DR. VLIET ON BREAST CANCER RISKS & HORMONES ..(RADIO BLOG TRANSCRIPT)

[Guest guest]

HI all,

For those who may not have been able to listen to Dr. Vliets radio blog you may want to read the text of the audio. (fair warning, it's long) I typed it out as I listened (and I wonder why I've never enough time *smile*) but I thought it was excellent and wanted to save it, but to be honest her own voice comes across better than the typed word (I think) *smile* and please forgive my own inserted comments, I do that for myself and where I did I always put my initials DT or my name.

Dee ~

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http://www.blogtalkradio.com/drvliet

(Here's another link if that one doesn't take you there (it did me) but in case not )

http://www.blogtalkradio.com/drvliet/2008/02/12/Dr-Vliets-Savvy-Womans-Health-Guide-Straight-Talk-About-Hormones

Dr. Vliet’s Savvy Woman’s Health Guide™ - Straight Talk About Hormones

Hormones and Cancers: Straight Talk About Risks

Date / Time: 2/11/2008 9:00 PM (AUDIO)

TEXT FROM THE AUDIO;

Typed by Dee as Dr. Vliet talked:

Dr.Vliet on straight talk about Hormones.....

about breast cancer, ovarian & uterine cancer.

''I want to put things in the proper perspective and what the current research is showing. My show is educational we do not sell any products nor do we have any ties with any products.

''Let's talk about Breast cancer:

It is a womans number one fear and concern....women of all ages report that breast cancer is their number one fear even though as I've pointed out it is NOT the number one cause of death for women. It is only 4% of women who die of breast cancer and over 50% of women who die of heart disease over 50 so starting right off the top let's put the risk in perspective.

First of all, to all of my listeners, please keep in mind first of all simply because we are female we have a higher risk of breast cancer as we get older whether or not we ever take hormones after menopause! I can't tell you how many patients say to me. "Oh well I don't have to worry about breast cancer because I'm not taking hormones after menopause or I don't have to have a mammogram because I'm not taking hormones.

WRONG! Those are not correct understandings. It's a myth that if you don't take hormones after menopause your risk of breast cancer goes down. Breast cancer risk goes up with age, even if you're 'not' taking hormones with menopause and it increases in women who are obese and we'll talk about that later in the show, so don't think you're off the hook after menopause because you don't take hormones or that don't have to have a mammogram it's simply NOT SO.

Now..... there's another myth out there that has been fueled by the exaggerated headlines particularly since 2002 and that myth is that estrogen causes breast cancer! We simply don't have evidence that estrogen is causing breast cancer and ladies who are listening to this, let's use some common sense, which women are very good at doing.

IF estrogen 'caused' breast cancer you'd think we would see a hugh spike in breast cancer in young women during pregnancy when the 'estradiol' levels can rise to levels as high as 20,000, and menopausal women are the highest risk for breast cancer and yet their estrogen levels on the same scale are maybe only 20 pcgs per ML.

So it is just simply flying in the face of common sense to say that estrogen causes cancer and the medical evidence doesn't show that.

What it 'does' show is that estrogen and progesterone 'or' progestins may stimulate the growth of 'existing' cancers. It's rather like putting fertilizer on plants and they grow faster and some experts actually think there may be some benefit to this effect since most breast cancers are slow growing, so if hormones increases the rate of growth it can actually help women develop, be identified, as having a cancer and develop a treatment approach, 'sooner' because the cancer is growing a little more quickly.

Cancer of the breast is believed to take from 8 to 10 years to develop from a microscopic point where you can't see it or feel it, to the point of being able to be seen on a mammogram or to be felt as a small lump.

And so that very longggg latent period of breast cancer development argues against the idea that women, even in the WHI trial, women taking Prempro for example who had a slightly increased risk for breast cancer and because breast cancer has such a long latency phase normally, the fact that cancer can be detected within a year or two really does argue against the fact that the hormone therapy 'caused' the cancer.

It's really entirely possible what we saw, because there were an additional 8 cancers per 10,000 women in the WHI (Womens health initiative) that got all the headlines and it's possible that taking the hormones in susceptible women it's feared that it caused them to have an accelerated growth of 'microscopic' cancers as a result of this hormone fuel or fertilizer, but that they had a pre-existing subclinical breast disease 'already' and that sits with the facts that this was an older group of patients.

They had a high percentage of women who were obese, a high percentage who had a first degree family history of breast cancer, and there were 40% who were former smokers, another risk factor, so I want to put it in perspective and simply say that the evidence supports that hormones increase the growth of 'existing' cancers, not that they 'caused' a new cancer to develop.

And now let's look at a couple of key points about the different roles of hormones.

During our normal menstrual cycle each month throughout our menstrual life and our reproductive life, there is breast growth during the first half of the cycle when estrogen is the dominant hormone and progesterone levels are quite low. But there is 'MORE" growth or proliferation of the breast in the second half of the cycle when 'progesterone' is the dominant hormone.

There is much greater growth of the breast tissue due to progesterone than what we see with estrogen and I am talking about the natural hormone progesterone here. That's every month in our own menstrual cycle.

If you think about it you can remember what your breasts felt like in the 2nd half of the menstrual cycle during your menstrual years. They'd always get full and tender and sensitive and they feel like they're engorged. That's the progesterone effect on the breasts so you've experienced that but perhaps just didn't know which hormone was doing it.

So 'that' is something that we've known from reproductive medicine for a long time and it fits with the data that is showing a greater risk of breast cancer for post menopausal women taking hormones if they are taking estrogen 'plus' progestin OR estrogen 'plus' progesterone. Now having said that, there does seem to be a differential in the risk from the combined hormones depending upon what 'type' of progestin is used and...whether or not you use natural progesterone versus synthetic progestins.

(12 min 13 sec. up to here on tape) (I took a break here *smile* DT)

For example medroxyprogesterone acetate or brand name Provera that was used in the womens health initiative (WHI) has a 'much greater' effect to stimulate the breast cell proliferation and breast density which makes it harder to read the mammograms, than does Norethisterone(sp?), for example in this country, a study was done on that overseas and in this country that progestin it's called Norethindrone and it's found in the products Activella and birth control pills for example like Femcon or Ovcon as well as some other uses.

So Norethindrone has less of an effect on stimulating the breasts than did medroxyprogesterone acetate or Provera and there is some preliminary evidence that natural progesterone even though it does stimulate the growth of the breasts during our menstrual cycle that it may have less adverse effects on the breasts after menopause than does Provera or (medroxyprogesterone acetate) .

So if you have a uterus after menopause and need to use the combination therapy then there may be some benefit to using the progesterone, particularly the non oral form as I'm doing with so many of my patients and using 'Prochieve' a vaginal progesterone for a lot of the need to oppose estrogen effect on the uterine lining.

And that's a clinical use that I'm doing even tho, and there's good data to support that, even though we don't yet have the full FDA approval for that particular use for post menopausal women. But using progesterone or Norethindrone instead of Provera makes a lot of sense for many reasons including the effects of medroxyprogesterone acetate on the brain as well as heart risk factors and the breast effects that I just mentioned. So, what about estrogen alone?

If a woman has no uterus, if she's had a hysterectomy and using estrogen alone after menopause we're 'not' seeing, from the studies today, the increased risk of breast cancer of using estrogen alone that we're seeing with adding the progestin or combined with post menopausal woman. So I think it's a really important issue for women to be aware of because what hormones you take and how you take them after menopause have a bearing on the breast cancer risk.

There's another fascinating field of research, and it's one of the reasons I keep going to the International conferences because I find it so intellectually stimulating with the research that I'm exposed to with some of the world leaders in this field as they are looking at many different issues than what we hear about here in the United States.

THIS NEXT PART IS VERY INTERESTING... Dee T

There is a French researcher named Pasqualini and you may want to google his name and his research and see what you come up but he's actually researched and published papers and presented them at the national endocrine society as far back as 2001 and he found that 'estradiol' 'inhibits' it's own biotranformation in the breast.

Now that's a big word, but what it basically means is that there are enzyme systems in the breast that actually takes testosterone and converts it to estrone and estradiol right there in the breast even if you're 'not' taking any hormones.

And after menopause one of those enzyme systems called sulphatase gets even 'more' active 'after' menopause than it was before! And its sitting there being it's own little estrogen producing factory within the breast and what Pasqualini found was that at ''low'' levels of estradiol such as would be the case in menopausal women that sulphatase enzyme was very active and made a "LOT" of estrone and more estradiol.. from the bodys own testosterone.

(COMMENT from Dee.... generally we do 'not' want any extra 'estrone' it's an estrogen that is naturally produced in higher quanities when we lose our estradiol as we go into menopause and 'estrone' loves fatty tissue (breasts) & obese women tend to over produce it and part of why obesity is also a risk factor for breast cancer) D. T.

BUT..... if estradiol was given at a certain thresh-hold level, that the presence of a higher level estradiol in the blood stream acted to 'inhibit' this enzyme system so that the concentration in the breast was actually lower! I think this is staggeringly important, it was presented in the United States in 2001 in the Endocrine Society meeting.

We didn't hear any press reports about that and yet we hear all the negatives, so that may help explain why we now actually have several clinical trials that have shown no increase in breasts of recurrence of breast cancer in women who have chosen to go 'back on' hormone therapy after being treated for breast cancer. And I find 'that' very important and that doesn't get much media attention either.

So it's an extremely complicated area and there is a lot more information to this whole picture than what you may have been hearing about from the headlines that have made it into the press.

The other thing that I think also is very interesting to keep in mind is if you're concerned about the risk of breast cancer & yet you'd like to use estrogen after menopause for 'symptom' relief, keep in mind that this is one of those situations where it may be better to use transdermal 'estradiol' such as 'Estrogel' the FDA approved estradiol gel, Or the estradiol patches, the brands are Climara and Vivelle and there is a generic estradiol patch as well because transdermal delivery has two important benefits that can play a role in breast cancer risk.

Number one: the non oral delivery the gel or the patch, now I'm talking about the FDA approved products by passes the liver first step and you don't have the transdermal estradiol converted to so much 'ESTRONE' as you do with the oral estrogens.

In addition using one of the FDA approved estradiol patches or gels, it is with lower dosages than what is found with the oral forms and much lower doses than what is delivered by the standard 'cookbook' approach in the United States with using Premarin.

So I think it's really important to know that you can choose approaches in working with your own physicians that are FDA approved, that are molecular copies of what your body has always made and can be delivered in ways that minimize the estrogen load compared to the standard mixture of horse estrogens (Premarin) that women in this country have been getting for so many years and that turns out to be perhaps not the best approach. So I hope that's helpful in looking at some of the options that you have.

TESTOSTERONE

There's been confusing information about Testosterone and its effect on breast cancer risk. I want to first mention first of all that testosterone in the basic science studies of the hormone acting on the breast tissue, testosterone tends to have an 'inhibitory' effect on the breast cell growth, and that's important in terms of having an inhibitory effect on cellular growth that can lead to cancerous changes.

There have been recent studies that have shown that testosterone therapy after menopause did NOT increase the risk of breast cancer and in fact had appeared to have an 'inhibitory' effect on the breast cell growth that is seen with estrogen and progesterone. (with a currently existing cancer, d.t.)

The one study that made the headlines was one that was based upon the US Nurses health study group using estrogen & testosterone and the headlines screamed at us, 'Estrogen plus Androgen' increased the risk of breast cancer!

But what they didn't go into in the articles that I saw, was that the Nurses health study was a group of women with over 90% of them who used combined estrogen and testosterone were using ESTRATEST....(a name brand dt)

Which is a product that contains an 'esterified' mixture of oral estrogens similiar to the mixture in Premarin, not exactly the same but very similiar and it delivers 'very high' levels of 'Estrone' (As does Premarin, DT) and it also contains 'Methyltestosterone'.. a potent sythetic form (of testosterone) that many European countries have actually banned and we're still left with it as a menopause therapy for menopausal women in this country because methyltesterone has many adverse effects on the body including an increased risk of Liver tumors from that methyl group.

(22:35 min line)

*COMMENT: The Methyltestosterone form may also be more prone to give those masculine side effects you may read about and you cannot measure a methyl form of T in the blood (it doesn't convert) no matter how much you use and why it's so easy to overuse it, it is definitely not the same as the bio-identical testosterone. Dee)

That's not the same hormone as the bio-identical testosterone that is used in some of the testosterone 'pellets' some of the compounding pharmacy testosterone options and also the testosterone patch that's approved all over Europe that we don't yet have.

So... I want to emphasize again the type of hormone, the delivery system, all of these factors play a role in terms of breast cancer risk and the Newspaper stories simply just don't get into that information as background, (for the most part at least) the ones I've read don't.

There are some other issues with the Nurses health study group that I want to get into, that I want to mention. First of all this group had a high percentage of obese women and we know that obesity increases the risk for breast cancer perhaps through more production of 'estrone' and perhaps through higher levels of circulating insulin and that growth factor that can stimulate the growth of various cancers.

The Nurses study also had a very high level of women who drank alcohol and we know that alcohol increases the risk of breast cancer if you drink more than one drink a day and alcohol use actually has a higher risk of breast cancer than what we've seen with hormone therapy, it just doesnt get the same amount of press! And there was a high % of the number of smokers in the Nurses Health group.

So in many respects there were other risk factors in that group of women that I think played a role, so we can't put all of the blame on what hormone that they took.

So if you're concerned about breast cancer, what are some pro-active things you can do to lower your risk?

First of all get out there and move your body. Aerobic exercise has been clearly shown to decrease the risk perhaps by lowering the total body fat, perhaps by other mechanisms. Stop smoking..smoking increases the risk of breast cancer.

Don't drink alcohol every day, even if you hear studies that say a drink a day is healthy for your heart it's not healthy for your breast and it's better to limit your alcohol to once or twice a week and don't drink large quanities at one time. It increases the bodys estrogen.

Keep your weight in a healthy range. Obesity increases the risk of breast cancer for several reasons, more 'estrone', higher levels of insulin, inflammatory chemicals that may interfere with your normal immune function and other factors that we haven't identified.

Lower the fat content in your diet and choose to eat healthy fat. Go with the Mediterranian plan of Olive Oil as opposed to some of the unhealthy fats that permeates many of our processed foods AND choose the right type of hormones, if you're going to take hormone therapy which I think is really important to consider and keep the balance right for all kinds of benefits then choose the right types.

Use non oral delivery when possible and don't use 'estriol' thinking it's going to lower your breast cancer risk... that's outdated information it's not correct and there's NO evidence that estriol has a preventive effect on breast cancer.

26:16 min.

Here she takes several phone calls. (not verbatim any longer) I pooped out. *smile* Listen to the tape if you want to hear the rest of it. (total show is about an hour long)

One is a very long one from a woman who did have breast cancer and she tells of the horrible side effects of the treatments she used for it... and how the loss of her hormones were hell for her and her husband, esp. the libido and painful sex with no lubrication etc., (he also gets on the phone and suggests everyone take time and not rush into a treatment so fast before you do some of your own research. Vliet agrees with him especially because breast cancer is so slow growing and states it's an excellent point. ...The woman after doing her own research (she was a registered nurse) did go back on the right bio-identical hormones and tells how it's turned both their lives around. It really was an excellent conversation.

Then there were 2 others that were ok.. and mostly praising Vliet with how their lives changed as well.

The whole tape is about an hour long... but with having to go back and forth from here to the tape for every single sentence to listen, then type it out then back again. it took too long to type the phone conversations. But I did get all of Vliets talk on hormones and is exactly what I have read and researched myself as well and I so totally agree with her. Much she didn't say with a time limit but what she did was absolutely correct in 'my' opinion and experience.

For those who aren't aware of her name, Dr. Vliet is the author of the well known book on hormones called:

'Screaming to be Heard, Hormonal connections that women suspect and doctors ^still* continue to ignore" Dee