Well, I’ll Be Damned, She’s Back!

I never thought I’d say that. The doctors seemed so certain, case closed, seen it a million times before. But that just goes to show, my body doesn’t fit  neatly into a mold created by modern medicine. She plays by her own rules, always has. And just when I get used to the idea of “what is supposed to happen now”, the agenda changes. But I should have known better. My body is a fighter.

One of the perils (or perks, depending on your point of view) of getting invasive breast cancer in your forties is the near certainty that menopause will follow chemotherapy. As my oncologist told me, “Don’t worry, your ovaries will be dead soon.” I fired him not long after that comment, oh, and the sepsis that he thought could wait until morning.

For a while, he was right. My last cycle was in June of 2013, before my lovely tango with Taxol began in July. My ovaries went into hiding like two frightened puppies under a blanket during a fierce thunderstorm. Except for a brief period earlier this year that I chalked up to experimenting with some hormones (bad girl!), I have been effectively menopausal for nearly a year. Hot flashes, mood swings, fatigue, weight gain, you name it, I’ve experienced it.

So, imagine my surprise when my monthly visitor came last Saturday. I had been in a horrible mood the week before, and I felt very crampy and bloated, but I just thought I was receiving yet more exciting menopause bonus gifts. Then I worried. One thing that breast cancer steals is your ability to just brush things off. Once active treatment ends, every pain, every headache, and every symptom that once would have been “normal” creates a small sense of panic.

Added to my fear was the fact that I’ve been using Estriol cream to offset the unpleasant sexual side effects of low estrogen (which works very well, by the way). This is not exactly sanctioned by my oncologist. Ok, not at all. I’ve done a lot of research, and Estriol doesn’t seem to cause growth of the uterine lining the way estradiol does, but there are always exceptions. So, as the spotting lingered on, my mind went to the possibility of uterine cancer. I called my gynecologist.

I had my appointment this morning with Dr. M, another wonderful doctor that I’ve been lucky enough to find. Just to let you know how unusual she is, she once called me from her cell phone on vacation to warn me against seeing the breast surgeon that I had originally chosen. It turned out that she had done her residency under him and saw him cut corners that put patients lives in jeopardy. No one would ever have known this because he is incredibly charming and prays with his patients, and they adore him. I can’t tell you what that meant to me.

Dr. M wasn’t particularly worried. She smiled at me and said, “I think you’re just menstruating.”

“But the oncologist told me I was done.”

“They say that all the time, but I see women get their periods back at your age. Now you really need to think about contraception.”

“Huh?” In the space of five minutes, I went from a menopausal crone to a woman with a cycle who needs to worry about getting pregnant. It must be the hair. When I went to Florida last month, I saw a fabulous hairstylist who erased my silver locks and made me a bithcin’ blonde. My body must have just taken notice of this turn of events and decided that we’re younger now.

Dr. M didn’t flinch when I told her about the Estriol. She said that she didn’t think that would cause bleeding using it only twice per week, but we’re waiting to see what happens. She told me that if the cycles didn’t have a pattern, or the spotting didn’t stop soon, to give her a call and she would order an ultrasound.

I guess I’ll have to take back all of the feminine products I moved to my daughter’s bathroom months ago. I know I should be freaking out that I have enough estrogen to restart a menstrual cycle, but in a strange way, I’m kind of tickled. My body is rebelling against the months of insults that have been hurled at it and trying to regain balance. In my opinion, that’s pretty awesome.

Estrogen Replacement To Prevent Breast Cancer Recurrence?

80’S CANCER JAM OF THE DAY:

 

For women with estrogen positive breast cancers, or any breast cancer for that matter, it’s a given that hormone replacement therapy is off the table forever. Or is it….? Surely if the cancer is driven by estrogen and/or progesterone, it would be a suicide mission to even contemplate this possibility. Yet I’ve often wondered if the link is really this simple.

I actually asked my oncologist about the link between hormones and breast cancer at our last visit. Intuitively, it makes sense to me that if cancers are hormonally driven, then the greatest incidence of cancers should appear at the time in a woman’s life when her estrogen and progesterone levels peak, namely pregnancy. Yet, it is extremely rare to hear of a pregnant woman diagnosed with breast cancer. Instead, the odds seem to increase as we age, with the great majority of women being diagnosed after menopause, when hormones should be in decline.

According to the latest  “Cancer Statistics Review” or “SEER” report put out by the National Cancer Institute, you have the following odds of being diagnosed with breast cancer per decade of life:

• Age 30 . . . . . . 0.44 percent (or 1 in 227)
• Age 40 . . . . . . 1.47 percent (or 1 in 68)
• Age 50 . . . . . . 2.38 percent (or 1 in 42)
• Age 60 . . . . . . 3.56 percent (or 1 in 28)
• Age 70 . . . . . . 3.82 percent (or 1 in 26)

Although I love my new doctor, I didn’t feel like he adequately answered my question. He said something about a woman still being able to produce a little bit of estrogen via her adrenals and her fat cells (particularly if she is overweight) after menopause. True. But this amount would still pale in comparison to the amount produced by a woman in the height of her reproductive years. In light of the above statistics, it would almost make more sense that a lack of adequate hormones increases the risk of breast cancer.

As some of you know, I’ve been reading a really fascinating book by Suzanne Somers about alternative doctors who are curing cancer with mostly non-toxic methods. Some of them do use low-dose chemo, but the low doses are made possible by the combination with the natural treatments. Even if you choose not to step off the mainstream path, I highly recommend reading this just to increase your awareness of what’s out there.

 

One of the doctors interviewed for Somers’ book is Jonathan Wright, who is one of the pioneers of hormone replacement in the U.S. His interview captivated me so much that I just bought his book, which is pictured here. He talks about using Estriol, which is the estrogen most abundant in pregnancy, as a kind of “natural Tamoxifen”.

The role of Tamoxifen in breast cancer therapy is to act as an estrogen receptor blocker to prevent the more potent and agressive estradiol from taking this spot and potentially causing cell proliferation. Tamoxifen is the “goalie”, so to speak. This works well in breast tissue; the problem comes in other parts of the body, where Tamoxifen acts more like estrogen. We see this mainly in the uterine lining, where a dangerous proliferation of tissue can occur, leading to uterine cancer.

Dr. Wright describes three types of estrogen: Estradiol (E2), Estriol (E3), and Estrone (E1). E2 and E1 are the more agressive forms, while Estriol or E3 has been shown to be cancer-protective. According to Wright, Estriol will block the estogen receptors in our cells like Tamoxifen, without the other side effects that we see so often. But, it will also help ease quality of life issues caused by menopause, which is a subject currently only addressed with anti-depressants or blank stares.

In addition to reading these books, I have been doing random PubMed searches entering “hormone replacement therapy breast cancer” . Surprisingly, most of the studies that I looked at found no increase in breast cancer recurrence or mortality in women using hormones following a breast cancer diagnosis. Granted, many of the studies did not specify whether the women were estrogen receptor positive or not, but this is the most common diagnosis.

Why do we care about all this? I can tell you from a personal standpoint that Tamoxifen scares the hell out of me. I’m not even talking about the prospect of getting uterine cancer here. I have serious concerns about my mental health if my hormones decline any further. Just the beating that they have taken during chemotherapy has reduced my quality of life. Estrogen stimulates serotonin receptors in the brain, and serotonin is responsible for feelings of happiness and self-esteem. I like those feelings.

This is a very controversial debate, but one that is deserving of attention. It’s just a shame that women who don’t fall obediently into the “medical model” have to search so hard to find alternatives. And it’s unethical that there is no funding to do the kinds of studies that would truly ease our minds about taking a different path. It’s not easy being a rebel!