WOMENS-HEALTH Messages for June, 1997: Re: HRTand breast CA risk

Re: HRTand breast CA risk

From: Janis (anonymous@obgyn.net)
Thu, 26 Jun 1997 08:49:46 -0500 (CDT)

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Reply: Laurie: "Re: HRTand breast CA risk"

At Thu, 19 Jun 1997, Laurie wrote:

>>My questions specifically are:
>>1. Does the low dosage of the Climara patch reduce the potential risk
>>for breast CA?
>
>Studies that suggest increased risk of breast cancer mostly show a
>dose-related effect, so that the higher the dose, the higher the risk
>for developing breast cancer.

Thank you for your thoughtful and detailed responses to my last posting on HRT and breast CA risk. I have been reviewing recent postings in the physician section on HRT dosing. There seems to be a mixture of opinions on the effective dosage (0.3 vs 0.625mg oral) in respect to cardiovascular disease and bone density. ----------------------------- You had posted: ----------------------------- "An obstacle to the utilization of transdermal hormone therapy has been ----------------------------- the lack of data indicating a beneficial impact on the lipoprotein profile.....English data are now available indicating that the transdermal administration of 50 ug estradiol twice a week is as effective as 0.625 mg oral conjugated estrogens on bone density and lipids over a year's time."

refs:Stevenson JC et al., Effects of transdermal versus oral hormone replacement therapy on bone density in spine and proximal femur in postmenopausal women, Lnacet 336:1327, 1990.

Crook D et al., Comparison of transdermal and oral estrogen-progestin replacement therapy: effects on serum lipids and lipoproteins, Am J Obstet Gynecol 166:950, 1992. --------------------- My question with respect to this is: How does the dosage 50 ug relate to --------------------- my 0.05 mg patch? I appreciate the possibly decreased breast CA risk --------------------- with lower dosage, but want to feel confident that I am adequately covering cardiovascular and bone issues. On 6/16 in this forum Dr. Chudacoff expressed opinion that transdermal administration of estrogen bypasses the liver and decreases the effectiveness in respect to cardiovascular issues. I am curious about this perspective, but as yet have found no other mention

>>2.. Do phytoestrogens reduce the risk for breast CA?
>
>I don't think we know enough about them yet to say that for sure, but
>the evidence looks promising. There are other estrogen compounds being
>examined that have different effects on different organs (bone, heart,
>breast, uterus) that also show promise.

I found an excellent article on phytos in a posting to http://www.y-me.org It describes the mechanism of isoflavones in relationship to naturally-occuring estrogens and suggests that they may be considered antiestrogens. Do you see any reason not to augment my 0.05 mg patch with a daily dose of soy?

I am also looking forward to more Raloxiphene data.

Thanks again.

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In reply to: Laurie: "Re: HRTand breast CA risk"
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