Chemoprevention Of Breast Cancer

There might be a place for chemoprevention with regard to breast cancer. In a group of women who have a familial constellation for breast cancer of both breasts the anti-estrogen medication tamoxifen was used to reduce the risk of developing breast cancer in the other breast after mastectomy (surgical removal of the one breast). The risk of breast cancer in the other breast was reduced to 40% of the expected risk with this medication.

However, there are significant tamoxifen side effects and the use of it is usually limited to high-risk settings. The idea of cancer prevention utilizing hormone modulating medications is not new. In males there is an equivalent prostate cancer prevention medication, finasteride, which is medication that is used for treatment of an enlarged prostate gland. It turns out that in males this also has a significant prostate cancer prevention effect and is even effective at reduced doses that are used for male baldness treatment with finasteride. This makes it more likely that in women there would also be a useful place in certain instances for chemoprevention of breast cancer. A new observation is that women on balanced hormone replacement with bio-identical estrogen and progesterone hormones enjoy longer lives with no development of breast, uterine, colon and other cancers. This fact has been published in the anti-aging literature between 2000 and 2008. Dr. Lee points out that with saliva hormone tests, which is the only reliable test that reflects the tissue levels of hormones, estrogen levels can be kept at a ratio of 1:200 (level of progesterone 200-fold higher or more than the estrogen level). This will keep estrogen under control and prevent the development of breast cancer or uterine cancer (Ref. 9 and 10).

Other agents of interest are retinoids (=vitamin A derivatives), which have been very effective in animal experiments and are being investigated for effectiveness in humans. The aromatase inhibitor, astrozole (brand name: Arimidex), prevents the conversion of androgens from the adrenal glands being converted into estrogen substances.

This will reduce the risk for breast cancer for those cancers that have positive estrogen receptors even further. Your doctor or oncologist can advise you what medication applies to your condition.

Here is a link to a government site that in the past did recommend chemoprevention of breast cancer in certain cases. However, it appears that now this type of approach is much more restricted. Perhaps it is still warranted in families where there is a genetically higher risk of breast cancer, but not the high risk setting that warrants bilateral removal of the breast tissue. This risk reduction has to be balanced with the knowledge that endometrial cancer (=uterine cancer is more common on Tamoxifen). Discuss this with your family doctor.

Bio-identical hormone replacement:

A more logical prevention of breast cancer is to go on a DASH diet, which contains a lot of fruit and vegetables (diet originally developed for patients with high blood pressure). In addition hormone replacement with bio-identical hormones applied as creams have been found useful as indicated above. Before estrogen is replaced, the patient is started on bio-identical progesterone hormone. This saturates the progesterone receptors and also partially the estrogen receptors in breast tissue, the uterus and the ovaries. If estrogen levels are low, a small amount of estrogen cream can be added (Bi-Est cream). However, the levels are monitored and the estrogen/progesterone ratio is kept at 1:200 (level of progesterone 200-fold higher or more than the estrogen level) or higher to avoid any risk of cancer. Ref. 9 gives details about this approach, but I have read many other articles and books that have confirmed this. This makes biological sense: it all has to do with the fact that women are born with a certain set of hormone receptors. Between puberty and up to the age of 30 the hormones are sufficiently produced by all your hormone glands, so that the hormone receptors that are distributed throughout all the major organs (including heart, brain, muscles, bones) are satisfied and in return allow the woman to have low cancer rates and cardiovascular risks. Melatonin and human growth hormone are slowly, but steadily produced less every year beyond the age of 30. Progesterone is being lost when the woman approaches menopause and occasionally an ovulation is skipped, reducing progesterone even more. At the time of the last period, when the woman is officially declared to be in menopause, both estrogen and progesterone decline steeply, but progesterone at a much greater rate. The end result is often that the estrogen/progesterone ratio is less than 1:200. This puts the woman at a higher risk of developing breast cancer, uterine cancer, ovarian cancer and colon cancer. However, when the hormone abnormalities are remedied, and the estrogen/progesterone ratio is normalized (1:200 or higher) the woman feels better, has more energy, sleeps better and the risk for cancer is back to being low as it was when she was less than 30 years old. The reason for this is that the hormone receptors are balanced again and the organs function normally.
Often the thyroid gland is starting to malfunction (hypothyroidism is setting in) as well, something your doctor may also have to address.

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Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

The following references were used apart from my own clinical experience:

1. Cancer: Principles &Practice of Oncology, 4th edition, by V.T. De Vita,Jr.,et. al J.B. LippincottCo.,Philadelphia, 1993.Vol.2: Chapter 48.

2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 177.

3. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter 36: 1541-1616.

4. BS Herbert et al. Breast Cancer Res 2001;3(3):146-149.

5. BS Herbert et al. J Natl Cancer Inst 2001 Jan 3;93(1):39-45.

8. Dr. John R. Lee and Virginia Hopkins: "Hormone Balance Made Simple - The Essential How-to Guide to Symptoms, Dosage, Timing, and More". Wellness Central, NY, 2006

9. Dr. John R. Lee, David Zava and Virginia Hopkins: "What your doctor may not tell you about breast cancer - How hormone balance can help save your life", Wellness Central, Hachette Book Group USA, 2005. Page 29 - 38 (Chapter 2): Risk factors for breast cancer. Page 360 to 374 explains about xenohormones and how they cause estrogen dominance. Pages 221 to 234 (chapter 12) explains why Tamoxifen is not recommended and bio-identical progesterone is more powerful in preventing breast and uterine cancer.

Last Modified: Feb. 4, 2012