NATUROPATHIC DOCTOR IN OTTAWA
Breast Cancer Risk In Hormone Therapy
Calculating Your Individual Risk To Make An Informed Decision
Assessing Your Personal Breast Cancer Risk
Many women (and their doctors) are concerned about the increased risk of breast cancer that is associated with hormone therapy. There is an increased risk (0.4% in women aged 50-59 if hormones are taken for up to 5 years), but both the woman’s baseline risk and total risk is often very much overestimated. Women often report hormone therapy as “life changing” once they start, so ensuring that more women get properly assessed to determine their risk (and therefore their options for bioidentical hormone therapy) is one of our missions as Naturopathic Doctors here at Sequence Wellness.
Breast Cancer Risk Assessment Tool
In order to safely prescribe bioidentical hormones, we must first assess cardiovascular risk, osteoporosis risk and breast cancer risk. We assess cardiovascular risk and osteoporosis risk in order to determine if there is added incentive to include hormone therapy in a woman’s treatment plan (as estrogen, given at the right age, right dose and right route of administration, can reduce the risk of both of these chronic conditions). However, we assess breast cancer risk because hormone therapy may increase a woman’s risk of developing this disease when exposed to exogenous progesterone for longer than 5 years. However! When we actually do the risk calculations, most patients are pleasantly surprised by their low baseline risk for breast cancer.
Here is an example patient:
| questions: | answers: |
|---|---|
1. Does the woman have a medical history of any breast cancer or of ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS) or has she received previous radiation therapy to the chest for treatment of Hodgkin lymphoma? | No |
2. Does the woman have a mutation in either the BRCA1 or BRCA2 gene, or a diagnosis of a genetic syndrome that may be associated with elevated risk of breast cancer? | Unknown |
3. What is the patient’s age? | 55 |
4. What is the patient’s race/ethnicity? | White |
a. What is the sub race/ethnicity or place of birth? | n/a |
5. Has the patient ever had a breast biopsy with a benign (not cancer) diagnosis? | Unknown |
a. How many breast biopsies with a benign diagnosis has the patient had? | n/a |
b. Has the patient ever had a breast biopsy with atypical hyperplasia? | n/a |
6. What was the woman’s age at the time of her first menstrual period? | 12 to 13 |
7. What was the woman’s age when she gave birth to her first child? | 25-29 |
8. How many of the woman’s first-degree relatives (mother, sisters, daughters) have had breast cancer? | None |
Another factor to note is that breastfeeding significantly reduces breast cancer risk.
Compared to women who breastfed for 0-11 months in their lifetime, there was a 66.3% reduction in breast cancer risk in women who breastfed for 12-23 months, 87.4% reduction in 24-35 months and 94% reduction in 36-47 months categories.
Oral Contraceptive Pills And Breast Cancer Risk
Before prescribing bioidentical hormone therapy a patient undergoes a thorough risk benefit analysis to determine if this health intervention reduces her risk, or increases her risk, and to which disease and how much. The only way to make a fully informed decision is to do a deep dive into your medical and family history, as well as other risk factors. In contrast, oral contraceptive medication (birth control pills), are readily prescribed without such extensive risk assessments, and are often prescribed for many years without reassessment. However, combined oral contraceptive (estrogen and progestogen containing pills) increase your risk of breast cancer similarly to menopausal hormone therapy.
The good news we can draw from this infographic about breast cancer risk is that there are other modifiable risk factors that a patient can improve upon to reduce her overall risk. For example, reducing alcohol, smoking cessation, and exercising make a big dent in breast cancer risk. And reducing your BMI to under 30 is VERY significant for improving risk.
For a woman who is at moderate risk, but who still wants to start hormone therapy due to current symptoms, she has the power to alter these other factors if she chooses to benefit from bioidentical hormone therapy.
Your Doctor: Meet Dr. Sarah
Dr. Sarah Goulding is a licensed naturopathic doctor in Ontario and has a BSc in neuroscience and biology from Dalhousie University (2004), and did her 4-year naturopathic training at the Canadian College of Naturopathic Medicine (2010). She’s since accumulated over a decade of clinical experience, and refined her practice to focus on women’s health and digestion. She is licensed and registered as a Naturopathic Doctor in Ontario by The College of Naturopaths of Ontario (CONO) and is a member of the Canadian Association of Naturopathic Doctors (CAND) and the Ontario Association of Naturopathic Doctors (OAND).
Dr. Sarah Goulding blends science and compassion, and acts as a personal health researcher to help you navigate your health. Tools that she uses include nutrition, supplements and botanicals, bioidentical hormones, and lifestyle modifications. The closer you get to the root cause, the gentler the therapies needed to resolve the issue.
