Suzanne Somors hormone replacement???

Thanks for the information on Dr. Vliet.  Interesting stuff.  I'm impressed with her credentials.  Williams and Mary and Johns Hopkin are schools she's been associated with. 

However, now I'm more confused than ever, as I just found this study.  It seems like a true study with real people and came out in March of '08, so it is fairly recent.  Wow, the more you know, the more you know you don't know.....

High levels of estrogen associated with breast cancer recurrence

PHILADELPHIA - Women whose breast cancer came back after treatment had almost twice as much estrogen in their blood than did women who remained cancer-free - despite treatment with anti-estrogen drugs in a majority of the women -according to researchers in a study published in the March issue of Cancer Epidemiology, Biomarkers and Prevention, a journal of the American Association for Cancer Research.

The findings suggest that high levels of estrogen contribute to an increased risk of cancer recurrence, just as they lead to the initial development of breast cancer, said the study's lead author, Cheryl L. Rock, Ph.D., a professor in the Department of Family and Preventive Medicine at the University of California, San Diego.

"While this makes sense, there have been only a few small studies that have looked at the link between sex hormones in the blood and cancer recurrence," she said. "This is the largest study to date and the only one to have included women taking agents such as tamoxifen to reduce estrogen's effect on cancer growth.

"What the results mean for women who have already been treated for breast cancer is that they should do as much as they can to reduce estrogen in their blood, such as exercising frequently and keeping weight down," she added. "Taking anti-estrogen drugs like tamoxifen may not completely wipe out the hormone's effect in women who have high levels of estrogen."

Participants from this study were drawn from the larger Women's Healthy Eating and Living Study (WHEL), a dietary intervention trial that followed 3,088 women who had been treated for early stage breast cancer but who were cancer-free at the time they enrolled. Participants were randomly assigned to one of two groups - one that ate a "normal" healthy diet and the other that ate extremely high amounts of fruits, fiber, and vegetables - and were followed for more than seven years. Breast cancer recurrence was about the same in each group, according to the results, published in 2007. Researchers interpreted the findings to mean that a normal diet that incorporates the U.S. Food and Drug Administration guidelines for recommended amounts of fruits and vegetables is sufficient.

In the current nested case-control study, 153 WHEL participants whose cancer had recurred were matched with 153 participants who remained cancer-free. These pairs were alike in terms of tumor type, body size, age, ethnicity, use of chemotherapy and other variables. Two-thirds of the participants were using tamoxifen, Rock said.

When they enrolled, researchers tested the women's blood for concentrations of the steroid hormones estradiol (the primary human estrogen) and testosterone. They analyzed different forms of estradiol and testosterone in the blood, such as how much was bound to transport proteins (such as to the sex hormone binding globulin, or SHBG) and how much was "free" circulating and able to enter a cell.

Researchers found that higher estradiol concentrations, in all forms, significantly predicted cancer recurrence. Overall, women whose cancer came back had an average total estradiol concentration that was more than double the average for women who remained cancer-free. Increased levels of testosterone or SHBG levels were not associated with recurrence, contradicting the findings of several previous studies.

Although genetic and metabolic factors likely influence the relationship between circulating sex hormones and risk of breast cancer recurrence, Rock said the study provides solid evidence that higher concentrations of estradiol in the blood contribute to risk for breast cancer recurrence.

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The Walton Family Foundation, the National Cancer Institute, and the National Institutes of Health funded the study.

The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes nearly 27,000 basic, translational, and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and more than 70 other countries. AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants. The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special Conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment, and patient care. AACR publishes five major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention. Its most recent publication and its sixth major journal, Cancer Prevention Research, is the only journal worldwide dedicated exclusively to cancer prevention, from preclinical research to clinical trials. The AACR also publishes CR, a magazine for cancer survivors, patient advocates, their families, physicians, and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship, and advocacy.

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Hi, LisaF,

1. What this report describes is stated in the title: higher levels of estrogen associated with breast cance recurrence.

2. What the scientists observed is that women who recur had more estrogen and testosterone in their blood. They stated there was AN ASSOCIATION between blood levels and recurrence.

3. Starting from this ASSOCIATION, the report then uses what are known as "weasel words" in the scientific community to establish a conjecture. The report then says "The findings SUGGEST that high levels of estrogen contribute to an increased risk of cancer recurrence." Notice they did not say "CAUSE," because the observation SUGGESTS nothing of the kind.

The authors then go on to make an irresponsible leap, not based on evidence, but on an association, that breast cancer patients should act on the observation of this ASSOCIATION. The patients are urged to try to reduce their estrogen levels.

4.**** In science, an ASSOCIATION in not a cause. For example, white blood cells are ASSOCIATED with infection. White blood cells do not CAUSE infection. They are a compensation mechanism, a healing response. What if you tried to reduce white blood cell levels during infection? You would be worse off. What if elevated estrogen levels were a defense mechanism and you tried to inhibit them?

5. I'm not saying white blood cells behave the same as estrogen. But I'm saying the authors have in NO WAY demonstrated that estrogen levels cause recurrence. The authors know this which is why they had to use the weasel words to support their irresponsible call to action.

The honest and responsible scientific approach would be for the authors to report their observations and say, "we have no idea what this association means," or in scientific language, "this association is not yet understood."

Anom

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Hi, Pretty,

I take one study at a time. I ignore nothing. That is the only way to approach accuracy and make decisions.

It isn't helpful or accurate to talk about the big collective "they" out there which has tested cell lines/genes/humans because you can never pinpoint what is being discussed and you can never test a hypothesis. Generalizations keep us from making progress or factfinding. Generalizations belong in barrooms where there is no pretense of getting at the truth.

I wasn't opting for an "alternative" perspective. I don't know what that is. Evidence is evidence.

There is not an alternative or conventional sector in science because there is no such thing as alternative biochemistry. Each study stands or falls on its own merits.

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Wow--this was a passionate thread! Great research everyone.

Here's what I think and I also read everything I can get my hands on. I believe from what studies I have read that for woman whose tumors are ER/PR + that estrogen hormones are likely to help 'feed' existing tumors and cause new tumors to grow. For these women (and I am one) I want to help myself in all natural ways I can--diet & exercise--as well as taking drugs that are prescribed, which for me will be tamoxifen. No drug is without a side effect--including everyday meds like ibuprofen. Side effects differ for everyone--and some drugs have higher rates of SE than others. I have talked to people and read about people on this site that do not have significant SEs from tamoxifen. I have read about many woman who do unfortunately have significant SEs--but I think if a drug might be useful in preventing a terrible disease which might be fatal, I am going to at least try it. I read feedback form a lot of women who are so worked up about what might happen that they don't even try it. 

I certainly understand not wanting to take drugs which can have unpleasant even extreme SEs. I know some people don't trust drs or drug companies--and granted the drug companies (and the FDA) certainly have earned our mistrust. But I think dismissing all the drugs and reported studies out of hand is unwise. Just my two cents. I just think if there was a natural solution with no SEs--we would have heard out it by now--big pharm or no.

Studies are studies--as one person said--take each one for what is studied and evaluate it that way. You can find something out there to support any theory if you want to avoid the drugs...but saying that there is nothing that supports that tamoxifen has not had good results for ER+ women is simply not true. (Again from what I've read...)

 Just my two cents! I am going to at least try it and see if I can tolerate it. I also am working to limit excess estrogen by eliminating chemicals and with my diet...our 'modern' way of life has gotten a lot of things in our bodies out of whack, and there is a lot to read on diets supporting that if you are interested.

The chance of ALL cancer increases with age as the incidence of DNA damage increases with age. This is why older women should not bear children ... the longer the eggs sit in the ovaries, the more damage they incur. Same with every cell in your body.

Estrogen has clearly been established through multiple large, multi-center, random studies as enhancing the growth of certain tumors. That doesn't mean it CAUSES cancer, but fans the fires of growth.

Lack of estrogen is called menopause. It's what happens naturally to your body as you age. It is not a causitive agent of neoplasms.

They know estrogen enhances tumor growth because there are receptors on some cancer cells to which estrogen binds which turns on the replication cycle.

Really, all this speculation and guessing is not beneficial to anyone. Study cellular biology and you will know the answers about how they know that estrogen and progesterone enhance tumor growth.

Triple negatives and ER/PR negative people are not prescribed estrogen blockers.

As cancer survivors, the chances of a second primary cancer is 20-40%. That is hugely higher than the average woman's chances. Pumping estrogen into a survivor is inviting trouble. A second primary can have a completely different ER/PR profile than the first cancer. It happens all the time.

If you are smart enough to understand what menopause is, then why do you keep asking if lack of estrogen causes cancer? Do you comprehend my response? It is estrogen receptors on tumor cells that are the problem. This is when estrogen causes problems. Since ER/PR positive cancer represents about 75% - 80% of breast cancers, then there isn't any smoking gun to suggest that estrogen waning is an issue. Aging is the issue. Gene damage causes cancer. That's not an opinion, it's fact.

You say you have every right to ask questions, but you ask them on a forum of people who have no answers. Ask your oncologist. He actually studied cancer. Virtually no one here has.

Further, I'm not offering "opinions" but facts. Facts are based in science and are established by scientific method. What is it that you would like me to cite? I'll be happy to provide links.

Whom would you suggest do scientific research other than drug companies? Do you have a clue about how much money it takes to conduct research? Companies need hundreds of millions to just find compounds that might work. They need that much money again to test the compounds to see if they work, as much again to go to clinical trials to prove they work. No one is made a lab rat without their consent. Trials are conducted with volunteers.

Why would other solutions to cancer treatment put them out of business? They are experts at making money. They would be quite delighted to find other revenue streams. And there are virtually no pharmaceutical companies who make most of their money on cancer treatments of any sort. Even I could make a profit on a cancer cure, and I"m no Wharton grad.

One wonders why the oncs aren't seeing this information.

Anom, that was a great link. Thanks! I am compling a list to show my docs. Not that it will do much good, but worth a try. LOL

I love the thread ladies...some great research....I still want to know why triple negative and her2 is happening so much if the whole story with bc is hormones?  Are we (researchers) only smart enough to only see already known hormones and proteins?  I know that true with TN bc because they can't tell me what I have as a receptor... only tell me what I don't have??  Doesn't the thyroid also make something like 150 kinds of hormones and the mammary glands under the breast bone makes numerous hormones? How do they only know it's these two? And there has been a connection with thyroid and bc.  Also I now know they are looking at auto-immune diseases being connected to bc.  This came out at the San Antonio conference this year. How does this fit in with the whole hormone thing? 

Bottom line if you have a recurrence can they stop progression?  Not in 95% of us.  The only known way to stop cancer is to cut it OUT!  So what do all this drugs really mean if you had good surgeon that got clean margin?  Did any of the drugs really help? chemo, hormones any of it? Do they test you hormone ladies regularly to see what your hormone levels are? My big thing is every one of us are made a little differently how do they know these drug are one size fit all? Be stage iv and do chemo and you will find out you may have the same cancer as Jane Doe but does not mean you are going to respond the same. They now have proof that minorities do not respond to chemo and other drugs the same as everyone else.  Their liver processes drugs differently. Is this taken into account?

Sorry just had to throw a few questions out that I have thought about for a long time. Any thoughts?

As for research dollars ask the American Cancer Society and Susan B Colman where the 100 billion the collected this year went!

Flalady

From what I understand, the AI's are not meant so much to prevent recurrance, but to slow down or halt the growth of stray cells.  Even if you are node neg, there are other nodes and vascular routes for these cells to spread.  Just check the stage IV thread and you will see how many of them had no positive nodes but still have mets.  I would much rather deal with a recurrance than mets.  

I also think that we too often try to simplify bc.  It is probably many different things that start it and we will never know what most of them are.  I think that the 'big bad drug companies' are doing their best to identify what they can.  When people state that they think they are just sitting on the cure I just shake my head.  Why would these companies want their best customers to die off.  The non regulated companies have much lower costs, no restrictions and make mega bucks off of desperate people.  I just think that everyone should step back and consider all the options rather than totally denounce a whole generation of science based on this theory of conspiracy. 

"How many had anything to treat after chemo?"  That is the million $ question.  They have no way of knowing.  So that is when the patient has to make an informed decision based on.....?  That is why we keep going back to the studies and statistics.  As for the length and dose of chemo, I was told that chemo given over a longer period of time allows the cancer cells to become resistant.  It makes sense to me.  

I absolutely agree that we should be trying for a cure.  But if they can't figure out what the triggers are, that becomes an impossible task.  It seems like baby steps because it is.  Our bodies are very complex machines.  It amazes me that with all that can go wrong, that more doesn't. 

barry, I believe bone loss is a side effect of aromatase inhibitors, such as arimidex, rather than tamoxifen.  As I recall what I learned about tamoxifen is that it allows our bodies to continue making estrogen, and the protection it offers is to bind with the receptors in our breast. 

LJ13, I don't know what a neoplasm is nor have I studies cellular biology, but I know that I don't need a medical degree to understand that mistrust of so-called experts by and large is earned and deserved.  And I've done plenty of studying on my own to arrive at that conclusion.  

I truly would love to have medical professionals that I can trust, that I can depend upon to know a whole lot more than I do about medicine, biology, disease and treatments.  My oncologist doesn't even test my hormone levels.  When I asked one of his nurses why not, I was told that they 'only test for things that are cancer-related.'  OK, so I had a tumor that fed on estrogen, but testing my estrogen levels is not cancer related.  Who came up with that reasoning??  Probably an insurance company.  When I asked the same question to my oncologist directly, his response was 'that information isn't helpful.'  To date my estrogen levels have been tested once, and that was three years post-dx.  

I don't think anyone here is claiming to have all the answers.  We're talking about what the answers might be someday.  There's a lot of conflicting information out there when you venture outside the allopathic realm.  I doubt this section of bc.org would exist if any of us were satisfied with what we found at our oncologists' offices.  

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In the O'meara study 56% percent of the participants were hormone receptor positive.

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