Ageless: The Naked Truth About Bioidentical Hormones (20 page)

SS:
How would that work, like a laser?

JT:
It will most likely be either oral or infusion. Tamoxifen is a form of targeted therapy and blocks the estrogen receptor of the cancer cell, causing it to become dormant. However, tamoxifen also targets your uterus, your brain, and activates your clotting system.

SS:
I find tamoxifen a troubling drug. I refused to take it when it was recommended to me. The side effects didn’t warrant the so-called benefits as far as I was concerned. Is tamoxifen the female version of Lupron for men with cancer of the prostate?

JT:
No, Lupron basically shuts off hormones at the brain. It shuts off the ability to give the signal to make hormones. Tamoxifen is a receptor blocker, so it actually works on the cell itself. It has a dual action. If it sits on an estrogen receptor, it can either stimulate or block. That’s why you can block the receptor cells to the breast, yet the uterus is stimulated and you can get cancer.

SS:
Sounds like trading a stomachache for a headache. The side effects of tamoxifen take away quality of life. Weight gain is a supposedly small side effect, but excess weight is undesirable and makes women unhappy. Then there’s the possibility of depression because this woman is without hormones, plus a 40 percent increased risk of
heart attack, stroke, or pulmonary embolism. Doesn’t sound like the benefits are worth it.

JT:
You are correct about the side effects of tamoxifen, but it doesn’t interfere with the ability to make hormones … it interferes with the ability to read the hormones in some parts of the body. Remember, tamoxifen can block or it can stimulate. It depends upon what organ we are talking about. But you’re right, tamoxifen can cause horrible effects in women; yet some women can take this drug and feel fine.

SS:
What’s that about?

JT:
In my practice it seems that the older women, the longer they’ve been menopausal, the more likely they may tolerate the drug better than the younger women.

SS:
Maybe it’s because they’ve been in hormonal imbalance longer and have gotten used to feeling lousy. Why do you think we get breast cancer?

JT:
First of all, I can tell you age is the biggest risk for any cancer.

SS:
So that means loss of hormones equals increased risk?

JT:
Yes, or lack thereof of hormones, if you’re looking at breast cancer specifically. Seventy-five percent of the breast cancer diagnoses are made after the age of fifty, which is after the time of menopause, when women are hormoneless. What’s also interesting is that the largest group of women to get cancer at any one time are ages forty-five to fifty.

SS:
Think about it, at forty-five they are in perimenopause.

JT:
Exactly, because there is the hormonal change from balanced, rhythmic hormone levels to which a woman then experiences hormonal falloff to menopause. You can’t ignore the fact that lower and erratic hormone levels have an influence on some kinds of breast cancer.

SS:
Then perimenopause should be taken very seriously as a condition and hormones should be followed very closely at this age as a preventive measure against cancer. Yet I must say, having been diagnosed at age fifty with breast cancer, not one,
not one
of my doctors ever mentioned perimenopause as a serious condition. In fact, it was treated kind of as a joke.

JT:
It’s a good idea for doctors to take perimenopause seriously.
But there are many people who are not happy that “perimenopause” has been made into a disease, since most women go through it and survive “the change.” Perimenopause is a transitional state for aging women, and the frequency, type, and intensity of symptoms vary; 10 to 15 percent have no symptoms when they stop having periods, and you’ve got 20 percent of women with symptoms so severe that they cannot function. And then you have this in-between range.

SS:
What is the difference? Is it the difference between women who have had children and have breast-fed and those who have not?

JT:
Yes, breast-feeding is very important for women, but that is just part of the whole picture. Breast cancer is one disease, but I’ve seen so many variations in the women who get cancer.

SS:
Add to that scenario the women who have been on birth control pills.

JT:
I think the birth control pills and certainly the older birth control pills of the sixties and seventies have been associated with an increased risk of breast cancer. The current third generation of birth control pills does seem to have a slight increased association with breast cancer. They are interfering with a natural hormonal process, and we don’t know the ultimate outcome of the big picture due to this altered state. Birth control pills (which are more like having a controlled menopause) delay pregnancy in young women. This has risk associated with it. The other factor is that women who tend to be highly educated and in business or whatever are the same women who are delaying pregnancy until their late twenties and into their forties. We know that a pregnancy after age thirty can increase the risk of breast cancer. Early pregnancies and breast-feeding for years are things we don’t do very well in this country, and they are the two things that strongly reduce the risk of breast cancer.

SS:
I have read that the best age to have your children is no older than twenty-eight, but most women don’t do that anymore.

JT:
Yes, twenty-eight is considered to be a “geriatric pregnancy,” according to OB/GYN textbooks. If you look at the biology of women, it’s kind of like “use it or lose it.” You’ve got this reproductive system. You see, years ago women would marry at eighteen and
have their baby at nineteen and breast-feed. When you do that, there’s a protective mechanism. Protective changes happen to the breast tissue at a younger age when you have first-term pregnancy. That protective effect does not happen after the age of twenty-eight or thirty.

SS:
But take a woman who has breast-fed, and let’s say she started having her children at thirty, thirty-two. She’s still in better shape than the woman who hasn’t yet done it at all, right?

JT:
Can’t tell you. But long-term breast-feeding is beneficial for both the mother and baby, no matter what.

SS:
So if it’s really about early pregnancy and early breast-feeding, then no wonder there’s a cancer epidemic in women of my generation. We burned our bras and wanted equality in the workplace. Plus, we could have all the sex we wanted because of the pill. We wanted to get paid like men and work like men.…

JT:
And end up like a man. I’m forty-seven, and I grew up in the 1970s when we thought we could have it all, and I feel like I have been sold a bill of goods. I had children at age thirty-one and thirty-four, but I was working literally a hundred hours a week. Total craziness. Somebody else was bringing up my children during the day, and I didn’t snag very much sleep. There is a price to pay.

SS:
The bill of goods was that baby formula was better than breast milk.

JT:
Yes, and in the 1970s, which was the peak, 85 percent of all babies in this country were fed formula. You start putting all these things together and you see a pattern forming, as T. S. Wiley did.

SS:
What’s the future for breast cancer?

JT:
Targeted therapy … better targeted therapy and prevention and patient education. More and more, I am finding that some of my patients who have been through the “standard of care” now want to be treated with bioidentical hormones. Some are like you, have evaluated the research and information and choose not to undergo the standard of care.

What’s important for me as an oncologist is the issue of choice. I offer all women the “standard of care,” which is surgery, lumpectomy or mastectomy, radiation, chemotherapy, and possibly hormone
blockade (like the aromatase inhibitors, tamoxifen, or raloxifene). With a lumpectomy plus or minus you might need radiation therapy to the chest; or if you have a lot of lymph nodes at the time of the section, we would also suggest radiation. Then it depends upon the tumor types and characteristics and how old the patient is. If she is premenopausal, the data shows us that chemotherapy is beneficial. If the tumor is estrogen receptor positive, then it’s tamoxifen or raloxifene for five years.

But we really don’t know much about it just yet. These drugs and this treatment could be curing breast cancer or just delaying it from coming back sooner.

SS:
What about someone like me who says no to most of the options of standard of care?

JT:
Well, these patients still need to be followed, but I offer it and say what is recommended. But if someone comes to me and says, “I don’t want to do that, I want to do something else,” or, “I want my hormones back,” I review the pros and cons of not having standard treatment as well as the risks and benefits of hormone replacement or the unknown risk of complementary options. Once a woman understands her informed choice, I do offer rhythmic hormonal cycling using mostly compounded bioidentical estradiol and progesterone. There are always some women who don’t want to do that much work to get it right. For doctors it’s really more work.

SS:
Yes, because prescribing hormones bioidentically is an art form, wouldn’t you agree?

JT:
Yes, because you are tailoring it to that particular woman. The physician has to be tuned in to … what this woman is going through every day. How is she sleeping? How is her libido? Her vaginal dryness? How many hot flashes? Is she having normal periods? It’s an art form trying to get this right. It also depends upon the pharmacy that makes the hormonal preparation, which can vary widely.

SS:
What’s your hunch? There’s standard of care. Then there’s the bioidentical approach.

JT:
Good question. I’m in this interesting position because I certainly have been trained to be a mainstream oncologist. And certainly I read all the data, and there’s tons of data that say that women given
tamoxifen after breast cancer have fewer breast cancer relapses. We consider them curable. I rarely use the word
cured
when it comes to breast cancer. The point I am trying to make is that there’s European data right now that followed premenopausal women who had breast cancer, and at twenty years they continue to relapse.

SS:
What do you think about Iscador as a cancer treatment? Iscador is an anthroposophic medicine. Not FDA approved, but legal in this country with a doctor’s prescription. I have been injecting Iscador for five years, and I’m still alive and well.

JT:
I have prescribed it to a few women because of you. There are some studies that show there is no major effect or harm. Yet there are a few promising published studies that also show an improvement in other areas such as relapse. It would be wonderful to have clinical trials studying Iscador. There is no real financial incentive to do studies on a natural substance or treatment that is not patentable. Western medicine has not looked at options like Iscador yet, but I bet it is coming.

Eli Lilly makes a chemotherapy used for several cancers called Gemzar, and I read that Gemzar has similar properties as those found in mistletoe, which of course is what Iscador is made from. So I found that interesting. But Gemzar does not work as an immune booster as Iscador apparently does. Gemzar becomes part of the cell’s DNA. So when the cells are going to replicate, they can’t.

I get frustrated because doctors don’t want to look anywhere else. My gynecologist found fibroids on my exam. She gave me the party line as the reason for them: “Because you take hormones,” she said. She informed me that it isn’t a matter of how much you take, it’s that uterine fibroids are stimulated by estrogen. I asked, “How could that be?” Young women in their twenties and thirties are flooded with estrogen, and they don’t get fibroids. Fibroids happen when you’re in your forties and perimenopausal, when your hormone levels are starting to fall. And, of course, we know that fibroids shrink after menopause.

SS:
I believe the problem is lawsuits. Doctors are afraid to prescribe outside the standard of care.

JT:
Yes, doctors are not encouraged to think anymore, and they
are too busy trying to make a living because of the way insurance works and reimbursements are handled. Quite a lot of the information we are fed comes from drug company–sponsored studies. There’s no time to sit there and do research on your own and come to your own conclusion if there are no studies available that address your questions. Also, I realize there’s a huge world of information we doctors don’t know about and for the most part are too busy to find out about.

SS:
Like Iscador.

JT:
Yes, and they don’t want to tear it down with poisonous chemicals that are supposed to help. We know that chemotherapy does this. As I told you, I can give a hundred women chemotherapy, and 20 percent at most are going to get the benefit. So as oncologists we know that eighty women out of a hundred get this toxic drug exposure for nothing.

If there was a guarantee … but there isn’t, so as an oncologist it’s heartbreaking. That’s why I’m more open to women making other informed choices.

SS:
As an oncologist … what do you dream about?

JT:
I hope in the future I will no longer have to poison people to treat cancer. My major job as an oncologist is giving and managing the effects of toxic drugs. We honestly believe we are helping people, and we do see results with these drugs, but in the future I hope there’s another way.

SS:
Thank you for your time … I hope your dreams come true.

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