Caring for Women

Hormones and Breast Cancer

Traditional medical dictum is that “hormones” (estrogens) are a risk factor for breast cancer and this is partially true. A woman’s own ovaries and the comparatively high level of estrogens they secrete (also influenced by genetics), and long-term high dose estrogens (birth control pills or traditional postmenopausal HRT) are somewhat positive risk factors for breast cancer. The key words are: a woman’s own ovaries, and “long-term high-dose.”

It’s now known (from combined analyses of over 45 long-term studies involving more than 750,000 women) that, as a blanket statement, estrogens do not alone cause breast cancer. A recent analysis of several large studies showed that if a woman with a previous history of breast cancer (“breast cancer survivor”) takes short-term (2 years or less) low dose HRT (e.g., to help with severe perimenopausal symptoms), she has no higher and probably decreased risk of dying from breast cancer than a woman who does not take estrogens!

If estrogens are taken, they key is: short-term, and low-dose. The key is understanding and individualization. The hormones a woman’s own ovaries secrete are far greater risk factors for breast cancer than short-term low dose estrogen supplementation.

However, if armed with this new knowledge you still are at heart fearful of estrogens and feel their effect on your breasts to be negative, you should not take them as this negative psychic stress may certainly impact negatively on your immune system, outweighing any possible beneficial hormonal effects. Find a suitable non-estrogen way to manage your symptoms.

Also, there is great promise in SERM’s (Selective Estrogen Receptive Modulators), synthetic compounds which certainly give the same bone and cardiac protection as estrogens and at the same time significantly lower the risk of breast cancer. The problem is, the presently available SERM’s (Raloxifen, Tamoxifen) do not in any way help menopausal symptoms – in fact, they make them worse.

However, the whole ball game will soon be different with FDA approval (expected in 1-2 years) of a new generation of SERM’s. One of these, Tibolone, has been used in Europe (under the trade name Livial) for more than a decade. Not only does it have the same protection as other SERM’s, but it helps with menopausal symptoms as well.

Recent Professional Activities:

Publication of Dr. Goodman's research paper "Female Genital Plastic Surgery: a Large National Multi-Centered Outcome Study", the largest study yet published worldwide on female genital plastic surgery, published in the Journal of Sexual Medicine.

 

Attendance at a training course for the new Pelleve Radiofrequency Procedure for noninvasive treatment of facial and neck wrinkles, skin tightening and toning in Phoenix, Arizona.

Dr. Goodman was asked to be on the speaker's bureau of Boeringer Ingelheim Pharmaceuticals, speaking and educating on female sexual dysfunction, and Novogyne Pharmaceuticals, United States, speaking and educating on hormone therapy for peri- and post-menopause.

Presentation of endocrine grand rounds at Stanford University in March of 2010 on transdermal versus oral estrogen replacement for post-menopausal women.

Faculty member of the first Global Conference on Female Genital Cosmetic Surgery at the American Academy of Cosmetic Surgery meeting, Orlando, Florida, January 25, 2010. Dr. Goodman contributed to presentations and moderated discussion groups on ethical and patient protection issues in female genital plastic surgery as well as sexual issues in vaginal tightening procedures.

Attendance at and faculty member of the 30th annual North American Menopause Society meeting n San Diego, California in October of 2009. Dr. Goodman presented his poster presentation on the use of oral versus transdermal hormone therapy.

Faculty member at the annual International Society for the Study of Women's Sexual Health meeting in St. Petersburg, Florida, participating in the "Great Debate" on female sexual dysfunction and presenting a paper on his large nationwide female genital plastic surgery study.

Dr. Goodman was invited to give Grand Rounds at Sutter Hospital in Davis, Ca in October. His topic was "Transdermal (Bioidentical) Hormone Therapy".

Dr. Goodman was quoted in "Endocrine Today".  http://www.endocrinetoday.com/view.aspx?rid=44251

Dr. Goodman was the senior author of two recently published peer-reviewed medical journal articles, "Is Elective Plastic Surgery Ever Warranted, and What Screening Should be Conducted Preoperatively," published in the Journal of Sexual Medicine,  (2007;4:269-276) and  "Female Cosmetic Genital Surgery," published in the journal, Obstetrics and Gynecology (2009;113: 156-159). 

The first chapter in a U. S. textbook on female genital aesthetic surgery, "Female Genital Plastic Surgery"  authored by Dr. Goodman, will be published in the new text, "Female Reproductive and Sexual Medicine" due out Fall, 2009.  

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