JohnL
05-14-2006, 10:07 AM
Dear All
Well now, here is an interesting divergence of medical views. So much so I thought I'd post a new thread based upon a letter we've just had. In the previous thread (see somewhere below) everyone had received a 'no way' response to the question of HRT.
Let me quote an extract from a letter we have just received from Monica's consultant.
'Monica is T1 G3 N0, ER negative, PgR negative HER2+++ and has completed surgery, chemo and Herceptin........ As she is ER negative and PgR negative, she has really no significant risk of being on a form of HRT such as Kliovance or a continuous combined preparation of your choice........ I am very supportive of her decision to go ahead with HRT...'
Now this consultant is a specialist in this area and in one of the world's leading breast cancer hospitals. Another professor of breast oncology has also confirmed the view that if ER/PR-ve, there's no problem with the low doses involved in HRT.
Obviously, we have discussed with them the earlier response of our GP (in fact two different members of the practice) both of whom said effectively, 'HRT and breast cancer - one precludes the other'.
This reflects the message everyone else seems to have had.
Monica's consultants are adopting a completely opposite view.
If you think about it, HER2+++ ER/PR-ve patients who don't have chemo which induces menopause are not put on something like Tamoxifen - so the continuing natural prescence of Eostrogen can't be seen as a significant risk in relapse. If it was, they'd block its expression.
I believe the level of hormone in HRT is very low compared with the natural levels pre-menopause.
Our Onc isn't a natural risk taker, so we're assuming that for him and a colleague to be comfortable with this, they have to have been made comfortable by something.
So here's the thing. Could it possibly be that many ER/PR-ve HER2 patients brought into early menopause could now be happy and healthier on HRT? That for this sub-goup, HRT represents no additional risk?
Who is right here, because if Monica's team are correct then this could be an important treatment option to improve quality of life and long term health that may have been unecessarily denied to many readers of this site.
If you are hormone -ve not on HRT and would like to be, maybe it's worth reasking the question and pushing for a clearer answer as to why 'no' and not 'yes'.
Is timing an issue. Is 2/3/4/5+ years post surgery long enough to be able to say, OK why not your background risk has declined to background level?
If we get those answers back, I'll be feeding them to Monica's onc and I will certainly let you know what their response is. I'll also try to find out how many other patients with hormone negative disease are on HRT.
Monica is also seeing an endocronologist who works with cancer patients in the next few weeks about the HRT, so get those responses in and I'll be giving him a printout of what is said in this and the previous string - and taking a note of what he says.
John L
Well now, here is an interesting divergence of medical views. So much so I thought I'd post a new thread based upon a letter we've just had. In the previous thread (see somewhere below) everyone had received a 'no way' response to the question of HRT.
Let me quote an extract from a letter we have just received from Monica's consultant.
'Monica is T1 G3 N0, ER negative, PgR negative HER2+++ and has completed surgery, chemo and Herceptin........ As she is ER negative and PgR negative, she has really no significant risk of being on a form of HRT such as Kliovance or a continuous combined preparation of your choice........ I am very supportive of her decision to go ahead with HRT...'
Now this consultant is a specialist in this area and in one of the world's leading breast cancer hospitals. Another professor of breast oncology has also confirmed the view that if ER/PR-ve, there's no problem with the low doses involved in HRT.
Obviously, we have discussed with them the earlier response of our GP (in fact two different members of the practice) both of whom said effectively, 'HRT and breast cancer - one precludes the other'.
This reflects the message everyone else seems to have had.
Monica's consultants are adopting a completely opposite view.
If you think about it, HER2+++ ER/PR-ve patients who don't have chemo which induces menopause are not put on something like Tamoxifen - so the continuing natural prescence of Eostrogen can't be seen as a significant risk in relapse. If it was, they'd block its expression.
I believe the level of hormone in HRT is very low compared with the natural levels pre-menopause.
Our Onc isn't a natural risk taker, so we're assuming that for him and a colleague to be comfortable with this, they have to have been made comfortable by something.
So here's the thing. Could it possibly be that many ER/PR-ve HER2 patients brought into early menopause could now be happy and healthier on HRT? That for this sub-goup, HRT represents no additional risk?
Who is right here, because if Monica's team are correct then this could be an important treatment option to improve quality of life and long term health that may have been unecessarily denied to many readers of this site.
If you are hormone -ve not on HRT and would like to be, maybe it's worth reasking the question and pushing for a clearer answer as to why 'no' and not 'yes'.
Is timing an issue. Is 2/3/4/5+ years post surgery long enough to be able to say, OK why not your background risk has declined to background level?
If we get those answers back, I'll be feeding them to Monica's onc and I will certainly let you know what their response is. I'll also try to find out how many other patients with hormone negative disease are on HRT.
Monica is also seeing an endocronologist who works with cancer patients in the next few weeks about the HRT, so get those responses in and I'll be giving him a printout of what is said in this and the previous string - and taking a note of what he says.
John L