Family history of breast cancer and HRT - what to ask at my consultant appointment?

[ChazsBrilliantAttitude]

I have a family history of breast cancer as DM had breast cancer close to the age of 40. I can’t remember exactly when as it’s over 50 years ago when I was a child. She died of another cancer at the age of 52 in the 1980s so no BRCA testing was done for her. I was screened for BC risk annually by the NHS from my mid 30s to early 50s (now covered by standard screening).
I also have a male sibling with prostate cancer.
I also suffered from endometriosis.
I’m 57 and I am tired, with brain fog and disrupted sleep.
I do use vaginal oestrogen as I know that is safe.

My GP has referred me to a consultant to discuss HRT risk. My appointment is next week any advice on what I should ask would be appreciated.

My thoughts were:

1. Do I need BRCA testing?
2. Are there options that are lower risk?
3. Am I overthinking this?
4. If I do take something will I need additional screening?

I want to get as much as I can out of the appointment.

I am realistic, I know there is a theoretical risk for everyone of taking HRT but for most it is outweighed by the benefits. I want enough information that I can do a proper risk benefit analysis for myself.

I'm high risk (brca) and still take HRT.
What cancer did your mum die of and what other family history do you have? That will determine whether you can get a brca test on the NHS. It might be worth doing.
There are no special low risk options. Having said that, transdermal estrogen is lower risk than oral and micronised progesterone is lower risk than synthetic.
You won't get additional screening just because you're on HRT but you would if you did turn out to be higher risk due to a genetic mutation.
Good luck!

@ChazsBrilliantAttitude Has your thread been moved from another part of MN?

Sorry you've not had any replies on over a week (I've not seen your post.)

You could have the BRACa test but look online at Cancer Research website. You may not be eligible as it's just one close family member but because of your Mum's age you may be. Do you own research before you see the consultant.

What sort of consultant are you seeing? Breast or menopause? Are they qualified to answer your questions? (That may sound odd but some are not experts on HRT.)

Prostate cancer risk is there for men whose mum's had BC but that doesn't necessarily mean you have much added genetic risk.

Some facts as they stand at the moment.
The risk of HRT with BC is the type of progesterone, used with estrogen.
Women on only estrogen have no added risk so it's been known for years that it's the combo of the two hormones.

Micronised progesterone has a lower risk as far as is known at the moment. The BMS has said it appears not to increase risk for at least 5 years.

All stats are observational based on women who have had or not had BC- there are no trials using HRT.

Using transdermal estrogen is safer re. blood clots but has no less risk for BC @WhereAreWeNow .

You can if you choose to pay for private mammograms if you want to.
I do, as I've been on HRT long term.

Thank you both so much for this information. It wasn’t moved I suspect most people are fortunate enough not to have to think about this so didn’t know what to say.

He was a consultant gynaecologist with an oncology background too but on the British Menopause Society list.

His view was that given my age and the fact that I had used hormonal contraception in the past if there was BRCA involvement it would have likely shown up by now.

My family history is relatively weak in that my DM was the only case but she had no sisters. Her mother and her maternal aunt both lived to old age so no early cancers. She died of a form of adrenal cancer so no obvious BRCA connection. At this stage I am not going to pursue genetic testing.

I decided to give it a go and I started everel conti patches on Thursday. I’ve just had the best night’s sleep in months (which might be psychological but I don’t care) and so feel much more life my old self.

I am going to check when my next mammogram is due and decide if I pay for one sooner.

Thank you both again for your replies. It’s so difficult when you see worrying headlines to know what to do when what you really need is a clear objective discussion on the risks v benefits.

@ChazsBrilliantAttitude I'm glad you got sorted. There is only one thing I'd add.

Sequential HRT has a lower risk (there are breast specialists on record saying this and the stats show it.) This is because the breasts get a 2 week break from the proliferative effect of the progesterone.

The other point is I'm surprised the dr has suggested a form of HRT with synthetic progesterone. I assume it's Norethisterone in the patch?

There is league table of BC risk with progesterone- the top is MPA, followed by Norethisterone, then micronised progesterone and dydrogesterone come lowest.

I'd suggest you seriously consider whether you want a combined patch with Norethisterone - you can have estrogen in any form and add in micronised progesterone.

(If you want context I've discussed this with my consultant for over 15 years - one of the best in UK.)

Yes the patch is Norethisterone. I have access via a private scheme in work to nurse led prescribers but they wouldn’t prescribe until the risk assessment was done.

I will speak to them and see about non synthetic options. I only have a month’s supply of the patches as I was planning to have a follow up discussion with the nurse led team.

It’s really helpful to have this information because now I know what to ask them.

I’ve just done some more research and I may not be able to take progesterone orally whilst I am using a GLP1 agonist for weight loss as the slower gut transit may give inconsistent absorption. As being overweight is a bigger risk factor I think his logic was it was better for me to stay on the weight loss jabs and use a transdermal form even if it is synthetic. I will discuss with the nurse led team and certainly reassess when I am no longer using the jabs.

One of the nurses I spoke to did say that the weight loss jabs do mean they are having rethink prescribing strategies.

I use progesterone capsules vaginally it’s off label but my GP was OK with trying it. ( progesterone has always affected my mood)

That’s an option I can explore too. Thanks I am noting all this down as I have an appointment next week with one of the nurses.

You can use micronised progesterone vaginally- it's off-licence but my consultant has suggested that way for years and years- it's the 'norm' in Europe. It goes straight to the uterus rather than via the digestive system.

Just to say my mum had triple neg breast cancer age 70 and my paternal grandmother had some type of breast cancer and died young in the 50s. My dad died of prostate cancer.

No one has had any gene testing and i don't meet the criteria.

I've decided against hrt but I'm early in peri and may change my mind.

It is a worry.

@ChazsBrilliantAttitude I think the current approach may be best in the short term- as being overweight is far more a risk for BC than HRT.

But if you lose weight and can swap to body identical progesterone in the next 6 -12 months that may be worth doing. ( I didn't know you were on weight loss jabs from your other posts.)

Following, as I’m in a similar situation (minus the WLIs). GP wouldn’t prescribe me HRT last week and has referred me to the Breast Clinic for advice before proceeding.

Sorry this got missed before you went to the consultant. When I went to request HRT I was referred to the Familial Breast Cancer unit because I have maternal aunts who have both had breast cancer, two different types of breast cancer. My Mum was tested for the gene but didn't have it but I am not sure my aunts had it either? I filled out a form in detail, spoke to them over the phone and they have agreed I fall into the normal risk category because of my age. My sisters however have been having mammograms since they were 35 as part of a monitoring program. I am in a completely different area and had my first mammogram this year.

I have endometriosis and I am 52, I also still have periods but am on Oestrogel on the lowest dose I believe and that is transdermal. I do also take Utrogestan orally once a day every day because of the endo. Having unopposed oestrogen for 2 weeks can flare up your endo so you need to be aware of that.

There was a podcast by Louise Newsom talking about endometriosis and I have the transcript. She talks about both vaginal and rectal progesterone pessaries for women with endometriosis and higher doses because it stays as progesterone. When it is taken orally it is apparently metabolised into a different type of progesterone.

Now I am no medical expert, I am just repeating what she said and I think it also has something to do with the proximity to the abdominal area also being beneficial. It is a while since I did all my "research" and peri brain is better but not perfect.

The day to day relief and improvement of my peri symptoms had to be weighed up against the risk of breast cancer. I do check my breasts every month as my friend had breast cancer twice.

I forgot to mention the WLI in my earlier posts and it only occurred to me when you questioned the synthetic progesterone that might be the reason for the patches at the moment.

@EndoEndoNoNo I had annual mammograms between 36-50 on the NHS. Their view was after 50 I was unlikely to be above population risk.

I did hold off using HRT for quite a long time partly because my symptoms were sort of manageable so the risk / benefit analysis was more evenly balanced. Over the last year or so my sleep, energy, libido and concentration have all crashed so the scales definitely tipped in favour of HRT if it wasn’t contraindicated.

@ChazsBrilliantAttitude I believe I was peri for about 4 years but still had periods and did not have hot sweats. I kept a diary of my symptoms just to remind myself what I had. Then I had dry hot flushes so red hot but no sweating and that became horrendous due to the frequency. I thought it would calm down but didn't. So I went in armed with a list.

I have an older sister who is still peri we think, no periods for years as she has mirena coil. She was full of helpful advice. She did say that once she hit 50 she was considered normal risk for breast cancer. She had the added precancerous cervical cells in her personal health journey.

I use oral micronised progesterone with WLIs. You might just need to take a higher dose of progesterone.