222. Estrogen Matters with Dr. Avrum Bluming

Estrogen Matters with Dr. Avrum Bluming
Avrum Bluming received his MD from the Columbia College of
Physicians and Surgeons. He spent four years as a senior investigator for the National Cancer Institute.
He organized the first study of lumpectomy for the treatment
of breast cancer in Southern California in 1978, and for more than two decades he has been studying the benefits and risks of hormone replacement therapy administered to women with a history of breast cancer. Dr. Bluming has served as a clinical professor of medicine at USC and  is the co-author of “Estrogen Matters: why taking hormones in menopause can improve women’s wellbeing and lengthen their lives – without raising the risk of breast cancer” with Dr. Carol Tavris.
 
Hear his story about how he became the advocate for hormones and hormones after breast cancer.
 
So many people think correlation = causation – case with E and breast cancer – just poor
education in our population?
 
“we don’t know what causes breast cancer” – can people handle a grey world?
 
Estrogen receptor positive doesn’t mean estrogen caused the cancer – discuss
 
Dispel the myth that early puberty and late menopause is a breast cancer risk – dogma – “lifetime exposure” – but women with lots of pregnancies have lower risk.
 
Should we just work on a re-brand? Go on HRT because if you do get breast cancer you will do better than if you weren’t on it?
 
How do aromatase inhibitors work? People call them “estrogen blockers” so people think estrogen causes cancer and recurrence. 
Why only in post-menopausal women?
 
What’s with adipose tissue? People always say it is because adipose tissue increases estrogen – is it estrone ?? Or inflammation?
 
Doctors don’t want to be sued. Do you know of any doctor getting sued for giving hormones in general or after breast cancer?
 
If estrogen is FDA approved for prevention of osteoporosis – why did the USPSTF say no to prevention and why are we screening for osteoporosis so late (age 65?)
 
Do you agree with the USPSTF about no for prevention.
Your opinion of Progestin causing Breast cancer"
Is the placebo arm bad? 
Is the risk not actually that high – from 2-4%
Is it the synthetic progestin?
 Everyone’s talking about dementia now – Dr. Bluming’s take
 There are 25 studies showing E is safe after breast cancer  and 20 review studies– and the HABITS trial is the only one that shows local recurrence and is flawed – how many studies are enough?
 
Advice for younger physicians who care about this work?
 
Do you think the world is just crazy? How does Dr. Bluming cope?
 
We discuss the new Danish study in the British Medical Journal and dissect the data to dispel the fear.
 
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