Archive for April, 2007

A possible decline in breast-cancer incidence in 2003

Thursday, April 19th, 2007

These are confusing times. The media quickly alerts us to potential health disasters and keep us ever-weary of the risks for cancer. Yet in all the hype and excitement, the value of bio-identical hormone replenishment is often discounted or overlooked. The New England Journal of Medicine April 19, 2007 issue releases a report about “The Decrease in Breast-Cancer Incidence in 2003 in the United States.” Assuming that the statistics are correct, then much can be speculated about the causes of this overall decline in the disease. And the authors certainly do speculate about this, without much information to truly lead them.

One speculation is the decreased use in Premarin and Prempro since the announcement of the WHI conclusions. The transition to fewer women replacing their hormones with synthetic derivatives could have played a role, but given the short interval between the reports from the WHI study and the change in breast-cancer incidence data, this seems unlikely. Also of note, the report states “No sudden decrease has yet been reported for breast-cancer incidence in heavily screened populations.” So speculation about routine screening also may enter the equation. Clearly, much still needs to be evaluated.

What the authors completely overlook, or at least fail to mention in their speculation, is that a great paradigm shift has begun. More people are realizing the healthy benefits of having their hormone levels measured and then replenished to levels of wellness, not replaced with a foreign hormone. They are seeking balance in their hormones, not supra-physiologic dosing or replacement.

They mention the change in diet that many women have chosen. More and more women are learning that substances such as Diindolemethane, CoQ10, anti-oxidants, vitamins A, E, & D, and iodine are important for breast health. Furthermore, they recognize the benfits of replenishing melatonin, progesterone and DHEA, as they all play a role in decreasing cancer states.

So by choosing bio-identical therapies, or by avoiding synthetic hormones that further suppress endogenous bio-identical hormones, women may be finding better breast health.

Further investigation is definitely warranted to elucidate the true correlations to this possible decline in breast-cancer incidence rates. Guesses are being made without getting the full information. Have prescription rates increased for compounded and pharmaceutical bio-identical hormone therapies? What are the serum DHEA-S , estradiol, progesterone, Vitamin A & E, 25 hydroxy vitamin D, free and total testosterone, dihydrotestosterone, melatonin, homocysteine, anti-oxidant levels and 24 hour urine iodine challenge test results of the women that do present with breast cancers? And those that never get cancer?

The other issue at hand is whether anabolic steroids should be available over the counter. Despite the fact that vitamin D is a very beneficial steroid hormone, it is not receiving the same scrutiny for access as dehydroepiandrosterone is. Where does this put us in our understanding of the value of DHEA? Researchers have found a potential benefit in using DHEA to kill androgen receptor-positive breast cancers. Another study suggests, however, that there no relation exists between DHEA-S or DHEA and overall breast cancer risks. There may be some association of DHEA with estrogen receptor-positive/ progesterone receptor-positive breast cancers, but it’s unclear how these levels were balanced in the study with the subjects’ other hormones and nutritional statuses.

Such fragments of data can be confusing. This is why it is so important that patients work with physicians who are thorough in their approaches to care, and understand the value of balancing hormones bio-identically, instead of suppressing them synthetically.

I am hopeful that breast cancer rates are truly declining, not just in 2003. We have much to assess, and it is far too soon to jump to full blown conclusions. May true health prevail.

References:
Ravdin PM, Cronin KA, Howlader N, Berg CD, Chleblowski RT, Feuer EJ, Edwards BK, Berry DA. The decrease in breast-cancer incidence in 2003 in the United States.
New England Journal of Medicine. 2007 April, 356(16):1670-74

Tworoger SS, Missmer SA, Eliassen AH, Spiegelman D, Folkerd E, Dowsett M, Barbieri RL, Hankinson SE. The association of plasma DHEA and DHEA sulfate with breast cancer risk in predominantly premenopausal women. Cancer Epidemiol Biomarkers Prev. 2006 May; 15(5):967-71.

Labrie F. Dehydroepiandrosterone, androgens, and the mammary gland. Gynecol Endocrinol. 2006 Mar; 22(3):118-30.

Hardin C, Pommier R, Calhoun K, Muller P, Jackson T, Pommier S. A new hormonal therapy for estrogen receptor-negative breast cancer. World J Surg. 2007 April 4.

Aceves C, Anguiano B, Delgado G. Is iodine a gatekeeper of the integrity of the mammary gland? J Mammary Gland Biol Neoplasia. 2005 Apr; 10(2):189-96.

Natalie Kather, MD
Family and Anti-Aging Medicine physician