| ANTI-AGEING MEDICINE | PEER-REVIEW
absent family history of breast or ovarian cancer. Sporadic cancer is considered to be a polygenic or multifactorial disorder involving many genes that interact with nutrition and lifestyle factors2
B . In addition,
oestrogen exposure is one of the most important risk factors as its metabolites can attack DNA and cause double-stranded breaks. For this reason, the functional polymorphisms of genes involved in oestrogen metabolism should be identified for inclusion in a multi-gene breast cancer risk reduction approach, as well as prior to the commencement of any hormone replacement therapy (HRT).
REAST CANCER IS THE MOST COMMON cause of cancer mortality in women worldwide, and its incidence continues to increase1
. The majority of breast cancer
cases (90–95%) are sporadic (i.e. non-hereditary), with only a modest or
among healthy postmenopausal women3
. The study
found a 26% increase in breast cancer cases, as well as increases in cardiovascular disease, deep vein thrombosis and stroke. Similarly, the Million Women Study found that the use of HRT by women aged 50–60 years in the UK over the previous decade resulted in an estimated 20000 extra breast cancer cases, 15000 of which have been associated with oestrogenÐ progestin4
. It The Million Women
Study found that the use of HRT by women aged 50–60 years in the UK
over the previous decade resulted in an estimated 20 000 extra breast
cancer cases, 15 000 of which have been associated with
The dangers of hormone replacement therapy Conventional HRT has been used for many years without any major health concerns, until The WomenÕs Health Initiative randomised controlled trial (which abruptly ended in July 2002) found that the overall health risk exceeded the benefit from the use of combined oestrogen and progestin for an average 5.2-year follow-up
oestrogenÐ progestin.
was found that conjugated equine oestrogens (CEE) and synthetic progestins in a conventional HRT
regimen
prescribed to every woman in the same dose, was mostly to blame (Figure 1). However, the French E3N cohort
study showed an unequal risk for breast cancer associated with different HRT regimens (conventional versus bioidentical), giving
DR SLY NEDIC, MBChB (BELG), is Aesthetic and Anti-ageing Physician, and Owner and Medical Director of 8th Sense Medi-clinic,Johannesburg, South Africa
email:
slynedic@8thsense.co.za a better
idea as to the direction in which HRT treatment approaches should go5 (Figure 2). From this study, it is possible to surmise that the smallest relative risk for breast cancer is after the use of combined oestrogenÐ
progesterone, preferably not longer than 6 years, and in combination with weaker oestrogens (e.g. estriol).
Understanding the role of oestrogen metabolites There is a complex
causal relationship between hormone-sensitive sporadic breast cancer and
KEYWORDS catechol oestrogens, genetic polymorphism, nutrigenetics, bioidentical hormone replacement therapy
prime-journal.com | January/February 2013 ❚ 49
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