Breast cancer is the most common form of cancer in the USA. Among women, breast cancer accounts for 30% of all cancer diagnoses, with 281,550 new cases estimated in 2021. According to the American Cancer Society, the lifetime risk of developing breast cancer is 1 in 8. The median age at diagnosis is 62, so this is a serious concern in menopause. The number one cause of death in menopausal women is heart disease, yet the fear of breast cancer often prevents women from considering taking hormone replacement therapy.

It is well known that there is an inflammatory component of breast cancer. When we dig deeper into the inter-connected processes of basic metabolism and inflammatory signaling in the context of estrogen metabolism the evidence shows a clear correlation between imbalances in estrogen and breast cancer. The time has come to provide strategies to shift the focus on breast cancer from early detection to prevention through a better understanding of hormone and energy metabolism so that prevention for high-risk patients becomes the gold standard. The Gail model is a current risk assessment tool, I propose that we look further into hormone testing as a means of identifying patients at higher risk of developing breast cancer. In a recent publication, “Workshop on Normal Reference Ranges For Estradiol in Postmenopausal Women September 2019, Chicago, Illinois” in Menopause (vol 27: No 6, pp 614-624), estradiol levels were evaluated as a means of disease prevention. The article stated, “The measurement of estradiol, estrone, and estrone-sulfate, as well as other hormones, would improve existing breast cancer risk-prediction models, which are currently based on clinical and genetic factors.” We would like to explore the physiology of cancer, estrogen metabolism, and the current studies that have been done on endogenous and exogenous hormones and breast cancer. 

Session Learning Objectives:

1.) Review hormone physiology as it pertains to cancer.

2.) Discuss different types of testing to assess estrogen load at the tissue level.

3.) Discuss estrogen metabolism and how it relates to cancer.

4.) Discuss which SNPs increase the risk of breast cancer.

5.) Review the evidence about hormone levels and HRT and cancer.