New information can help you make an informed decision with your healthcare provider.

It’s been ten years since the results of the Women’s Health Initiative (WHI) were announced claiming there was an increase in breast cancer, heart attacks and strokes with the use of hormone therapy (HT) for postmenopausal women. Many women were afraid to use hormone therapy, thinking it was harmful.

There has been a lot of confusion regarding the safety of HT. Headlines warned women against taking HT without fully disclosing all the facts and issues pertaining to this study.

The HT public fear was so great 56% of HT users aged 50 and older tried to discontinue therapy after this study. What was not revealed in those headlines was that the WHI was not studying treatment of menopausal symptoms. It was a study focused on determining whether HT prevented chronic illness. The average age of the participants was 63, with two-thirds of them starting hormone therapy more than ten years after menopause.

Women with severe symptoms were generally not included in the WHI. A few years later, the WHI narrowed its focus on a second trial, looking at the health effects of HT in younger (under 60 years old) versus older women. They found that younger postmenopausal women actually experienced a lower risk of adverse health effects from HT than their older counterparts.

There have been many other studies focusing on HT and heart disease, revealing that menopausal women between the ages of 50 to 59 who took HT for less than ten years did not have an increased risk of adverse effects.

March 2012, The North American Menopause Society published a new Hormone Therapy Position Statement based on the latest studies that further distinguishes the emerging differences in the therapeutic benefit-risk ratio between estrogen therapy (ET) and combined estrogen-progestogen therapy (EPT) at various ages and time intervals since menopause onset.

A great deal has been learned in the 10 years since the first results emerged from the Women’s Health Initiative (WHI). Hormone therapy (HT) remains the most effective treatment available for menopausal hot flashes and night sweats. However, there is a growing body of evidence that formulation, route of administration, timing of therapy, and duration of therapy may produce different effects.

It is essential to evaluate a personal benefit-risk profile for each woman considering HT. Individual factors contributing to the HT decision include the severity of menopausal symptoms and effect on quality of life.

The absolute risks of HT in healthy women ages 50 to 59 are low. In contrast, long-term HT or HT initiation in older women is associated with greater risks.

SUMMARY
• The recommendation for duration of therapy differs for EPT in women with a uterus, and ET in women who have had a hysterectomy.
• For EPT, duration is limited by the increased risk of breast cancer associated with more than 3 to 5 years of use. ET has a more favorable benefit-risk profile with no apparent increase in risk of breast cancer during an average of 7 years of use, a finding that allows more flexibility in duration of therapy.
• Individualizing is still key in the decision to use HT and should incorporate the woman’s health and quality-of-life priorities as well as her personal risk factors, such as risk of blood clots, heart disease, stroke, and breast cancer.
• For relief of hot flashes, women with a uterus should take EPT so that a progestogen will protect the lining of the uterus from the cancer-promoting effects of estrogen alone.
• Low-dose vaginal ET is advised when symptoms are limited to vaginal dryness or discomfort with intercourse.
• Neither ET nor EPT increases the risk of heart disease in healthy women under age 60 or within 10 years of menopause. The risk of stroke can be increased but is considered rare in the 50s.
• Women with premature or early menopause who are otherwise appropriate candidates can use HT until the average age of natural menopause (age 51). Longer duration of treatment can be considered if needed for symptom management.
• There is a lack of safety data supporting the use of HT in breast cancer survivors.
• Both ET delivered through the skin and low-dose oral ET have been associated with lower risks of blood clots and stroke than standard doses of oral estrogen, but confirmation of benefits in randomized trials is not yet available.
• Additional research is needed to understand the different effects of ET and EPT and how they apply to individual women.

Hormone therapy is still the most effective treatment for menopausal symptoms. We are all different. Discuss your concerns with your practitioner, who can help you decide whether to take HT, and, if so, at what age, the dosage and for how long. Combined with a healthy lifestyle and attitude towards aging, going through “the change” can be a time of reinvention.

10 Ways to Lower Your Risk of Getting Breast Cancer

by Staness Jonekos

The Menopause Makeover

Why don’t most women perform monthly breast exams? I confess, I have done three self-breast exams in my entire life! Considering I have spent a lifetime on birth control pills to manage endometriosis and ovarian cysts, and now on post menopause hormone therapy, I should be doing monthly breast exams, but I don’t – why?

Maybe it was my Catholic upbringing – “Don’t touch yourself” was the message from my Sunday catechism teacher. Maybe it was the social messages I got from the media – boobs are for babies and hubbies.

Feeling embarrassed that I don’t do monthly breast self-exams, I decided to talk with other women. I interviewed 100 women, ages 25 to 75. My first question, “Do you perform monthly breast self-exams?” I was shocked that 92 percent of these women said, “No.” I was not alone.

Curious, I asked, “Why not?” The majority of women admitted that they, too, did not feel comfortable touching their breasts. The second reason was the fear of finding something scary, a lump – breast cancer.

Breasts have many connotations: sexuality, femininity, and motherhood. We do lots of things to our breasts: strap them into brassieres, augment their size, pierce them, and use them to get attention. I actually hide mine. I don’t like people looking at them. I would rather have them look at my face. Perhaps residual Catholic fear that showing my cleavage would conjure up some form of trouble, I dress around my 34DDs with higher necklines.

I am not the only one with a story about my breasts. I have many friends who have had “boob jobs.” Most of them had breast augmentation in their 20s and 30s. They claimed it was for their self-esteem, but most finally admitted they loved the attention. Many altered their breasts after nursing. The remainder decided to have their boobs lifted after menopause in an effort to hold onto their youth. That’s a lot of attention and money spent on an area of the body most of us don’t personally touch!

My husband loves my breasts. I know it is time for me to love them too. I looked at them in the mirror just this morning. At 52 my boobs have shifted four inches south of their origins. I cupped them and held them up – unfortunately they did not look like they did in the beginning. I bent over and looked at the effects of gravity – unfortunately they did not look like they did in the beginning. Then I jumped up and down, and fortunately I felt better at the humor of actually looking at my breast move naturally after being strapped in most of the day. It was an interesting moment. Funny, curious, and insightful, and then it happened. I just stared at them without judgment and realized how beautiful they are, and how lucky I am that they are healthy.

Over ten years ago, my dear friend Leslie died of breast cancer. She decided to bypass her yearly check-up for financial reasons, and it cost Leslie her life. Leslie’s husband and two children lost the center of their universe to breast cancer, and I lost a friend. I remember weeks before her death, she grabbed my hand that was nervously knitting to avoid the inevitable truth that she was dying, and drew me near. She whispered, with the little energy she had, “Never miss your yearly check-up, I am dying an angry woman because I did.” I still weep over Leslie’s death. She was only in her 40s.

I have seven other friends who had breast lumps that were discovered during their annual check-ups. Two of those seven friends had stage 2 and 3 cancer but they caught it early enough and were able to manage it. I am happy to report they are now cancer free. The others did not have cancer. Leslie was right, early detection can save lives.

According to the American Cancer Society, “Breast cancer is the second leading cause of cancer death in women, exceeded only by lung cancer.” About 1 out of every 7 women will get breast cancer over a 90-year life span. All women are at risk for breast cancer.

This year about 207,090 new cases of invasive breast cancer will be diagnosed in women. About 40,000 moms, daughters, sisters, granddaughters and best friends that will die from breast cancer this year.

The American Cancer Society states, “Death rates from breast cancer have been declining since about 1990, with larger decreases in women younger than 50. These decreases are believed to be the result of earlier detection through screening and increased awareness, as well as improved treatment.”

The chance that breast cancer will be responsible for a woman’s death is about 1 in 35 (about 3%). At this time there are over 2.5 million breast cancer survivors in the United States.

A woman’s risk of breast cancer approximately doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer. About 20-30% of women diagnosed with breast cancer have a family history of breast cancer.

About 70-80% of breast cancers occur in women who have no family history of breast cancer due to genetic abnormalities that happen as a result of the aging process and life in general, rather than inherited mutations.

There are ways to reduce your risk.

What can you do to lower your risk of getting breast cancer?

1. Maintain an ideal weight: The chance of developing breast cancer after menopause is higher in women who are overweight or obese.
2. Exercise: The American Cancer Society recommends engaging in 45-60 minutes of physical exercise 5 or more days a week.
3. Alcohol consumption: Alcohol can limit your liver’s ability to control blood levels of the hormone estrogen, which in turn can increase risk. The Harvard Nurses’ Health study, along with several others, has shown that consuming more than one alcoholic beverage a day can increase breast cancer risk by as much as 20-25 percent.
4. Exposure to estrogen: The female hormone estrogen stimulates breast cell growth, so exposure to estrogen over long periods of time, without breaks, can increase the risk of breast cancer.
5. Oral contraceptive use: Recent use may slightly increase a woman’s risk for breast cancer.
6. Fruits and vegetables: Broccoli, cabbage, Brussels sprouts, kale, spinach, carrots, tomatoes, cauliflower, berries and cherries are all breast cancer fighters.
7. High glycemic carbohydrates: Eat low to medium glycemic foods and avoid white rice, white potatoes, and sugar products, because these foods may trigger hormonal changes that promote cellular growth in breast tissue. Eat whole grains and legumes.
8. Smoking: Smoking is associated with an increase in breast cancer risk, and in the risk of other cancers.
9. Stress and anxiety: There is no clear proof that stress and anxiety can increase breast cancer risk, but some research suggests that practicing yoga, prayer, and meditation to manage stress can strengthen the immune system.
10. Perform monthly breast self-exams, get routine screenings and work closely with your healthcare provider.

We cannot control our gender, age, race, or family history of breast cancer, but early detection can save lives. Performing a monthly breast self-exam is something you can control.

Nearly 70% of all breast cancers are found through self-exams, and with early detection the 5-year survival rate is 98%.

Dr. Wendy Klein, leading women’s health expert and co-author of The Menopause Makeover says, “Discuss your breast self-exam technique with your healthcare provider, and report any asymmetrical changes in your breast right away. Regular breast self-exams in conjunction with other screening methods, working closely with your doctor, are simple common sense for good breast health.”

Today I celebrate my health by lowering my breast cancer risk factors. Today I honor my breast health empowered. Today I do a breast self-exam.

What is your risk of getting breast cancer?

Click here for the National Cancer Institutes Breast Cancer Risk Assessment Tool:

http://www.cancer.gov/bcrisktool/

How to do a breast self-exam:

http://www.nationalbreastcancer.org/about-breast-cancer/breast-self-exam.aspx

References

NationalBreastCance.org. National Breast Cancer Foundation® Official Site – Information, Awareness & Donations, “Self Examination – National Breast Cancer Foundation.” 10 September 2010. < http://www.nationalbreastcancer.org/about-breast-cancer/breast-self-exam.aspx>

Jonekos, S. and W. Klein.  The Menopause Makeover.  Ontario, Canada: Harlequin Enterprises; 2009.

Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2008: A review of current American Cancer Society guidelines and cancer screening issues. CA Cancer J Clin. 2008;58:161-179.

Cancer.org. National Cancer Institute – Comprehensive Cancer Information, “ Breast Cancer Risk Assessment Tool.” 02 October 2010 <http://www.cancer.gov/bcrisktool/>

NationalBreastCancer.org. National Breast Cancer Foundation® Official Site – Information, Awareness & Donations,  “Self Examination – National Breast Cancer Foundation.” 02 October 2010 <http://www.nationalbreastcancer.org/about-breast-cancer/breast-self-exam.aspx>

Cancer.gov. National Cancer Institute – Comprehensive Cancer Information, “Breast Cancer Prevention – National Cancer Institute.” 12 March 2010. <http://www.cancer.gov/cancertopics/pdq/prevention/breast/patient>

CDC.gov. Centers for Disease Control and Prevention, “CDC- Screening for Breast Cancer.” 31 August 2010. <http://www.cdc.gov/cancer/breast/basic_info/screening.htm>

BreastCancer.org. Breast Cancer Treatment Information and Pictures, “Lower Your Risk for Breast Cancer.” 07 August 2008. <http://www.breastcancer.org/risk>

Cancer.org. American Cancer Society:: Information and Resources for Cancer: Breast, Colon, Prostate, Lung and Other Forms, “Breast awareness and self exam.” 02 October  2010 <http://www.cancer.org/Cancer/BreastCancer/MoreInformation/BreastCancerEarlyDetection/breast-cancer-early-detection-a-c-s-recs-b-s-e>

MedlinePlus, National Library of Medicine – National Institutes of Health, “Breast self exam: MedlinePlus Medical Encyclopedia.” 02 October 2010  <http://www.nlm.nih.gov/medlineplus/ency/article/001993.htm>