This is in stark contrast to bio-identical progesterone, which reduces the risk of breast cancer by 10%.

“As far as the east is from the west”—that is how different the effects of progesterone and synthetic progestins are on the breast. Holtorf concludes his article in Postgraduate Medicine with statements like this: “With respect to the risk for breast cancer, heart disease, heart attack, and stroke, substantial scientific and medical evidence demonstrates that bioidentical hormones are safer.”

In my next post, I’ll look at synthetic premarin versus bioidentical hormone estrogen.

Related articles by Zemanta

• The Bioidentical Hormone Debate (www.postgradmed.com)
• Abstract: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? (holtorfmed.com)
• Study: Hormone therapy caused breast cancer for thousands (cnn.com)

Why you should be concerned about estrogen dominance

October is breast cancer awareness month!

Last week, in a post about three ways to help prevent breast cancer, I talked a little bit about estrogen dominance. You’re probably wondering what it is and why it matters.  I’ll do my best to explain this as thoroughly as I can without getting too technical.

What is it?

Estrogen dominance occurs when you stop ovulating. During the first half of a woman’s cycle, estrogen stimulates growth of her uterine lining. Half way through the cycle, ovulation occurs. At this point progesterone production dominates-which limits further estrogen growth.  Without ovulation, progesterone does not balance the estrogen produced in the first half of the cycle. Instead, a woman’s body continues to produce estrogen resulting in estrogen dominance.

When does this occur?

Estrogen dominance can occurs for several reasons.  First is when young teenagers start their periods. They often have irregular periods for the first two to three years because of lack of ovulation. Second is during perimenopause (the transition to menopause). During perimenopause, a woman again stops ovulating and stops producing progesterone to balance estrogen. Finally, estrogen dominance occurs in women who have polycystic ovarian syndrome. This syndrome is a collection of hormonal symptoms that have at their root cause, lack of ovulation and thus estrogen dominance.

Why is this important?

Estrogen dominance during the perimenopause puts women at a greater risk for weight gain and breast cancer. High levels of estrogen can lead to constant stimulation for growth. This means all estrogen is encouraging all cells to grow-normal cells and abnormal cancerous cells in the breast.

What can we do about estrogen dominance?

During perimenopause, the simple addition of bio-identical progesterone can balance the estrogen. This corrects estrogen dominance, helps women lose weight, and reduces the incidence of breast cancer.

(Special thanks to MesserWoland for providing copyright permission of the pink ribbon through Wikipedia.)