[AlaskaAngel]

Hi Tricia,

Lani's title of the thread helps I think. (I need a bigger brain myself for some of it!)

What has been quite puzzling to me in particular is the longtime disconnect between most medical practice and endocrinology when it comes to cancers like breast cancer or prostate cancer.

I think the study demonstrates the concern that endocrinologists have about the lack of standardization of a test for estrogen levels because it is so key to being able to offer patients more definite metabolic management, rather than the present hit-and/or-miss endocrine guessing game that we are presently subject to when making decisions about our treatment. I think endocrinologists are starting to see that practitioners in other fields are not accepting or sharing enough responsibility for helping to put more emphasis on seeing to it that the development of that standardization be done.

The issue of weight gain post-treatment postmenopause and how it affects recurrence, and the complete absence of medical application of that information at the time of my treatment led me first to the cancer center dietitian for help. He had awareness of the importance of weight management but was not as aware of the endocrine/metabolic basis behind it in terms of figuring out how to best target the problem.

That then led me to schedule with an endocrinologist. That it itself was a real eye-opener for me. They seem to be so solidly booked just dealing with diabetes/pancreatic imbalances, and thyroid issues that they have no background training for dealing with the endocrinologic issues in regard to cancers like breast cancer. Even with trying to schedule an appointment in such a large city of Seattle, they were all turning me away without being willing to even see me one single time about it. I finally connected with one who reluctantly agreed to see me.

Eventually I mentioned that I was aware that a number of clinical trials were beginning for the use of the very common metabolic drug metformin for breast cancer patients to reduce recurrence rates. Although he is very knowledgeable in his field, he was unaware of the trials. The disconnect between endocrinology and other medical practice beyond diabetes and thyroid disease has been very real.

I think endocrinologists are seeking to make sure it is understood that for better medical care to happen, everyone needs to recognize the importance of the lack of standardization for testing such key information as estrogen levels.

I hope that helps some....

A.A.