Can Estrogens Prevent Breast Cancer?

QUESTION: I am approaching menopause, and the question of using estrogens has
me quite perplexed. I've heard the hormone can cause cancer, now the news is
that it doesn't. Help! Can estrogens prevent breast cancer?
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ANSWER: Estrogens are often used to counteract the symptoms of menopause by
replacing the estrogen levels found in pre-menopausal women.
A variety of studies have come to a variety of conclusions about the
relationship of estrogens to breast cancer: Estrogens have been associated
with increasing the risk of breast cancer, protecting against it, and having
nothing to do with it.
The concern about estrogens and breast cancer has arisen because of the
association of these hormones with endometrial cancer. However, although both
the breast and the uterus are affected by estrogen, they respond differently.
If you have an intact uterus, your doctor may recommend reducing the estrogen
risk by adding progestins to your therapy.
However, progestins may eliminate the beneficial effect that estrogen has
on cholesterol: estrogens reduce the level of harmful low-density
lipoproteins (LDLs), while progestins increase them. By attempting to reduce
the risk of breast cancer by adding progestin, you may lose the protection
estrogen provides against coronary heart disease--the number one cause of
death among middle-aged and older women.
Some women, such as those with benign breast disease, may be at increased
risk of estrogen-related breast cancer, but for most women, the risk is not
affected by the low-dose estrogen used to control menopausal symptoms. Based
on your own history and your family history of breast cancer and heart
disease, you and your doctor can decide whether estrogen, or a combination of
estrogen and progestin, is best for you.