Thursday, September 28, 2023

Does Hormone Therapy Cause Cancer

What Are Male Sex Hormones

Does Type of Hormone Replacement Therapy Affect Breast Cancer Risk?

Hormones are substances that are made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs.

Androgens are a class of hormones that control the development and maintenance of male characteristics. The most abundant androgens in men are testosterone and dihydrotestosterone .

Androgens are required for normal growth and function of the prostate, a gland in the male reproductive system that helps make . Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells . Once activated, the androgen receptor stimulates the expression of specific genes that cause prostate cells to grow .

Almost all testosterone is produced in the testicles a small amount is produced by the adrenal glands. Although prostate cells do not normally make testosterone, some prostate cancer cells acquire the ability to do so .

Hormone Replacement Therapy And Risk Of Breast Cancer

This resource was developed, reviewed or revised more than 5 years ago and may no longer reflect current evidence or best practice.

Cancer Australias Breast Cancer the Risk Factors website provides the most up-to-date evidence in relation to breast cancer risk factors including menopausal hormone therapy/hormone replacement therapy and menopausal hormone therapy/hormone replacement therapy

This position statement applies only to Hormone Replacement Therapy and breast cancer risk in women it does not address other risks or benefits to women from HRT usage.

For more information see the Recommendations â HRT & Breast cancer riskbelow.

For the purposes of this position statement, Cancer Australia defines HRT as the use of exogenous hormones to manage menopausal symptoms.

There are various forms and combinations of HRT. This position statement refers to the following types of HRT: oestrogen-alone , combined HRT , combined oestrogen and testosterone, tibolone and natural therapies.

The 2004-2005 National Health Survey indicates that 11% of Australian women aged 45 years and over were currently using HRT prescribed by a doctor, and that of these women the majority had been using HRT for 5 years or more.1

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Can Hormone Therapy Be Used To Prevent Breast Cancer

Yes. Most breast cancers are ER positive, and clinical trials have tested whether hormone therapy can be used to prevent breast cancer in women who are at increased risk of developing the disease.

A large NCI-sponsored randomized clinical trial called the Breast Cancer Prevention Trial found that tamoxifen, taken for 5 years, reduces the risk of developing invasive breast cancer by about 50% in postmenopausal women who were at increased risk . Long-term follow-up of another randomized trial, the International Breast Cancer Intervention Study I, found that 5 years of tamoxifen treatment reduces the incidence of breast cancer for at least 20 years . A subsequent large randomized trial, the Study of Tamoxifen and Raloxifene, which was also sponsored by NCI, found that 5 years of raloxifene reduces breast cancer risk in such women by about 38% .

As a result of these trials, both tamoxifen and raloxifene have been approved by the FDA to reduce the risk of developing breast cancer in women at high risk of the disease. Tamoxifen is approved for this use regardless of menopausal status. Raloxifene is approved for use only in postmenopausal women.

Less Common Types Of Hormone Therapy

Does hormone replacement therapy increase cancer risk?

Some other types of hormone therapy that were used more often in the past, but are rarely given now include:

  • Megestrol acetate , a progesterone-like drug
  • Androgens , like testosterone

These might be options if other forms of hormone therapy are no longer working, but they can often cause side effects.

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Are There Alternatives For Women Who Choose Not To Take Menopausal Hormone Therapy

Women who are concerned about the changes that occur naturally with the decline in hormone production that occurs during menopause can make changes in their lifestyle and diet to reduce the risk of certain health effects. For example, eating foods that are rich in calcium and vitamin D or taking dietary supplements containing these nutrients may help to prevent osteoporosis. FDA-approved drugs such as alendronate , raloxifene , and risedronate have been shown in randomized trials to prevent bone loss.

Medications approved by the FDA for treating depression and seizures may help to relieve menopausal symptoms such as hot flashes . Drugs that have been shown in randomized clinical trials to be effective in treating hot flashes include venlafaxine , desvenlafaxine , paroxetine , fluoxetine , citalopram , gabapentin , and pregabalin .

Side Effects Of Hormone Replacement Therapy

If youre going through menopause, hormone replacement therapy might be on your mind. This involves taking doses of female sex hormones: estrogen, progesterone, or both. HRT is used to ease the unpleasant symptoms that are typically associated with menopause.

This phase is a normal part of aging. It typically happens between the ages of 45 and 54, and its marked by a drastic drop in estrogen and progesterone. As a result, you might have hot flashes, vaginal discomfort, and mood swings. Your risk for osteoporosis also shoots up.

HRT can reduce these symptoms. However, with that relief comes lots of side effects. Depending on your pre-existing conditions, HRT may or may not be right for you. Before you take the dive, learn about the risks and side effects of hormone replacement therapy.

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Hormone Therapy And Prostate Cancer

Prostate cancer is fueled by testosterone, a hormone produced in the testicles. The aim of HT is to interfere with either testosterone production or cancer cells ability to use testosterone. Medical evidence tells us that eliminating or substantially reducing testosterone production has a significant impact on controlling progression of the disease and may even halt progression. Testosterone is one of several hormones called androgens that are linked to sexual health and other processes in the body. This is why HT is often referred to as androgen deprivation therapy .

To be clear, this is not the hormone therapy of which you often hear. Women get hormone therapy to supplement waning estrogen levels, and older men without prostate cancer may get hormone therapy that administers additional testosterone. The hormone therapy we are talking about for men with prostate cancer is more accurately described as androgyn deprivation therapy . It is given to lower testosterone levels.

Rationales For Combined Treatment Adtebrt

Intermittent Hormone Therapy for Prostate Cancer 101 | Ask a Prostate Expert, Mark Scholz, MD

In an early work, Huggins and Hodges stated that male hormones promote the growth of both prostate gland and cancer cells.10 However, recently it has been recognized that the relationship between serum levels of testosterone and PC progression is not that straightforward. Very low concentrations of serum testosterone are enough to fulfill its activating role on the PC cell through the so-called aberrant androgen-signaling pathways.11,12 Moreover, there is an evidence for a significant increase in local synthesis of testosterone within prostate stimulated by castrate levels of serum hormone.13 Even so, the incomplete eradication of testosterone with surgical or pharmacological castration has proved to improve the results of RT, and multiple studies looked into the possible mechanism and character of that interaction.

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How Will I Know That My Hormone Therapy Is Working

Doctors cannot predict how long hormone therapy will be effective in suppressing the growth of any individual mans prostate cancer. Therefore, men who take hormone therapy for more than a few months are regularly tested to determine the level of PSA in their blood. An increase in PSA level may indicate that a mans cancer has started growing again. A PSA level that continues to increase while hormone therapy is successfully keeping androgen levels extremely low is an indicator that a mans prostate cancer has become resistant to the hormone therapy that is currently being used.

Drugs That Lower Estrogen Levels

Some drugs, called aromatase inhibitors , stop the body from making estrogen in tissues such as fat and skin. But, these drugs do not work to make the ovaries stop making estrogen. For this reason, they are used mainly to lower estrogen levels in women who have been through menopause . Their ovaries no longer make estrogen.

Premenopausal women can take AIs if they are also taking drugs that stop their ovaries from making estrogen.

Aromatase inhibitors include:

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Why Would A Woman In Menopause Take Hrt Some Women Take Hormone Replacement Therapy To Ease Menopausal Symptoms Hrt Is Medicine That Contains Hormones That The Ovaries Make Less Of As Women Age And Reach Menopause Hrt Can Be Taken As Estrogen Only Or As A Combination Of Estrogen Plus Progestin Combined Hrt Is Most Commonly Used Estrogen

Combined HRT may help relieve menopausal symptoms, protect against osteoporosis and reduce the risk of colon cancer.

Research shows that long-term use of combined HRT increases the risk of breast and ovarian cancer, heart disease, stroke and pulmonary embolism . The research suggests that the risks of long-term combined HRT use outweigh the benefits for most women.

The decision to take HRT is personal and should be made with the help of your doctor. Concerns about cancer, heart disease and stroke should be discussed when considering the benefits and risks of HRT.

What Can I Expect With Hormone Therapy

How does hormone therapy work?

Its often necessary to take hormone therapy for several years. Knowing this ahead of time is important so you can plan and prepare. If your doctor recommends surgery, such as ovary removal or prostate removal to manage hormone levels, it is generally permanent. This is equally important to know, especially if it will affect your reproductive ability. Talk with your doctor about all your treatment options. Your doctor can help you weigh the risks and benefits and decide on the best course of action for you.

  • Adrenal Gland Tumor. American Society of Clinical Oncology.
  • Aromatase Inhibitors. Susan G. Komen.
  • Hormone Receptor Status.
  • Hormone Therapy for Breast Cancer. American Cancer Society.
  • Hormone Therapy for Ovarian Cancer. American Cancer Society.
  • Hormone Therapy for Prostate Cancer. American Cancer Society.
  • Hormone Therapy to Treat Cancer. National Cancer Institute.
  • How to Read Hormone Receptor Test Results.
  • Other Drugs Used to Treat Adrenal Cancer. American Cancer Society.
  • Prostate Cancer. American Urological Association.
  • Thyroid Cancer: Thyroid Hormone Therapy. American Cancer Society.
  • Uterine Cancer. American Society of Clinical Oncology.
  • What Is Ovarian Cancer? National Ovarian Cancer Coalition.
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    Causes Of High Estrogen

    High levels of estrogen can develop naturally, but too much estrogen can also result from taking certain medications. For example, estrogen replacement therapy, a popular treatment for symptoms of menopause, may cause estrogen to reach problematic levels.

    Your body may also develop low testosterone or low progesterone levels, which can upset your hormonal balance. If you have estrogen levels that are abnormally high relative to your progesterone levels, its known as estrogen dominance.

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    Cancers Treated With Hormone Therapy

    Hormone therapy is used to treat prostate and breast cancers that use hormones to grow. Hormone therapy is most often used along with other cancer treatments. The types of treatment that you need depend on the type of cancer, if it has spread and how far, if it uses hormones to grow, and if you have other health problems.

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    Role Of Hormones In Endometrial Cancer

    The established risk factors for endometrial cancer show that exposure to estrogens unopposed to progestins can predict risk of endometrial cancer . During the pre-menopausal period, risk of endometrial cancer can be attributed to mitotic activity during the first half of the menstrual cycle when estrogen is unopposed by progesterone . Use of sequential oral contraceptives doubled the risk of endometrial cancer among women who used them prior to their removal from the market in 1976 . In contrast, combination oral contraceptives , which deliver estrogen and a high dose progesterone for 21 days of a 28 day cycle, decrease the risk of endometrial cancer .

    Obesity is also an important risk factor for endometrial cancer. In post-menopausal women, it is postulated that the conversion of androstenedione to estrone in adipose tissue results in the increased risk. In premenopausal women, obesity is thought to operate through increased anovulatory cycles and associated progesterone insufficiency .

    The protective effect of parity can also be explained by the unopposed estrogen hypothesis . The highest risk of endometrial cancer occurs in nulliparous women and risk decreases with each pregnancy. This is explained by the fact that no mitotic activity occurs during pregnancy due to the persistently high progesterone levels.

    How Is Hormone Therapy Used To Treat Breast Cancer

    Hormone Therapy for Prostate Cancer

    There are three main ways that hormone therapy is used to treat hormone-sensitive breast cancer:

    Adjuvant therapy for early-stage breast cancer:Tamoxifen is FDA approved for adjuvant hormone treatment of premenopausal and postmenopausal women with ER-positive early-stage breast cancer, and the aromatase inhibitorsanastrozole, letrozole, and exemestane are approved for this use in postmenopausal women.

    Research has shown that women who receive at least 5 years of adjuvant therapy with tamoxifen after having surgery for early-stage ER-positive breast cancer have reduced risks of breast cancer recurrence, including a new breast cancer in the other breast, and reduced risk of death at 15 years .

    Until recently, most women who received adjuvant hormone therapy to reduce the chance of a breast cancer recurrence took tamoxifen every day for 5 years. However, with the introduction of newer hormone therapies , some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common .

    Some premenopausal women with early-stage ER-positive breast cancer may have ovarian suppression plus an aromatase inhibitor, which was found to have higher rates of freedom from recurrence than ovarian suppression plus tamoxifen or tamoxifen alone .

    Men with early-stage ER-positive breast cancer who receive adjuvant therapy are usually treated first with tamoxifen. Those treated with an aromatase inhibitor usually also take a GnRH agonist.

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    Why Does Hormone Therapy Cause Side Effects

    Hormones are chemicals made by the body that move through your bloodstream. They control the activity of certain cells or organs. Changes to the amount of a hormone in your body can interfere with a specific activity in the body and cause side effects. Some hormones affect several body functions, so hormone therapy can cause many different side effects.

    Can Other Drugs Interfere With Hormone Therapy

    Certain drugs, including several commonly prescribed antidepressants , inhibit an enzyme called CYP2D6. This enzyme plays a critical role in the body’s use of tamoxifen because CYP2D6 metabolizes, or breaks down, tamoxifen into molecules, or metabolites, that are much more active than tamoxifen itself.

    The possibility that SSRIs might, by inhibiting CYP2D6, slow the metabolism of tamoxifen and reduce its effectiveness is a concern given that as many as one-fourth of breast cancer patients experience clinical depression and may be treated with SSRIs. In addition, SSRIs are sometimes used to treat hot flashes caused by hormone therapy.

    Many experts suggest that patients who are taking antidepressants along with tamoxifen should discuss treatment options with their doctors, such as switching from an SSRI that is a potent inhibitor of CYP2D6, such as paroxetine hydrochloride , to one that is a weaker inhibitor, such as sertraline or citalopram , or to an antidepressant that does not inhibit CYP2D6, such as venlafaxine . Or doctors may suggest that their postmenopausal patients take an aromatase inhibitor instead of tamoxifen.

    Other medications that inhibit CYP2D6 include the following:

    • quinidine, which is used to treat abnormal heart rhythms

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    Hrt And Breast Cancer

    Breast cancer is the most frequently diagnosed cancer and is the leading cause of cancer-related death in women. It affects up to one of eight women who survive up to the age of 85 years in Western countries. The disease reaches a peak of incidence in the 5059 years age range .

    The WHI study results suggested a breast cancer increase in HRT users , but no data about mortality were reported because of a short follow-up period . This risk, in absolute terms, corresponds to 9 additional breast cancers per 10,000 women using estrogen-progestin therapy for five or more years . Breast cancer increase in HRT users had already been observed 20 years before, in 1997, in the Collaborative Group Study this review of 50 observational studies evidenced a relative risk of 1.35 for women who had used HRT for five years or longer. No significant excess of breast cancer had been seen five or more years after cessation of HRT use or in relation to the duration of use .

    The North American Menopause Society position statement of 2017 asserts that different types of estrogen or progestogen, as well as different formulations, doses, durations, times of initiation, and patient characteristics, may play a role in HRTs effects on breast tissue. Other risk factors need to be also considered in prescribing HRT, such as BMI, cardiovascular diseases, and lifestyle factors including smoke, physical activity, and alcohol intake.

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