the estrogen conundrum

I recently gave a talk on women's health for a company. The talk was about healthy hormone balance. It was a small group of women and they were very passionate and had many questions. It was an interesting talk, in that it was interactive, the women spoke of their concerns, and they felt it was helpful to even just talk about it. Some were very opinionated on certain topics, others felt more reserved. I think the overall consensus was that each woman needs to assess her own risk of hormone-dependent cancers and other health concerns like fibroids, cysts, pre-menstrual syndrome, cardiovascular disease, osteoporosis and others, that are related to the hormone estrogen.

I spoke about the benefits and risks of too much or too little estrogen. I also spoke of the role of progesterone, as the hormone in opposition to estrogen. The stimulation of hormones for ovulation, and the fact that as we get older, we do not always ovulate and this also affects our hormone balance.

I spoke of the role of the liver and its ability to detoxify estrogen, and the role of fiber in the elimination of estrogen to minimize the entero-hepatic circulation of estrogen.

We spoke about the role of stress, and whether hormone imbalance causes stress, or reduced capacity to handle stress (may be true for a reduced progesterone output).

The topic of hormone balance is very complex, since hormones are a factor of many different things including our mind and psychology, our diet, our genetics, our habits, our immune system, our sleep patterns, and our environment.

Some of the issues that came up were:

1) should I be taking the birth control pill? what if I have a family history of breast cancer?

2) does diet really make a difference?

3) is organic food really important for breast cancer prevention?

Here are some of the answers we talked about:

The Birth Control Pill

1) The recommendations for the birth control pill may only be made by a medical doctor. However, I encourage those who can, to seek out second opinions, educate on the level of risk to benefit, to feel confident in their own health decisions, and to ask the important questions to their Doctor. The science of the birth control pill is very contradictory. It appears that the birth control pill is not recommended with a personal history of breast cancer. In women with no breast cancer, newer studies and meta-analyses demonstrate an increased risk in breast cancer in women with current or recent use of the pill, before their first pregnancy. However, the risk goes back to normal once the pill is stopped for 10 years or more. And even more recent studies demonstrate very little to no risk with low-dose estrogens and progesterone. I would encourage follow-up information here from Harvard University:

On a side-note, if you have cervical HPV, taking the birth control pill for more than 5 years increases your risk of it progressing to cervical cancer (1)

Diet and Breast Cancer

2) According to the Women's Nutrition Intervention Study (WINS) and the observational Women's Healthy Eating and Living (WHEL) study, post-menopausal women with a history of breast cancer may have a small improvement in the risk of occurrence using dietary changes (the study did not reach statistical significance), in particular, by increasing cruciferous vegetables and regular vegetable intake. On further sub-analysis, the effect was even greater for women who did not have hot flashes after breast cancer treatment. The conclusion was that it is not sufficient to say that diet plays an important independent role. (2)

Weight reduction and low-fat diet does appear to reduce breast cancer recurrence (3). In terms of primary prevention, having 5 servings of fruits and vegetables per day may confer some protection but may not prevent breast cancer. Body weight is an important risk factor for the prevention of breast cancer, and weight loss is still the best prevention for breast cancer recurrence. (2,3).

Organic?

3) Unfortunately, this cannot be answered. At this time, it is unknown whether pesticides found in foods is an independent risk factor for breast cancer prevention, however the majority of the research seems to say no. Most of the information regarding pesticide exposure comes from people working directly with pesticides (4), or from animal studies that should be interpreted with caution. Serum and adipose (fat) tissue did not show increased pesticides, from food, in breast cancer patients (5). However, more studies would need to be made to know for certain whether eating organic food protects against breast cancer.

Of course, this is a very small blog entry, and the study of women's health, and breast cancer, is very vast. Seeking information from many places, deciding on two lifestyle habits you can change for yourself at a time, and having someone to accompany you, all help you to achieve your health goals, in the timely manner. I hope this sparks your curiosity to dig a little deeper.

1) Green et al. (2003). Human papillomavirus infection and use of oral contraceptives. Br J Cancer. 88(11):1713-1720

2) Pierce, J. (2010) Diet and Breast Cancer Prognosis: Making sense of the WINS and WHEL trials. Curr Opin Obstet Gynecol. 21(1):86-91.

3) Blackburn and Wang. (2007). Dietary fat reduction and breast cancer outcome: results from the Women's Intervention Nutrition Study (WINS) Am J Clin Nutr. 86(3):878-881.

4) Bassil et al. (2007). Cancer health effects of pesticides. Can Fam Physician. 53:1704-1711.

5) Snedeker. (2001). Pesticides and breast cancer risk: a review of DDT, DDE, and Dieldrin. Environ Health Perspect. 109(Supp1):35-47.