HRT with family history of Breast Cancer

[LunaStarlight]

Hi all,

Super stressed and first time posting.
Crying my eyes out.

I’ve been on Evertol Sequi now for 5 months, I’m 48 and my sister whose 40 has just been diagnosed with triple negative BC, I had an aunt die at 49 years ago with BC, I’ve rang the docs and their advice is to stop HRT immediately, I rang the breast clinic and again was advised to stop.I have an appointment in February to discuss, im on the waiting list to see the menopause clinic, I’m waiting to hear if my sister has the BRAC1-2 gene.
lve been looking online for alternatives, the doc could only offer antidepressants??
Being on HRT has changed my life, no more mood swings, hot flashes etc, I’m so happy, but now I don’t know what to do, I can’t go back to being a monster, my HRT treatment has made me feel like a woman again, can anyone please advise me, I’m going crazy not knowing what to do, I’ve read there’s a 1 in 7 chance of getting BC anyway but last night I read my chances have increased to 75%… what’s anyones thoughts on this, has anyone got some real advice or experience.
My doctor will not give me a repeat prescription, if I understand the risks then isn’t it my choice?

Many thanks in advance, I’m not sleeping and stressing my head off :-(

Jingling I am treated at a specialist Cancer hospital and both my Oncologist and Breast Surgeon are engaged in research, teaching and my surgeon is on the steering committee of various training and trial management committees. He is a complete geek and would no doubt enjoy nothing more than to share numerous papers with me. That is what I like about him, no tilted head or hand holding, just the science in all its blunt reality. He told me that at five years my chances of dying of breast cancer were lower than the average woman my age because all the women who were going to get Cancer and die had been culled from my statistical population. I knew some of those women so even I was a bit shocked but as I say blunt. Neither of them regard the role of hormones in the growth of breast cancer as in any doubt and my breast surgeon played an important role in shifting the treatment protocols for hormone positives cancers away from chemotherapy (which it turned out was only effective because it induced “chemical castration “ - another of his charming terms) to hormone therapy.

I really do not understand why any medical professionals would underplay the role of Estrogen (and progesterone, since some cancers retain those receptors too) in Breast Cancer when an important arm of the treatment is hormone therapy aimed at reducing your exposure to those hormones through menopause and drugs like Tamoxifen (which mimics estrogen and binds to the receptors preventing them from feeding on estrogen.) I know a 22 year old who has been thrown into menopause as part of her treatment, not something they have done without regarding it as vital given the life changing implications.

I also do not understand why a medical professional would talk in terms of estrogen “causing” cancer either. With Cancer that is not really the issue. We all have Cancer all the time as cells mutate and misfire, the issue is why does the immune system sometimes fail to mop those cells up and why do they replicate into not so much an army but a bunch of disorganised oiks reeking havoc on your body? It is probably a complicated interaction of factors encompassing environment, genetics (known and unknown) , the presence or absence of certain proteins (Her2Neu) etc but in hormone positive cancers they hang on to the receptors that exist in all our reproductive organs (so the same is true of ovarian, endometrial, cervical cancers too ) because they can use those hormones to grow and evade the immune system.

Some of the Protective factors that statistically lower your Breast Cancer risk are ones that reduce your lifetime exposure to hormones such as late onset of menarche and the time you spend breast feeding which may explain why women who have many children have less incidence. However 50% of all breast Cancer in women under 40 is associated with pregnancy so yes pregnancy is a danger point. I know several women whose diagnosis. was delayed because their lumps were dismissed as breast feeding issues to the point where there were many lymph nodes involved.

As I have said all along I don’t doubt that some or even most women can use HRT safely because they have not had that previous exposure to estrogen but for some of us thrown into the mix of factors that tip those rogue cells into action our lifetime exposure to hormones are definitely a factor.

Also as a balance to the evils of menopause hormones were never my friend, escaping the rollercoaster of moods and emotions and monthly floods that had me needing to change the most ultra sanitary protection every hour (from my first period at 17) for a week a month was actually a relief. Sudden menopause was not great either but my 5 years of tamoxifen were like a holiday. I don’t exactly enjoy the sleep difficulties and sweats which are my main remaining symptoms of menopause but I can actually manage those with diet and exercise much better than I could my hormone swings and estrogen dominance. I suspect most women with a history of hormone overload will relate to that and my concern is making sure those women are not falsely reassured by this pro HRT movement which seems inclined to dismiss the dangers for that group of women (and even someone like me apparently)

@JinglingHellsBells! I’ve tried to send you a PM but your not current taking messages.
It’s appreciated though.
I’ll read all the information given and the links on Monday, it’s too chaotic at home at the weekend when men are floating about and need me 🙄 I need no distractions.
@FindingMeno, whatever works for you is fab, we’re all on this journey together.

my concern is making sure those women are not falsely reassured by this pro HRT movement which seems inclined to dismiss the dangers for that group of women (and even someone like me apparently)

But you accept that not all oncologists or breast cancer consultants agree?

The most recent research points to estrogen feeding existing cancer. Not causing it.

It's like a fertiliser when the plant is already growing.

No cause/ effect has ever been proved.

And don't dismiss the benefits for most women. cardiovascular disease is the most common cause of female death along with dementia. Complications from osteoporosis come before BC ( 100K a year die of it.) HRT protects from all of those.

BC is 7th on the list.

Many women have to make hard choices against the most likely cause of ill health in old age and the possible risk linked to HRT.

I do not take the risk lightly and am personally concerned but know other existing health issues would get worse without it.

@Emilyontmoor Don't get the impression I don't know or care about the risks of HRT.

Yes, estrogen plays a huge role. I didn't say it didn't. But the stats at the moment are based mainly on the older types of HRT in larger doses and synthetic types. There is a little research where women use micronised progesterone and 2 out 3 of those trials showed no additional risk.

The risks at the moment (based on the old types) show around 1 case per 1000 women (per year) or put another way, 4 more cases per 1000 women over 5 years. For obese women it rises to 28 cases and almost the same for alcohol over 12 units a week.

I completely get where you are coming from.
If I may ask, why is your treatment still continuing as it must be many years since you were first diagnosed? I assumed (maybe wrongly) that once women had taken their 5 or even 10 years of drug therapy, (if that is what they have to do) they had annual mammograms and that was 'it'.

Jingle Breakthrough bleeding (after years of none ) and other symptoms of possible recurrence that need to be investigated. Osteopenia that needs to be monitored and other side effects of chemo (including chronic neutropenia). Hormone therapy actually ideally continues for life with several drugs for post menopausal women that follow on from Tamoxifen (Letrozole etc) which I have tried but had to stop because of side effects (similar to menopause) and they were contraindicated for osteopenia. As my Consultant says tumours don’t confirm to mammogram timetables. No, the consequences of a breast diagnosis and treatment definitely don’t end after 5 years of tamoxifen. I don’t know anyone who does not have long term ongoing treatments / investigations of some sort.

And for the greater part of my life the high levels of estrogen were not from the pill or, any more than anyone else, from unnatural sources. In fact I was only on that high dose pill because low doses did not control my cycle. I had to stop taking it after 5years because of pains in my neck and arms, the possible warning signs of stroke.

There are theories to account for the increase in hormonal cancers in men and women that there are good (natural and pre existing) and bad (from pollution, excess alcohol, the hormone levels in the water supply, plastic bottles even,etc) sources of estrogen and that some people who are vulnerable anyway get tipped to disease by these new pathogens. I just think it is all enough for people to treat introducing more estrogens, or other hormones, into their lives with extreme caution.