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nosurrender

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Reply with quote  #1 
High levels of estrogen associated with breast cancer recurrence

6-Mar-2008
American Association for Cancer Research


PHILADELPHIA - Women whose breast cancer came back after treatment had almost twice as much estrogen in their blood than did women who remained cancer-free - despite treatment with anti-estrogen drugs in a majority of the women -according to researchers in a study published in the March issue of Cancer Epidemiology, Biomarkers and Prevention, a journal of the American Association for Cancer Research.

The findings suggest that high levels of estrogen contribute to an increased risk of cancer recurrence, just as they lead to the initial development of breast cancer, said the study's lead author, Cheryl L. Rock, Ph.D., a professor in the Department of Family and Preventive Medicine at the University of California, San Diego.

"While this makes sense, there have been only a few small studies that have looked at the link between sex hormones in the blood and cancer recurrence," she said. "This is the largest study to date and the only one to have included women taking agents such as tamoxifen to reduce estrogen's effect on cancer growth.

"What the results mean for women who have already been treated for breast cancer is that they should do as much as they can to reduce estrogen in their blood, such as exercising frequently and keeping weight down," she added. "Taking anti-estrogen drugs like tamoxifen may not completely wipe out the hormone's effect in women who have high levels of estrogen."

Participants from this study were drawn from the larger Women's Healthy Eating and Living Study (WHEL), a dietary intervention trial that followed 3,088 women who had been treated for early stage breast cancer but who were cancer-free at the time they enrolled. Participants were randomly assigned to one of two groups - one that ate a "normal" healthy diet and the other that ate extremely high amounts of fruits, fiber, and vegetables - and were followed for more than seven years. Breast cancer recurrence was about the same in each group, according to the results, published in 2007. Researchers interpreted the findings to mean that a normal diet that incorporates the U.S. Food and Drug Administration guidelines for recommended amounts of fruits and vegetables is sufficient.

In the current nested case-control study, 153 WHEL participants whose cancer had recurred were matched with 153 participants who remained cancer-free. These pairs were alike in terms of tumor type, body size, age, ethnicity, use of chemotherapy and other variables. Two-thirds of the participants were using tamoxifen, Rock said.

When they enrolled, researchers tested the women's blood for concentrations of the steroid hormones estradiol (the primary human estrogen) and testosterone. They analyzed different forms of estradiol and testosterone in the blood, such as how much was bound to transport proteins (such as to the sex hormone binding globulin, or SHBG) and how much was "free" circulating and able to enter a cell.

Researchers found that higher estradiol concentrations, in all forms, significantly predicted cancer recurrence. Overall, women whose cancer came back had an average total estradiol concentration that was more than double the average for women who remained cancer-free. Increased levels of testosterone or SHBG levels were not associated with recurrence, contradicting the findings of several previous studies.

Although genetic and metabolic factors likely influence the relationship between circulating sex hormones and risk of breast cancer recurrence, Rock said the study provides solid evidence that higher concentrations of estradiol in the blood contribute to risk for breast cancer recurrence.



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Bren

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Reply with quote  #2 

In the current nested case-control study, 153 WHEL participants whose cancer had recurred were matched with 153 participants who remained cancer-free. These pairs were alike in terms of tumor type, body size, age, ethnicity, use of chemotherapy and other variables. Two-thirds of the participants were using tamoxifen, Rock said.
 
Gina, I didn't understand the above paragraph from the article.  Two-thirds of which participants were taking tamoxifen?  And was 153 the total number of recurrence's out of the 3,088?
 
This article says the recurrence rate was the same for both groups after seven years.  So, what is the author trying to say ... that for some, even with anti-estrogen therapy, they still have high levels of estrogen floating in their blood.  

Maybe you can break this down for me. 

Thanks for posting the article
Bren


PS - Hope you're feeling better after your port removal today.  I know you're feeling kind've sore right now.  Big HUGS to you!  Love you!

samdah

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Reply with quote  #3 
Makes me glad that I got that one ovary removed and am on Lupron to shut down the remaining one along with taking Tamoxifen!

Hope you are doing well after your port!

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Reply with quote  #4 

If I am reading that article right I am even happier I had an ooph no matter how slow (mentally and physically) I feel after it.


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Reply with quote  #5 
Gina, Thanks for this article, it's very relevent.

My onc draws for estradiol(the BAD estrogen) every time he does bloodwork.Which is each time I see him-every 3 months.
My blood estradiol level was important in him "letting me" stop femara, despite the fact that I hadnt had 5 years of HT.My damn estradiol, after less than 4 years of Femara is ....**9**--a single digit!How much does that suck?No wonder I was suffering so much on femara! Nightmare.
We need our estrogen for so many things we never even consider.

Yes, it's bad for us to have too much circulating estrogen.(But it is also unhealthy for us to have (almost) NO estrogen.)
Our Edge told me the drug companies are tweaking AIs to add-back some estrogen!( The GOOD estrogens, I'm sure.)

The thing that makes me question the article is that they mention only Tamox.
Tamox doesnt REMOVE estrogen from the body.AIs do.Tamox BLOCKS the estrogen receptors in the breasts.
There's a difference!Big one.
Tamox patients should be able to enjoy the other benefits of estrogen, like pain-free joints, not having insomnia,  continuing to have clear minds, good vision and hearing.Energy.Muscle retention.
And lots more.
BUT..yes they will have more circulating estrogen.
So maybe the point of the article is...
blood tests for estrogen values should be given to determine whether the patient needs AI or tamox?

I was 12 years post menopause when I was DX.I didnt HAVE much estrogen THEN! And stopping Prempro was probably all the HT I needed.

For younger women, I think an ooph would probably be very good.Then you could go on an AI, and hoop-la!Your circulating supplemental estrogen could be 9 too!
Should this really be desirable.

Hugs, j






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Bren

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Reply with quote  #6 
Hi Joan,
 
How are you feeling these days?  How long post Femara are you?  Symptoms improving?
 
I've been off Tamox for 6 months now.  Only took it for 6 weeks and took Arimidex for 1 week prior to that.  I guess my lack of a decision of whether or not to try another is pretty much a decision in itself.  Of course, I see the surgeon and PCP, both again in two weeks. They want me to try Evista or Femara. I don't have any ovaries or uterus either and have been off HT since last Feb. when I was dx.  I'm 52 now.  I've gained a ton of belly fat (not good) due to not being able to strenuously garden (LE), my usual physical activity, and anxiety-related eating.  And of course normal menopausal belly fat accumulation.  So, I have decided to work on the weight loss, gradually resume my gardening, fence building activities, etc.
 
Kind of a catch-22.  I struggle with my decision/lack of decision all the time.  Will it be my fault if my cancer comes back and it's positive again? And can I live with that? 
 
I'd really like to hear from others who have decided against HRT and how they handle their decision emotionally, mentally, etc.
 
love,
Bren
JoanofArdmore

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Reply with quote  #7 
Dear Bren,
I came to say PUH-LEEEEZE dont buy into the guilt trip thing!!
I gotta say my onc, when I first met him, gave me the most wonderful response to the musical question "What did I do to get BC??WHY did I get it?"
He said "Because you're a human being."

So now I understand it is true.There really is nothing we can do, or not do which will cause us to get bc.As people say,"it's all a crapshoot.Women who have done "everything right" get bc or recurrances.And women who have done everything "wrong" DONT!(As well, of course, as women doing everything right and NOT getting it, and everything wrong and getting it!There are lots of combos and they all work.

PLEASE trust yourself and DONT WORRY!!Do what you can to stay generally healthy.Being healthy makes us be able to endure TX better, as well as  it makes us able to just get older better!

Years ago my mother had a wooden "picnic basket" handbag.Painted on it was:
"365 days a year.Every day a holiday!"
Hey--go for it!

Thanks for asking.I'm doing slowly better.(every day a holidaybig laugh)
Trouble with me is I'm old but not wise.I keep setting myself back.By doing things like getting cable and watching so many movies that my knees, which were greatly improving from no femara since November,are all wonky again from climbing out of my low, cushy leather couch.I havent sat in my couch for years, when my arthritis first came!People with arthritic knees need high, hard chairs.A nice Queen Anne wing chair...which I got rid of when I moved...
Just like I'm always throwing on shoes w/out adding my orthotics which I now have for the plantar fasciitis Tamox gave me!"Just to go outside with Woody" So I'm crippled for the next week.
Some people have NO SENSE!
But--wonder of wonders!I'm waking up not feeling like a dead animal!Yikes!I havent done that in YEARS!!

Bob Dylan had a song, I forget when.The chorus was
"Trust yourself!
If you dont trust nobody else, trust yourself!"

Lots of love, j















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CherylG

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Reply with quote  #8 
Yep I agree.. trust your decison. I did Tamox quit then did Arimidex quit then did Femera. So far Femera is the best for me but I take a break when I can't handle the SE's anymore. I would rather be strong enough in case I need tx again than go into it sick and tired already. Femera is now giving me headaches which scares me ... I think I will be taking a break and see what happens.
It's kind of damned if you do and damned if you don't... I agree with Joan
people do everything right and still get BC. It's a crapshoot. Remember quality of life is important too.
Tamox I felt like 80 and Arimidex felt like 90.... I only feel like 60 with Femera LOL. (I'm 54)
HUgs
CherylG

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Reply with quote  #9 
Hello,
This is my first post. I have been reading all your wonderful messages for a couple months now and wishing I had found this site when I was newly diagnosed. I was diagnosed in August 2004 with highly ER, PR+ IDC. I had two surgeries, 6 months chemo, radiation--you know the drill. I was on tamoxifen quite happily until September 2007, when my oncologist switched me to Arimidex. I had not had a period since January 2005 (chemo-induced menopause) so we thought we were safe to assume I am post-menopausal. The first time we measured my estradiol level, in January 2008, it was 49. So I immediately switched back to tamoxifen. My estradiol level continues to hover in the 50-70 range. I could not help but notice that this is over twice the average level of the recurrence group.
My question: Is it time for me to consider an ooph? Or just root for menopause? I am 49. It's worth noting that I was quite miserable on Arimidex and am fine on Tamoxifen. My oncologist says "stay the course" but I've heard that before and it wasn't true then either! I know no one here can answer this question for me but I need to bounce it around a little bit. Thanks for your input. This is a wonderful place.

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