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[Jane50]

Hi all,

Unfortunately my sister has just been diagnosed with breast cancer and has been told to stop HRT completely. She's now an emotional wreck and can't sleep and I'm guessing more symptoms will start soon too... Does anyone have any advice or tips on how best to navigate through this kind of situation? Alternatives to HRT that may help?? She's 53.

Thanks in advance x

[Katejo]

Hi all,

Unfortunately my sister has just been diagnosed with breast cancer and has been told to stop HRT completely. She's now an emotional wreck and can't sleep and I'm guessing more symptoms will start soon too... Does anyone have any advice or tips on how best to navigate through this kind of situation? Alternatives to HRT that may help?? She's 53.

Thanks in advance x

It may not be necessary to stop local oestrogen which doesn't go into the bloodstream. Have a look at this book! There is a chapter on women with breast cancer. https://www.amazon.co.uk/Oestrogen-Matters-Hormones-Menopause-Well-Being/dp/0349421773

[HellsBells]

Is it a hormonal BC? I had triple negative and was told I could have HRT if I wanted.

[bombsh3ll]

I'm so sorry to hear of your sister's diagnosis.

Vaginal estrogen can still be used but that only treats vaginal symptoms not the whole person.

Tamoxifen can be used in breast cancer patients - this is a SERM and blocks estrogen's activity in the breast but has estrogenic effects on the bones, cardiovascular and genital system, therefore mitigating some of the consequences of estrogen loss.

As has been previously mentioned if the particular tumour is ER/PR negative HRT can still be used although may well have to be sourced privately.

Antidepressants can be used to help manage vasomotor symptoms.

There is also a new drug called fezolinitant which is not yet available on the NHS which also only treats hot flushes. This has no safety data yet in breast cancer patients and I would not rush to get on this as it can cause derangement of liver function tests, which in a cancer patient would prompt concern about hepatic metastases and could potentially result in more investigations and distress.

Once a patient is 5 years clear, hormone therapy can be considered and is a personal choice whether to accept a degree of risk for quality of life and other health benefits, although this frequently has to be obtained privately after previous breast cancer.

As a non-carrier within a BRCA2 family who has had risk reducing mastectomies myself I would also encourage your sister to advocate for mastectomy (ideally both sides) rather than lumpectomy if she is interested in resuming hormone therapy in the future, as this provides more complete peace of mind and risk minimisation, as well as potentially avoiding radiotherapy in those with early stage breast cancers, plus never needing to have another mammogram. 

[Aprilflower]

It's important to know what stage and type of cancer has been diagnosed.

Very early or pre-cancers do not require mastectomy and have only a small chance of reoccurring with a lumpectomy and radiation therapy.  That is regarded as almost as effective as a mastectomy.

Surely it's best to see what happens on no HRT.  There are other natural remedies that help and many women manage this way.

I would say don't rush.

[CLKD]

In the 1990s I had a lump removed which had 'changes at the margins' so underwent radiatiotherapy - the Oncologist at my last appt "No HRT for you young Lady" - however it does depend on the type of cancer as well as quality of life.  If HRT is so dangerous then women should be offered bilateral mastectomy so that they are able to continue with replacement.

Tell your sister to make notes as to her worries to take to each appt..  Quality of Life is important.  Tamoxifen disagreed with me: heightened my sense of smell and taste so I was unable to eat so I stopped taking it after 4 months.  I believe that there is another similar drug which is used instead of that.

[bombsh3ll]

I think when women are steered towards breast conserving surgeries the general expectation is that they will forego future hormone therapy.

This should absolutely be taken into account and discussed with the surgeon when deciding on treatment.

In postmenopausal women letrozole can be used in places of tamoxifen however this strips every last drop of estrogen out of the body, is considered less safe to take vaginal estrogen alongside, and has no positive effects on bone, cardiovascular or genital health.

Postmenopausal women can therefore request tamoxifen instead - this is often not made clear.

[Aprilflower]

Well I'm about to start Letrozole and am well aware of the negatives.  My consultant didn't push it at all, but said to stop if the side effects were too problematic.

I'm willing to give it a go but, according to my risk score, it will only make a 3% difference.  That is reducing my reoccurance risk from 5% to 2%.

I have to stress that I was told any treatment post surgery was my choice.  Surgery alone would have put my risk at around 15%, which is much the same as the overall risk of breast cancer anyway.

I'm fully confident in my choice to have radiotherapy.  It's a much improved and less damaging treatment than it was.  Lucky I only need 5 session anyway.

It's very difficult to judge from the very general information that is available.  Every woman's case is different and it's only when you get your own personal risk assessment and treatment options that you can decide.

[Nas]

Hi Jane,
Sorry to hear of your sister’s diagnosis.

As others have said, it does very much depend on the hormonal status of the cancer. If it is strongly oestrogen receptive, then HRT will unfortunately be a firm “ no”. If it’s not hormone dependent, then I can’t see why your sister cant continue with her HRT.

I have oestrogen + metastic BC, so no HRT for me either. I take Veozah (fulvestrant) the non hormonal drug for hot flushes. As bomb mentioned, it is only available on private prescription but it doesn’t address any other menopause symptoms.

After my primary BC, I went to see a very well known MS and she prescribed me HRT. We had an adult conversation about benefits and risks etc.

So, for your sister, HRT may not be off the cards permanently; just via a GP.


Best of luck.

[CLKD]

As an aside - how soon after beginning HRT would the breast cancer develop ?  Weeks, months, years ? 

[Nas]

CLKD, as you are probably aware  there are many different types and sub types of BC. Some are aggressive and some are not. I don’t think we can definitively say “ HRT causes BC” But if you have a cancer which feeds off oestrogen, you’d need to make that informed decision with your specialist. I don’t regret taking HRT, after a primary BC diagnosis. It gave me a libido, energy and a lighter mood. Did nothing for sleep however. I know of women who never took HRT and their BC returned.

Tis the luck of the draw as they say! 😊

[Jane50]

Thank you so much to everyone who's replied - it is very much appreciated. I have ordered the book that was recommended and will have a chat with my sister about her possible choices regarding HRT following on from your suggestions. This group is such a wonderful source of support and knowledge. Thank you all! Xx

[CLKD]

Nas - quality of life?   

Jane50 - let us know how you both get on!  All experiences shared can help others.

[joziel]

Jane, you might also want to look at the Balance Menopause website for their articles on BC.

Really, this should be a decision made by each woman after weighing up the pros and cons - not a 'computer says no' response from above. No one else lives your sister's life except for her. If her quality of life is awful off HRT, then she may well make a reasoned decision to continue it.

And yes, if you look at the book called Estrogen Matters by Bluming (and google Bluming in podcasts for interviews) you will see that estrogen is actually protective against BC. Even in the WHI study, the arm of women taking estrogen only HRT (because they didn't have a uterus) had a LOWER incidence of BC than the women in the combination HRT or NO HRT arms.

BC is much less common in younger women - who have higher levels of estrogen - than it is in post-menopausal women, who have lowest levels of estrogen.

And even when women are BC survivors, they are not advised to avoid pregnancy - despite pregnancy involving astronomically high levels of estrogen - and they are not at increased risk of recurrence after pregnancy.

It simply doesn't add up that E causes BC....

[CLKD]

Good points made here.  I was 42 when I found a lump in the R breast in 1994.  It never showed on mammogram. I saw the Surgeon 10 days later who thought it non-sinister but I underwent surgery the following June at his insistence. " I can't be certain until I have the lump in my hand ."  After the operation he told me "I had in my hand was I expected to find" .......... lucky him 

At histology the margins of the lump were showing 'changes' so he went in again 8 days later and removed more cells followed by a bone scan, plus 4 weeks precautionary radiation, mammograms and discussion with the oncologist.

Things should have moved on by now, I suspect that Surgeons don't want to risk litigation should cancer reappear in women that decide upon HRT.  I knew a lady who had breast disease in her 40s, had treatment, followed by HRT - eventually.  She died aged 88 ;-).