Journal Articles

Estrogen and Your Breast Cancer Risk Estrogen is probably the hardest-working hormone in a woman’s body, but it also has a dark side: Research has determined that estrogen often plays a key role in the development of breast cancer, especially after a woman reaches menopause. How? The estrogen in a woman’s body seems to raise breast cancer risk by encouraging the growth of breast tissue, which can speed up an existing tumor’s growth. Here's what you need to know. • Combination hormone therapy (HT): If you’re considering taking estrogen and progestin (a synthetic form of the hormone progesterone) to give you relief from annoying menopause symptoms like hot flashes and night sweats, be sure to limit the time you’re on the drugs. That’s because over time your breast cancer risk climbs, says JoAnn Manson, MD, professor of medicine at Harvard Medical School and author of Hot Flashes, Hormones & Your Health. "In the Women’s Health Initiative (WHI) trial, when women got seven years of estrogen alone, there was no increased risk of breast cancer, but after four to five years on combined hormone therapy, the risk emerges," she says. In fact, over time, estrogen plus progestin can raise a woman’s risk for breast cancer by 24%; even if you take estrogen on its own for more than 10 to 15 years, your risk may still go up. Dr. Manson was a coauthor on a March 2008 study in the Journal of the American Medical Association that followed up on the WHI trial. It showed that even after the women stopped taking combination HT, their breast cancer risk remained elevated. "The risk of breast cancer does decline after stopping hormone therapy," she stresses, "but if a tumor has formed while a woman is on hormones it’s very likely to come to light even after she stops hormones, so there is some residual risk. Stopping drug therapy doesn’t mean a tumor evaporates, but the risk gradually declines." • HT and early diagnosis of breast cancer: If you have no family history of the disease, you’ve probably been encouraged to get your first mammogram by age 40 and every one to two years after that to help ensure that any tumor is caught early, when it’s most treatable. That’s good advice, but taking HT may complicate things. "Estrogen-andprogestin HT can lead to increased mammographic density"—denser breast tissue—"that can obscure breast tumors and delay diagnosis," says Dr. Manson. Denser breasts are believed to be an independent risk factor for breast cancer, but they also make it harder to accurately read a mammogram and that "can lead to abnormal mammograms that may require extensive follow-up and anxiety about repeat testing and even unnecessary biopsies," Dr. Manson adds. • HT and risk for benign breast disease: In April 2008, the Journal of the National Cancer Institute found that postmenopausal women who’d taken estrogen on its own doubled their risk of a noncancerous type of breast disease, but one that’s associated with a higher risk of breast cancer. A September 2008 study led by the same author, Thomas E. Rohan, MD, PhD, an epidemiologist at the Albert Einstein College of Medicine, in New York City, found similarly disturbing evidence in a study of women taking

estrogen and progestin: Combined HT raised a woman’s risk of benign breast disease by 74%. http://www.health.com/health/conditionarticle/0,,20250049,00.html

Baby Boomers and Stroke Risk “When does your risk for stroke increase?” The American Stroke Association asked this question, and found that most baby boomers consistently gave the wrong answer, predicting that stroke risk increases at an age that was much older than their own. The correct answer is that the risk of stroke begins to double at age 55. Maybe they were just hoping “It will never happen to me.” Even those people 55 or older believed that their risk for stroke didn’t increase until sometime in the distant future. It’s a dangerous belief. The truth is that there are many risk factors for stroke. Some cannot be controlled – such as age and gender (men have a higher risk of stroke than women). Some can be controlled, such as blood pressure, weight, and to some extent cardiovascular health. One way to reduce the risk of stroke is to work on those things that can be controlled. High blood pressure and high cholesterol can be reduced with prescription medications, but may come with unpleasant side effects. Fortunately, more doctors have become aware of the benefits of nutritional supplements. As more and more research is published in medical journals about the effectiveness of Essential Fatty Aids for controlling blood pressure and cholesterol, doctors are welcoming the idea of recommending these products for some of their patients. Other nutrients may receive less press coverage, because not many clinical trials have been performed on them, but Coenzyme Q-10 is also a heart-healthy supplement, and lesser known nutrients such as Tocotrienols work closely with Vitamin E to provide even greater antioxidant benefits for the heart. Baby Boomers can take control of their health and wellness by being aware of increased health risks naturally associated with growing older, and taking some simple steps that may lead to a happy and healthy future. http://www.biometics.com/article.asp?id=483

Women With Breast Cancer Gene Favor Preventive Mastectomy MONDAY, March 9 (HealthDay News) -- Women who know they carry a gene that puts them at higher risk of breast cancer tend to opt for preventive mastectomy, a new study concludes. Several type of risk management strategies are available to women found to have a mutated BRCA1 or BRCA2 gene, which is known to elevate a woman's risk of breast cancer. These range from simply having more frequent screening exams to the preemptive removal of a breast. Researchers at the University of Texas M. D. Anderson Cancer Center in Houston interviewed women who were tested for the mutation. They researchers found that roughly two-thirds of women who tested positive for the BRCA mutation believed that a preventive mastectomy was the most effective way to prevent breast cancer from developing or reduce their worry about the disease. Only 40% of women who tested negative for the mutation saw the surgery as the best preventative and only a third thought the procedure was the best way to alleviate their worry about having breast cancer. "Health care providers and genetic counselors must take this into account when assessing a woman's needs at the time of genetic testing and results disclosure," the authors wrote in the April 15 issue of Cancer. The researchers found that 81% of women who saw preventive mastectomy as the best way to reduce cancer risk ended up having the procedure after testing positive. Slightly more (84.2%) had the surgery if they viewed it as the only way to reduce worry about possible breast cancer. -- Kevin McKeever http://www.medicinenet.com/script/main/art.asp?articlekey=9835 9