Webinars

Webinars

Questions and answers

• What do you explain to the patient when they ask for the BC risk if they want to start CHC as a contraceptive? To clarify my question: I’d like to know this for young women in the general population, who may have to use CHC for a long time (>10yrs). They usually express their concerns about the increased BC risk, but I find it difficult how to ‘reassure’ them.
  Thanks for the good question. You find the exact numbers for the risk increase on the ESC homepage TTT session breast cancer. I reassure and say that the impact is minimal especially if not using more than 10 years, Lifestyle smoling and having no children at all has a higher impact.
• Not a question, but a statement – as wonderful as a copper device contraceptive is, there are very few fertile women who do not suffer from dysmenorrhea, mennorrhagia, acne, PMS etc, and therefore a copper device would certainly not improve their QOL!
  Good statement, cu-IUP is good option for many, but not all women.
  
• In my country we can´t routinely do BRCA 1-2, which suggests with young women with mothers with breast cancer at an early age. Specifically, I am referring to the risk of ovarian cancer?
  Thanks! the recommendations are to screen the breast 5 years before the age of mother’s breast cancer by Mamogram (1 xray ) and MRI/year and for ovarian cancer recommend an oophorectomy at the age of 35-40 after the pregnancies. If possible see the patient every 6 months at the age of 20-25 depending of the family history.
• Is it necessary to test patients with BRCA1 and 2 before starting hormonal contraception?? In Italy we have a great problem with legal sequelael!!
  No definively not !!! Only to discuss if hte mother is positive
• Might there be a benefit of using the CHC in higher risk groups for a few years to reduce the risk of ovarian Cancer up to e.g. 10 years before the breast cancer diganosis of the mother, as this is often diagnosed at very late stages?
  Only in cases were risk-reduing mastectomy is not performed and recommended.
• What is the evidence that estrogens can exert non-receptor-mediated effects on tumour cells? What is the evidence that E- and P- tumor cells can be influenced by hormone therapy?
  Changes in RNA, seen in cellcultures.
• What would you prescribe for women with current or previous BC who present with AUB?
  Endoemtrial ablation
  
• Woman 55 after mastektomy for insitu cancer, Can she take MHT?
  No, try all the alternatives. In rare cases if life is impossible, MHT can be used but with a high risk of invasive BC
• No hx of breast cancer for genitourinary symptoms in the menopause?
  moistures, laser?? Studies on going on fat injections
• With BC with ER+ and PR+ What options do you know to decrease mortality?
  Adjuvant treatment by aromatase inhibitors or antiestrogens. Can help: lifestyle: exercicse, decrease alcohol intake, maintain normal BMI
• What to explain a 50 yr perimenopauzal woman, no history, about the risks of MHT use <5 yrs for: Breast cancer, VTE, CVD?
  BC is the only risk at long term. It is lower with mirconized progesterone or dydrogesterone. It depends on the baseline level of breast cancrer risk. If you use transdermal estrdaiol and micronized progesterone or dydrogesterone no risk of VTE. CV risk depends on her risk factors. If no risk, No risk during 10 years after menopause.
• What about Ospemifene?
  Ospemifene is a serm. Efficient on vaginal symptoms. But increase in VTE and probably stroke. Why used a systemic treatment when a toical treatment can be sufficient?
  
• What do you think about DHEA (vaginal or sistemic?)
  vaginal DHEA: recent treatment. Efficient on vaginal dryness. Less risk than with tomical estrogens??? Not demonstrated. Systeic DHA: difficult to monitore the elvels of estradiol and testosterone: DHA is a precursor which will be metabolized to androgens and possibly by aromatisation to estorgens. My experience: low efficacy or side effects. No safety data on endometrium and breast. The only validated indication is for patients wiht adrenal insufficiency.