This is a really clear conversation, and the HRT section does the most useful work, since that's where the fear has most outrun the evidence.
The point worth underlining is that the 2002 WHI headline collapsed two different interventions into one message. The estrogen-alone arm actually showed reduced breast cancer risk, and the elevation came from the combined regimen with synthetic progestins, so many women were handed a warning built on a therapy they were never on. Two decades of caution rested on a lumped result that split apart the moment you separated the arms.
Thank you so much for this post. I’ve been living with metastatic breast cancer for almost two years and have the BRCA mutation. I have a 21 year old daughter who I will need to tell about this someday and she will need to be tested. If positive, I’m so afraid she will take the most extreme steps to avoid any risk at all as it seems too many oncologist are so willing to advise, or support, patients decisions to go to the extreme. I hope more doctors will move towards helping patients weigh all the risks and benefits of such extreme steps before we get to the time she may have to make these choices…
Thank you for writing in, Fanshen. I agree it's crucial to have doctors who can speak to the risks on both sides of any decision. Sending you warm wishes ❤️
What a positive and affirming conversation! I would also say, recovery from breast cancer is incremental and built on making the next good choice, day after day, which is what paving is about. And that’s ok. Thank you both for sharing your thoughts.
When I was perimenopausal, my former primary care doctor told me she was obligated to tell me that I qualified for breast MRI based on my (then) high breast cancer risk because of very dense breast tissue. She did not encourage me to get the MRI. When I asked her thoughts, she mentioned the radiation involved in the MRI, and said that would be ongoing. She said that was a lot of radiation. I asked if the MRI’s could be staggered, and expressed interest in doing that. This was during Covid, and neither of us followed up on it. Later, when I sought hormone therapy for night sweats and bone protection, she used my high breast cancer risk as one of many reasons to discourage me from hormone therapy. I was aware that my last couple mammogram results had showed that my breast cancer risk had dropped into the normal range; she was not aware of this and had to go back and look at the results. When I asked again about the breast MRI that was never followed up on; she said that I no longer qualified for the breast MRI because I was no longer in the high risk category.
I’m curious, if I had started the breast MRI when I was high risk, would I have continued to “qualify” and be monitored with MRI when my risk changed to normal??
I am wondering if it’s worth considering breast MRI through the WISDOM study if they are still enrolling. However, I’m also afraid that any results could cause my prescribing doctor to take away my hormone therapy; and I am at high risk for osteoporosis. 🙄
HI there! I am worried you are not getting accurate information - which is sadly true for so many people. First, MRI does not involve radiation. That's the beauty of MRI. Second, being at risk for breast cancer is NOT a reason to not take HRT. HRT doesn't cause breast cancer. That is outdated information. Third, mammograms can't change a woman's risk for breast cancer overnight. The risk for breast cancer is a mathematical projection - a composite of many variables. Use the online Tyrer Cuzick risk calc to find yours. The TC score is not determinative; it's just an estimate which, if > 20%, means you should consider adding annual breast MRI in addition to mammography annually. The decision to pursue additional screenings with MRI is up to you - but don't let the myth of radiation exposure from MRI influence that decision, because there is none! Whether or not your insurance will pay for additional screening with breast MRI is up to your insurance carrier. Finally, it's not too late to start HRT. But first I'd find another doctor whose advice is factual. I hope that helps!
Oh my! That is scary that she told me that!! I had a “last straw” with her and started looking for a new doctor. This happened to coincide with her retirement after only 15 years of practicing medicine. I have a new doctor who I like and feel comfortable talking to. If I ask a question he’s unsure of, he doesn’t get defensive, but looks into it. When I realized my former primary care was fearmongering about HRT, I started seeing a gynecologist who prescribed HRT.
It appears that former primary care was only looking at radiology report to determine risk. I will check out the risk calculator you mentioned. Thanks for your response!
P.S. Your feedback about protocols for prescribing thyroid medication was very helpful! My new primary care agreed that with only a subclinical result; I probably don’t need to be on it ( after 9 years of Levothyroxine use). After a month of halving my dose; I feel no difference, and will most likely discontinue it. Thank you for all the valuable information you provide!! 🙏 🙏 🙏
I am so glad you finally got what you needed with your GYN - and that your new primary is a good fit so far. Yes the radiology studies do not alone predict risk.. ugh I am sorry you got so misled.
How great that you were able to discontinue a medication you didn't need.
This is a really clear conversation, and the HRT section does the most useful work, since that's where the fear has most outrun the evidence.
The point worth underlining is that the 2002 WHI headline collapsed two different interventions into one message. The estrogen-alone arm actually showed reduced breast cancer risk, and the elevation came from the combined regimen with synthetic progestins, so many women were handed a warning built on a therapy they were never on. Two decades of caution rested on a lumped result that split apart the moment you separated the arms.
Thank you for listening and for your comment! Your point is important- thank you for highlighting this distinction.
Thank you so much for this post. I’ve been living with metastatic breast cancer for almost two years and have the BRCA mutation. I have a 21 year old daughter who I will need to tell about this someday and she will need to be tested. If positive, I’m so afraid she will take the most extreme steps to avoid any risk at all as it seems too many oncologist are so willing to advise, or support, patients decisions to go to the extreme. I hope more doctors will move towards helping patients weigh all the risks and benefits of such extreme steps before we get to the time she may have to make these choices…
Thank you for writing in, Fanshen. I agree it's crucial to have doctors who can speak to the risks on both sides of any decision. Sending you warm wishes ❤️
Thank you for always bringing important topics to the forefront.
Thank you so much!
What a positive and affirming conversation! I would also say, recovery from breast cancer is incremental and built on making the next good choice, day after day, which is what paving is about. And that’s ok. Thank you both for sharing your thoughts.
thank you!!!
When I was perimenopausal, my former primary care doctor told me she was obligated to tell me that I qualified for breast MRI based on my (then) high breast cancer risk because of very dense breast tissue. She did not encourage me to get the MRI. When I asked her thoughts, she mentioned the radiation involved in the MRI, and said that would be ongoing. She said that was a lot of radiation. I asked if the MRI’s could be staggered, and expressed interest in doing that. This was during Covid, and neither of us followed up on it. Later, when I sought hormone therapy for night sweats and bone protection, she used my high breast cancer risk as one of many reasons to discourage me from hormone therapy. I was aware that my last couple mammogram results had showed that my breast cancer risk had dropped into the normal range; she was not aware of this and had to go back and look at the results. When I asked again about the breast MRI that was never followed up on; she said that I no longer qualified for the breast MRI because I was no longer in the high risk category.
I’m curious, if I had started the breast MRI when I was high risk, would I have continued to “qualify” and be monitored with MRI when my risk changed to normal??
I am wondering if it’s worth considering breast MRI through the WISDOM study if they are still enrolling. However, I’m also afraid that any results could cause my prescribing doctor to take away my hormone therapy; and I am at high risk for osteoporosis. 🙄
HI there! I am worried you are not getting accurate information - which is sadly true for so many people. First, MRI does not involve radiation. That's the beauty of MRI. Second, being at risk for breast cancer is NOT a reason to not take HRT. HRT doesn't cause breast cancer. That is outdated information. Third, mammograms can't change a woman's risk for breast cancer overnight. The risk for breast cancer is a mathematical projection - a composite of many variables. Use the online Tyrer Cuzick risk calc to find yours. The TC score is not determinative; it's just an estimate which, if > 20%, means you should consider adding annual breast MRI in addition to mammography annually. The decision to pursue additional screenings with MRI is up to you - but don't let the myth of radiation exposure from MRI influence that decision, because there is none! Whether or not your insurance will pay for additional screening with breast MRI is up to your insurance carrier. Finally, it's not too late to start HRT. But first I'd find another doctor whose advice is factual. I hope that helps!
Oh my! That is scary that she told me that!! I had a “last straw” with her and started looking for a new doctor. This happened to coincide with her retirement after only 15 years of practicing medicine. I have a new doctor who I like and feel comfortable talking to. If I ask a question he’s unsure of, he doesn’t get defensive, but looks into it. When I realized my former primary care was fearmongering about HRT, I started seeing a gynecologist who prescribed HRT.
It appears that former primary care was only looking at radiology report to determine risk. I will check out the risk calculator you mentioned. Thanks for your response!
P.S. Your feedback about protocols for prescribing thyroid medication was very helpful! My new primary care agreed that with only a subclinical result; I probably don’t need to be on it ( after 9 years of Levothyroxine use). After a month of halving my dose; I feel no difference, and will most likely discontinue it. Thank you for all the valuable information you provide!! 🙏 🙏 🙏
I am so glad you finally got what you needed with your GYN - and that your new primary is a good fit so far. Yes the radiology studies do not alone predict risk.. ugh I am sorry you got so misled.
How great that you were able to discontinue a medication you didn't need.
Glad to help :)
I really appreciate how you post both the conversation and the written summary!
Me too! I usually prefer reading over video and podcast. I appreciate the multiple modes of information!!