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[Jari]

Hi GypsyRoseLee

I hope you are doing ok.

I am afraid ( with experience ) I do not go with what private doctors are happy to dish out. My GP made it very clear to me when she said ? yes but you are paying them ?

From the Cancer.org site...

Doctors are concerned because of the known link between estrogen levels and breast cancer growth.  The HABITS study found that BC survivors taking hrt were much more likely to develop new or recurrent BC than women who were not taking the drug.

It is obviously up to each individual depending on their symptoms and the risks they are willing to take and weighing it all up. I do not think it is worth the risk, but my menopause symptoms are nearly gone now.

What stage are you at in your menopause and what are your main symptoms? X

[CLKD]

By how much % though Jari?

So: I ask again.  If a breast disease is triggered by oestrogen, why aren't women offered bilateral mastectomy there and then? 

This would surely negate any worry about taking HRT in the future?  I would really get rid of breasts that are no longer required if I was suffering with menopausal symptoms but told that HRT was not recommended.  In fact, as I left the last oncology appt., I was told "No HRT for you young lady" and I thought, "We'll c about that!".  Having already had really bad periods no way would I suffer!!
 

[Jari]

I believe women are offered full mastectomies CLKD.

It would, I imagine, depend on the stage it was discovered and what the patient's choice is. Eg if an ER BC is diagnosed at very early stage, then this could be removed by lumpectomy. Some women would want to go for full mastectomies and others would not want this, but I believe it would absolutely be offered?!

I am not sure that would mean hrt would not cause problems for ovarian cancer?! This would need to be carefully thought out as to whether hrt is worth the risk. I think it totally depends on the individual and how bad menopause symptoms are.. x

[GypsyRoseLee]

Hi Hari

Actually Nick Panay also prescribes HRT + Tamoxifen for the patients he sees at his NHS clinic, too.

I have read the HABITs study and it has largely been debunked now. Especially as the Stockholm study refuted much of the evidence presented in HABITs.

Have you read 'Oestrogen Matters' by Dr Avrum Bluming? He's a top consultant oncologist with a specialism in HRT. He tears the HABITs study to shreds with surgical precision. Same with the ridiculously biased WHO study back in 2003.

To be frank, I wouldn't trust a GP to prescribe HRT. I have seen 5 GPs over the last 7 years, and none were as knowledgeable about HRT as I am (or most of the women on here).

[GypsyRoseLee]

Actually Jari, they really don't offer double mastectomies anymore. Certainly not on a routine basis and not if you only have a DX of stage 1 or 2. It's considered a complete overkill of treatment. I actually asked about a mastectomy and my surgeon virtually laughed (in a nice way) and told me it totally unnecessary.

[Jari]

Hi GRL,

Re mastectomies, i was answering CLKD question as to why women would not have them, when they have an ER BC diagnosis. I was meaning, I am sure they can if they feel better to do that, but it all depends I am sure on the stage of the cancer.

I do not know about Dr Bluming. Is he charging for his services? I am afraid I am very sceptical, having had a bad experience with a private meno specialist. That is not to say of course that they are all cashing in.

Re ER BC it makes complete sense to me that taking estrogen would be feeding the cancer. It all very much depends on the type of BC as to what would be the right treatment. Very individual.

I think we are all so different and must research and question things and go with what we feel is right for us.

I also do not know Nick Panay, but out of interest I just looked at his NHS site. It says his advice is aimed at relieving short term symptoms and treatment and advice is based on NICE guidelines and is individualised according to personal health risks and benefits, which seems sensible. This includes women who have high risk conditions such as breast cancer..

As said, I think it very much depends on how bad your symptoms are. If you can see it through without hrt (if you have BC) I think that would be best, but of course it depends on how bad symptoms are. Mine have only been hot flushes, night sweats and joint pain, which have all but passed over 2 years.. they were worst around a year ago and have faded since then..


Wishing you well. X

[GypsyRoseLee]

Dr Bluming is one of the top American oncologists, so because of the American medical system he does get paid by his patients obviously. However he has never been sponsored by 'big pharma' and he conducted a 12 year study (out of his own pocket) into whether breast cancer survivors on HRT have an increased risk of reoccurance. They didn't. He also cites 20 other similar studies that have been conducted world wide since 1992. Not one of them found an increased risk of reoccurance - and they used randomised, blind control groups. Or did in depth retrospective studies. All said no increased risk.

The only study that said otherwise was HABITS. Probably because out of the 348 women they recruited they didn't bother to screen a single one to see if they already had any pre existing cancer cells!! Which considering 1 in 8 women will get breast cancer, was incredibly stupid and negligent!

Dr Bluming really put his money where his mouth is - both his wife and daughter have had BC, and they are both on HRT.

It's a truly enlightening book if you want to look beyond the traditional dogma surrounding HRT.

GPs aren't saints. They are very much aware of who holds the purse strings - I had a real battle to be prescribed estrogel rather than oestrodose, purely because estrogel is slightly more expensive. My GP insisted they were identical products. I knew they weren't because oestrodose gave me a rash. I did my research and it turned out that while they had identical active ingredients, the carrier gel was slightly different. My GP grumpily agreed to specify estrogel on my prescription...

[Jari]

Hi GRL,

I do not know about Dr Bluming's report, but I would be interested to know if it was based on trailing ER BC or not?

This is the main point I would ask myself.

Possibly his trial relates to non ER BC? I do not know?! Perhaps you can tell us? It would be strange if he does not talk about which type of BC ladies his report was based on.

I would be really surprised, if not horrified if he willingly gives out hrt to ladies with ER BC!

My gp ( when my m symptoms were at their worst over that year ) wrote to our local breast cancer clinic/specialists who replied by saying, as I had ER BC history, they absolutely could not recommend that I take hrt. They followed on to say, if my m symptoms were really so bad that I found it difficult to cope, then they would reluctantly say I could go in it, if monitored every 3 months for breast checks and that it should be taken for the shortest time possible.

I did take it for under 3 months. My breast tissue changed, it became harder and lumpy plus it gave me breathing difficulties which are linked to possible blood clot, so the medical team told me to come off it immediately. I am very glad I did as my m symptoms have all but passed naturally.

Again, it all depends on the type of BC and the severity of m symptoms.

Wishing you well.   X

[Wrensong]

I agree with what GRL says here

Actually Jari, they really don't offer double mastectomies anymore. Certainly not on a routine basis and not if you only have a DX of stage 1 or 2. It's considered a complete overkill of treatment. I actually asked about a mastectomy and my surgeon virtually laughed (in a nice way) and told me it totally unnecessary.

but would just add the following. 

Lumpectomy with (or occasionally without) adjunctive treatment(s) such as Radiotherapy, Chemo & hormone blockers, seems currently to be considered the gold standard, with the reasoning that there is potentially less emotional trauma for the patient in not losing an entire breast & lumpectomy is usually a smaller operation with comparatively lower risks, often a shorter inpatient stay & reduced recovery time.  As GRL says, mastectomy is often considered over-treatment, so that on diagnosis a patient's MDT will usually recommend the more conservative surgery of lumpectomy.

My understanding is that after the scandal of the Patterson inquiry & "the Angelina effect", guidelines relating to type of surgery routinely offered were tightened.  I'm reliably informed that his very unfortunate case has led to many breast surgeons being afraid to carry out more than the minimum essential surgery, even when their patient's preference is for mastectomy.

Unilateral mastectomy is sometimes still offered, even for early stage cancers (at least it was in this area a couple of years ago), but reconstruction may not necessarily be offered alongside.  Both, as I understand it, may depend upon individual HA policy, so currently it may vary according to where a patient is diagnosed/treated.

There are varied reasons for mastectomy, including stage & type of tumour, patient preference & the proportionate size of the affected breast to tumour size.   A small breast with a relatively large area of abnormality sometimes makes mastectomy the only practical option, given it's standard practice to also remove as big a margin of surrounding tissue as is sensible, within surgical guidelines.

Bilateral mastectomies are now rarely available, as no-one wants to remove a healthy breast, except in risk-reducing scenarios for the small proportion of the population with high genetic susceptibility.

Mastectomy doesn't guarantee a cancer-free future, but in some situations there is reduced recurrence risk.

As GRL says, Avrum Bluming's book is an interesting eye-opener, considering the benefits of HRT & the flawed studies that led to so many women going without it.  It also carefully examines the case for its use after BC, offering reassurance to the many women who will find themselves faced with the dilemma of need for HRT after a diagnosis of breast cancer. 

I hope no-one feels this post is not warranted on this thread - breast cancer is such an important issue & not that thoroughly aired on the forum.

[Wrensong]

Jari, even ER+ patients are sometimes given their surgeon's blessing to use HRT after their BC has been successfully treated.  There are individual situations where when this is put to the patient's MDT (including her oncologist) who consider it carefully, it's sometimes concluded that it's a reasonable decision if the patient's risk of recurrence is considered to be low & her need for HRT warrants this.

It is very much a decision to be jointly taken by the informed patient & the experts involved in her care.  No-one knows exactly how they will feel until they themselves are in this situation.

[Jari]

Hi Wrensong. I agree with GRL too. Mastectomies are not generally offered nowadays.

I was replying to CLKD who asked, if a lady has ER BC why would she not want a mastectomy. I was meaning that I think if a lady wanted to go that route, then I am sure they can have that option, so as to minimise recurrence.

I have had a brief read of Dr Bluming but he seems to talk about BC generally. If anyone has his full report as to exactly which BC he talks about when he recommends hrt, I would be interested to know. I cannot imagine that he would recommend a lady with ER BC to take hrt. I have emailed him to ask exactly that, will see if he replies.

I know some ladies regard Dr Newson highly. She disagrees with Bluming saying that she personally feels more work needs to be done before routinely giving hrt to women with past history.

NICE guidelines incidentally say: Hrt with estrogen and progesterone can be associated with an increased risk but the risk reduces after stopping hrt.

As a reminder, which is worth bearing in mind, NICE guidelines also say menopause symptoms generally last 4 years from last period and for 10% of women they can last up to 12 years.

Wishing you well. X

[Jari]

Hi Wrensong... our posts crossed paths.

I agree with you, it is very much up to individual circumstances, type of BC, stage, severity of current menopause symptoms etc..

As I have ER BC history and my menopause symptoms are now 2 years since last period and much milder now, I would absolutely not take hrt. Very much a personal choice, but a topic close to my heart and important to share all experiences and knowledge, so as to make informed decisions.

Wishing you well. X

[GypsyRoseLee]

Hi Jari, he trialled both ER+/- breast cancer. Also, I think both his wife and daughter had ER+.

I was pleasantly surprised that, while he strongly recommended I stopped HRT, my breast surgeon also said that quality of life was vitally important too, and that 'we just don't know what the increased risk might be' so it had to be a very personal decision. My breast nurse all told me not 'to beat myself up about taking HRT' because she knew how severe the menopause symptoms could be, and several of her ladies still took HRT.

So far I have halved my dose down to 2 pumps with no ill effects.

[GypsyRoseLee]

For Dr Bluming's full discourse on BC + HRT you really need to read the book, especially chapter 6 where he discusses his own studies + lists and discusses the 20 or so other studies which found no risk of increase in reoccurance.

Alternatively, you could browse through the dozens of peer reviewed studies which have been logged on the ncbi website (National Centre for Biotechnology Information) which is part of the American National Library of Medicine. They all cite there simply is no increased risk of reoccurance.

I have actually been in contact with Diane Danzibrink and Dr Newson, and I do know that Dr Newson can and will prescribe HRT after breast cancer, on an individual basis. As will Dr Nick Panay, Prof John Studd and Prof Michael Baum (one of the UK's leading consultant breast oncologists).

GPs do a sterling job. But comparing their knowledge with the knowledge of those I have mentioned above is like comparing someone with a GCSE in Biology with a fully qualified GP.

[Jari]

Hi GRL, I am pleased that it is working well for you.

We are all so different.

I will see if my local library has his book, so I can have a quick read out of interest.

Either way, I would not take hrt, but it is very much a personal/individual decision.

Wishing you all the best. X