The still unknown benefits of hormone therapy

This text is part of the special Health and well-being section

One in eight Canadian women will be affected by breast cancer during their lifetime. The statistics are brutal and call for demystifying certain aspects and treatments of this disease. For more than twenty years, female hormone therapy has been underprescribed in Quebec, after the publication of a study which put the associated risks into perspective. Clinician and researcher Sylvie Demers believes that this approach can prevent and treat breast cancer, as well as many other diseases. In her new book, she debunks the myths in this regard.

Hormone therapy is a treatment historically used to treat the symptoms of menopause, which also helps slow or stop the growth of cancer cells. Science has proven that “adjuvant” hormonal therapy, initiated after surgical treatment of the tumor or after chemotherapy and radiotherapy, can significantly reduce the risk of recurrence and mortality from breast cancer.

In his most recent book, Prevent and treat breast cancer. The power of female hormonesdesigned as a real investigation, the D^D Sylvie Demers dissects the mechanisms and benefits of these treatments according to existing literature and her clinical observations. According to her, hormone therapy must be prescribed with “art and science”. The dosage, in particular, is essential, according to Sylvie Demers, who has studied the subject for almost 30 years.

“We give endocrine treatments to fight against hormone-dependent cancers, which represent 75% of breast cancers,” explains Sylvie Demers. Their effectiveness is caused by the increase in the effect of estrogens, after their action has been blocked, which will trigger apoptosis [la mort] cancer cells. » In other words, these hormones have protective effects against breast cancer, according to the researcher, contrary to the idea which has continued to be conveyed for more than twenty years.

“Bioidentical” hormones

From the 1930s to the early 2000s, hormone therapy was quite popular and recognized for treating the symptoms of menopause, preventing osteoporosis and endometrial cancer. In 2002, like an earthquake in the medical field, the American Women’s Health Initiative (WHI) study called everything into question. This clinical trial concluded that the risks of stroke, coronary heart disease and breast cancer were greater than the benefits.

In the years that followed, several reanalyses refuted most of the results of this study, which had flaws and whose results were largely exaggerated, according to an investigation by journalist Madeleine Roy. “But the damage was done, it created a fear of hormone therapy all over the world,” says the D^D Sylvie Demers.

Risks linked to hormones do exist, in particular the formation of blood clots which can lead to thrombosis. In his work, the D^D Sylvie Demers insists on the importance of differentiating the types of hormone therapy. She prescribes bioidentical hormones like micronized progesterone and estradiol, which have the same chemical structure as those made naturally by women.

“We know that estrogens, bioidentical or not, do not increase the risk of breast cancer. On the contrary, these hormones are protective, she explains. The real culprits are progestins, which were analyzed as part of the WHI study. » Often present in contraceptive pills, progestin (or medroxyprogesterone acetate) is non-bioidentical and is believed to be the sole cause of the increased risk of breast cancer and cardiovascular disease.

Sweep away the fear

However, this distinction between progesterone and progestin is not present in the clinical guidelines of the Society of Obstetricians and Gynecologists of Canada (SOGC), which does not consider bioidentical hormones to be safer. This prevents many women from having access to it, a public health problem long ignored, then made visible by the documentary Loto-Méno by Véronique Cloutier.

“When we really push the subject, we realize the absurdity of the situation,” says Sylvie Demers, who also advocates for improving care in transgender medicine. It’s even a scandal when we know how treatments can greatly improve women’s quality of life. » She has been training doctors for years, notably during “scientific Fridays”, to discuss clinical cases and help the medical profession to better understand the types of treatment.

“I’m not saying that hormones solve everything, but they need to be more recognized,” concludes the D^D Demers. I refuse to continue to let women who are wrongly overdiagnosed and who are frightened suffer. Much distress, expense and illness would be saved. » The pharmaceutical industry also has its role to play in investing and collaborating in carrying out more advanced research, with the aim of providing targeted, adequate and safe hormone therapy treatments.

This content was produced by the Special Publications team at Duty, relating to marketing. The writing of the Duty did not take part.

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