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I had to call a patient and tell her she had breast cancer. She came to my office having found a quarter-size lump a few weeks ago. It didn’t change with her cycle, it didn’t hurt, it was squishy and it was mobile. As she is peri-menopausal, her primary care doctor put her on an estrogen/progestin (fake progesterone) combination and she reported being off and on it for the last 10 years.
I asked her if she knew the risks involved with doing estrogen and progestin and that she may have to stop it depending on the results. She was shocked. She had no idea the risks involved – as far as she was concerned it helped her mood, eliminated the hot flashes and let her sleep soundly. I asked her if she had ever had her hormones tested. She had not. I asked her if she was aware of all the press hormones were receiving on Oprah and Dr. Phil – she did not own a TV right now.
Normally I wouldn’t tell a patient over the phone however due to her living/driving situation she requested a phone call and I obliged. She was very stoic about the results, half expecting them because of how concerned the imaging center appeared while going over the lump several times and asking her to come back for additional images and a biopsy.
At then end of our conversation I said, “And I’m going to have to ask you to stop your hormones.”
“Really?” she replied.
“Yes, unfortunately estrogen and progestin can make breast cancers grow and I don’t want yours growing at all right now.”
“What if I can’t sleep? What if the hot flashes come back? What do I do then?” she asked.
I started to answer, “Well….” But she cut me off.
“It’s okay, Dr. Jones, I think I have other things to be more concerned with than a few hot flashes. And I don’t think I’m going to sleep tonight regardless.”
I thought about our conversation a lot over the week and talked with several colleagues who work with breast cancer patients much more than I do. We all had roughly the same thought process – educate our patients to make informed decisions. I am a huge believer in education and even though hormones are all over the web and on TV, this particular patient did not have the financial means to see it online or on Oprah.
Did the hormones cause her cancer? Who knows for certain? She hadn’t had a mammogram for almost 10 years – only coming in because of the lump which can take years to grow into a palpable size. She didn’t have any of the commonly held risk factors other than being a woman, which is the number one risk factor for breast cancer. All I know is that she is going to be properly educated about her health from now on!
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