Question 1 - HRT & Breast Cancer


Hi Dr. N,

I am on the verge of going for HRT. Four years ago I had a mastectomy, stage II, 28 lymph nodes removed (two were invaded). Chemo for six months (Taxol being the last three months). I was put on Tamoxefin. After one year I stopped taking the Tamoxefin because it made me extremely ill. Not long after that, I needed a hysterectomy (cleaned out completely). My hysterectomy was two years ago. My oncologist has always said "No" to hormones since my cancer is hormone positive. I have just gone to a new doctor (obgyn), who is also a geneticist. He has told me that I would do well with HRT. That I already have cancer and therefore the HRT cannot "give" me cancer. He called my surgeon and asked him about my taking the replacement therapy. My surgeon told him that they (my oncologist and he) didn't want to deal with a lawsuit if my other breast then became cancerous. This made me pretty angry. First of all, the HRT would be my decision, how could there even be a lawsuit? I also felt that they were not thinking of me, but themselves. Now I feel that I am going to go ahead with HRT. That the quality of my life is very important. Also, I could find cancer again without the therapy. Who's to say if it is the HRT that caused the cancer or not? I know this is a big question to put before you, but I'd like another opinion to add to the pot. What do you think of HRT and cancer? I have toadd, I am damn tired of the hot flashes, insomnia, and complete lack of sex drive. Oh, and I am only 44 years old! Thanks for your time.

Reply:

I am in complete agreement with you. I believe that your evaluation of the situation is accurate. Your oncologist has always told you "no" to hormones as your cancer was "hormone positive."

As far as I know, there has never been a study that demonstrated that this makes any difference in outcome or cancer reoccurrence. And, I don't believe that HRT is responsible for any increased rate of breast cancer.

My surgeon told him that they (my oncologist and he) didn't want to deal with a lawsuit if my other breast then became cancerous.

Unfortunately, this is a fallout of the lawsuit prone society that we live in. It is an unhappy circumstance that a physician's medical decisions are often influenced by the fear of a possible malpractice claim. In your case, I believe that physicians who are knowledgeable about the issues involved are aware that HRT has no downside for you and has the potential to positively affect your quality of life and longevity. It may be that most these physicians, even if they know that HRT is in your best interests, would be uncomfortable in suggesting it or prescribing it to you. It is a terrible circumstance, but making the right medical decision doesn't necessarily protect them from a malpractice claim.

You are angry, and you should be. But, fortunately you have the mental wherewithal and are self-directed enough to make your own decisions. Yes, E-Mail Dr N You are entitled to feel better and live longer, and the likelihood is that HRT will make a remarkable difference for you. The tragedy is that most women who find themselves in the same circumstance are more easily manipulated by other peoples agendas.

Please let me know how you're doing.

Dr N