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[Ann B]

Avrum Bluming an American Oncologist is pro HRT and ERT - including after BC.

I don't know if this June 2022 abstract has been discussed already.  Some may already have read his book 'Oestrogen Matters'.

This abstract may be of general interest for those on HRT, ERT, and VET.  I would, however, be interested in feedback particularly on his conclusions regarding their safety after BC.

Dr Liz Newson is in his camp.  Dr Liz O'Riordan is not a fan and has produced a short critique on his theories.

https://www.ajec.com.mx/wp-content/uploads/2022/07/CancerJ2022183-190.pdf

Ann

[CLKD]

His points have been discussed on the Forum.  The way to find out how ladies have coped is to contact the Author and ask the question.  'tamoxifen' made me ill.  My Surgeon gave me the option of meeting with other patients but I wasn't interested, had enough to do with my own diagnosis and treatment. 

If I was having bad symptoms I would consider HRT.  Quality of Life is important to me, having suffered severe anxiety and depression over the years.  One may not require enough years of HRT which would trigger the possibility of recurrence.

If HRT is so dangerous, women should be advised to undergo bilateral mastectomy. 

[Wrensong]

Ann, I've always found Dr Bluming's articles in this field reassuring, persuasive & compassionate & this paper is another compelling example.  That said, stats can be misleading & not being qualified to interpret them, I rely not only on what I can find & understand (!) in the way of published research to help me make decisions about crucial health choices, but on my own reasoning & feelings about my unique needs & the possible consequences of one course of action compared with another.   

I take HRT because it helps me manage a difficult cumulative load from a combination of health conditions & with osteopenia, to try to safeguard my bones.  But I choose not to drink alcohol regularly because, although I enjoy it, I don't need it & it's one step I feel can take to reduce my breast risk.  Other women I know with concerns about breast health feel HRT is too a great a risk for them personally, but that regular alcohol intake is not.  It comes down to individual perception of the balance between risks & benefits & what we are each comfortable with.  Both ways of looking at it seem reasonable to me & we support & respect each other's choices.

I think as things stand, no one can give us absolute assurances & we simply have to make the best decisions we can, according to our individual circumstances.  We can also choose to keep an eye on research relating to whatever particular concerns/interests we have & change our minds about what's best for us as the science evolves, or our own needs change.

As CLKD says, Dr Bluming's book (& podcast of an interview he did with with Dr Newson) have been mentioned on the forum before if you'd like to do a search for others' views.  I don't remember this paper being posted, but I don't follow the forum that closely, missing weeks at a time.

You know my circumstances so please feel free to PM me any time if that might help.
Wx

[Ann B]

Hi Wrensong

I totally concur with your very sensible comments, and my position is the same on alcohol.  I also add bmi, and exercise etc, into the preventative mix.

I too find Bluming's writings very persuasive, but he has his critics like Dr Liz O' Riordan.  Dr O'Riordans critique is unsettling regarding ERT safety, although she seems to be a proponent of vaginal oestrogen.  I can understand her caution given the fact she has had BC twice and was stage 4 IIRC.

As they are quite public and vocal about their stance and allegedly appear to want to help post-menopausal women, I emailed some general questions regarding oestrogen risks to Dr Liz Newson, Dr Liz O' Riordan, Dr Rachel Rubin. Dr Avrum Bluming.  Only Dr Bluming took the time to reply and address my general questions.  I think that says something about the man.  Dr Newson and her team ignored the email.  The other two gave an anodyne and stock response.

I would absolutely love to accept Dr Bluming's conclusions on systemic oestrogen, but I am extremely cautious, 'once bitten, twice shy'.  I did everything by the book 23 years ago when I took low-dose transdermal oestrogen following a surgical menopause.  The research was revised and said that low-dose bioidentical transdermal oestrogen was even preventative of BC with so many added benefits.  Perhaps it was not causation, but I will never know!

Your third para is very apt Wrensong.  That was and is my position.

Ann

[Wrensong]

Hi Ann, like you I exercise, my BMI is low (too low, but that's another story) & I eat as healthily as I can, cooking mostly from scratch & making my own rye bread.

I must have come across Dr O'Riordan's writings in researching BC & HRT, but can't recall them if I did.  If you haven't heard podcast interviews with Prof Lesley Regan & Dr Tina Peers in which they talk about their decisions to use HRT after BC, I think you might be interested to hear their points of view.  I think the interviews were in Dr Newson's series, though from memory BC was not the main topic.  I bookmarked them but Newson Health's website changed some time ago & since then I find many of the links no longer work.  If you want I can see if I can locate them & let you have them via PM.  Both medics, if I remember rightly, spoke of having resumed use of HRT for essential QOL after initial successful treatment & again following treatment for recurrence.  But the individual nature of their BC & the treatment they subsequently underwent of course informed their decisions, as it must with all of us, together with discussion with those specialist medics who know our history.  I'm not suggesting any course of action based on their choices, but simply, personally, found their experiences & reasoning helped me in retrospect to be more at peace with decisions I had earlier made at a time I had no knowledge of their circs.

In fact I'm on edge every time I post on this topic, afraid something I say might adversely affect someone's state of mind or influence a difficult & important decision.  But when I feel robust enough I do post about it because many, many women will sadly find themselves faced with the need for HRT after BC & it can be isolating & I think compounds the worry if we feel we have to deal with it alone.

If as you say even Dr O'Riordan is OK with the use of vaginal HRT, do you find that reassuring?

I'm surprised you heard nothing from Dr Newson as I was briefly in touch with her via email on the topic a few years ago & she did reply personally.  I should perhaps say I wasn't asking for advice, but thanking her for bringing this somewhat taboo issue out into the open.  It might simply be that NH is so much busier now that perhaps your email got missed?

My heart goes out to you Ann & I agree that at this stage of scientific knowledge, none of us will likely ever know what causes us to develop BC.  When we start HRT we do so for the best of reasons: either to manage difficult symptoms or, with conditions like osteopenia - with a view to keeping ourselves as healthy as we can for as long as possible, or both.  In taking HRT after surgically induced menopause you did nothing wrong - you have simply, sadly, been unlucky.
Wx

[CLKD]

I wonder if: as with many treatment regimes : no medic will take responsibility for telling ladies who require VA applications to use after BC.?


Years ago I discussed with an Oncologist whether chemo therapy wasn't too severe for many - whether a longer treatment regime over many more months with gaps, would be more suitable.  "This has been discussed at high levels between Oncologists but no-one will suggest altering what we know works for most patients.  It will take a brave man who decides to trial longer regimes as well as prescribing less chemo at each treatment session".

[Ann B]

Thanks, Wrensong for another very helpful reply.

You asked if the fact that Dr O'Riordan's support of vaginal oestrogen was reassuring.  The most recent positive comment of hers I found, was a tweet in response to the 2022 Danish Study on vaginal oestrogen.  She may have made subsequent comments, but I have not found them.  I am not on Twitter.

IIRC the Danish study's selection of over 8.400 participants excluded those who had taken HRT prior to BC.  Unfortunately, I fall into that excluded cohort of a previous HRT user, so the study basically excluded me.  I was a little puzzled by this exclusion because there was no mention of the exclusion of those on birth control pills.  Some pills had high doses of oestrogen, particularly the earlier ones, and the age range of those in the study was up to 95 years. 

I asked Dr O Riordan about the above cohort that was excluded and the implications of the study for them.

I never took the pill because of the risks, and have thus considered my lifetime exposure to supplemental oestrogen would have been lower than someone on the pill, despite taking ERT for 20 years.  However, this is a complex scientific equation and obviously outside the parameters of the study.

In my questions to the 4 doctors, I sought to keep them general and not personal.

I agree with your last para and thank you for your last comment.

I would be most interested in what Prof Lesley Regan & Dr Tina Peers have to say.

Ann

[Ann B]

His points have been discussed on the Forum.  The way to find out how ladies have coped is to contact the Author and ask the question.  'tamoxifen' made me ill.  My Surgeon gave me the option of meeting with other patients but I wasn't interested, had enough to do with my own diagnosis and treatment. 

If I was having bad symptoms I would consider HRT.  Quality of Life is important to me, having suffered severe anxiety and depression over the years.  One may not require enough years of HRT which would trigger the possibility of recurrence.

If HRT is so dangerous, women should be advised to undergo bilateral mastectomy.

Hi CLKD

I would be interested to read about your experience with Tamoxifen.

Ann

[CLKD]

It made me ill.  Altered my taste buds and sense of smell.

DH had made a Dundee cake: it was in a tin with the lid on in a pantry with door closed shut.  Every time I walked by I could taste the 2 tablespoons of water he had added to the mixture.  I was in Hospital when he cooked it all so it wasn't lingering association odour.

We bought pork chops - even though I was in another part of the house, knowing what he was cooking I could smell/taste them.  It's not the room that holds cooking smells, that's another room. 

I felt so sick that I was unable to eat.  = high levels of anxiety with suicidal ideation.  So after 3 months I stopped for 6 weeks, then tried again: after 3 weeks the symptoms returned to so I stopped.  As it was prescribed on an 'in case' basis: in that there was no proof that it actually would stop the cancer returning, I stopped swallowing it.

That was in 1990s.  No problems in all those years. 

'tamoxifen' can increase the risks of cancer of the womb though my Surgeon glossed over that.  A friend took it for 15 years and died of womb cancer. 

[Ann B]

That's interesting CLKD.

Congratulations on your success in the absence of Tamoxifen.

Ann

[Ann B]

I must give a shout-out for Dr Rachel Rubin.  This evening she came back with a more specific answer re vaginal oestrogen.

"The risk of not using vaginal hormones when someone has urinary symptoms and gets utis far out weighs any data that exists on the harms of using it. We have no slam dunk data showing harm. Lots of amazing data showing life saving benefit.
We need more data sure. But not a reason to suffer".

[CLKD]

That's great news.  Does the news help you though?

I wasn't going to feel constantly sick with 'tamoxifen'.  I was suicidal within a few weeks  .  Knowing that the lump 'showed changes in the margins' was enough for me to get on with Life.  VA was so difficult to live with, I am prepared to use it: my GP didn't hesitate in prescribing.  After all, once VA is under control, many are able to keep symptoms comfortable with twice weekly treatment.

[Wrensong]

Ann, I will try to find the Drs Regan & Peers interviews & PM you the links or post them here if no commercial content barring that.  No time to read latest posts on this thread thoroughly yet.  Will, come back to them.
Wx

[Ann B]

That's great news.  Does the news help you though?

I wasn't going to feel constantly sick with 'tamoxifen'.  I was suicidal within a few weeks  .  Knowing that the lump 'showed changes in the margins' was enough for me to get on with Life.  VA was so difficult to live with, I am prepared to use it: my GP didn't hesitate in prescribing.  After all, once VA is under control, many are able to keep symptoms comfortable with twice weekly treatment.

Hi CLKD

I am 3 years post-BC surgery.  Like you, I decided against Tamoxifen or any endocrine therapy, after extensive reading about them.  I did not even commence Tamoxifen.

I was concerned about the effects endocrine therapy would have on my body, particularly as I had a BSO.

You ask if Dr Rubin's reply helps with my decision regarding vaginal oestrogen.  In all honesty, I am still undecided.  I suppose it was the shock of getting BC after doing everything by the book.   I took purely low-dose bioidentical transdermal oestrogen, and in effect also had oestrogen ablation via BSO, yet still got ER-sensitive BC.  This has made me super cautious, regarding oestrogen.

In addition, despite being recently diagnosed with V.A. I have not been, and am currently not experiencing any vaginal discomfort, other than dyspareunia.  The reason I was specifically interested in V.E. was because I was alarmed by a recent lab-based urine test which indicated a very high level of leucocytes.  I stopped ERT 3 years ago, and for the last 2 years dipstick testing has always shown leucocyturia. This may/probably be indicative of degeneration of urinary and vaginal tissue.

I am, therefore, concerned to halt further degeneration, which I understand from reading is probably inevitable.  I don't want problems in the near future, particularly if they can be prevented by action taken now.  I also understand it is better to act sooner rather than later with V.A.

However, although I am poised to take V.E. I hold back when I also read on the MMF of so many ladies experiencing often significant discomfort and ongoing issues with V.E.T.  It is a bit offputting particularly when other than dyspareunia, I am vaginally quite comfortable, at the moment.  I have often operated under the principle 'if it ain't broke don't fix it'.  I don't want to 'go out of the frying pan into the fire' - maybe literally!

This is where I currently am.

What are you taking CLKD, and are you comfortable and problem free?

Ann

[CLKD]

I insert 'ovestin' as necessary.  It works for me, internally and around the outer labia.  Or KY Jelly to stop any itchiness. 

As for whether your low-dose HRT regime triggered your breast disease, who can be absolutely certain?  Apart from 4 weeks of HRT many years ago which didn't suit - can't remember what for now  - there is nothing in my medical history that would pre-dispose me to cancer.  At surgery the Consultant didn't suspect what was shown at histology.  It could have been slow growing and never materialised.  I found the lump on palpation. 

HRT may not trigger disease.  Too many unknowns which is why I opt for Quality of Life.