Case Histories

Cancer and Genomics

A 50-year old Caucasian woman suffered from migraine headaches after a complete hysterectomy at age 35. To manage the acute and chronic aspects of her headaches, she was on four medications. Even though hormone replacement therapy (Premarin and Provera) proved ineffective as a migraine treatment due to serious side effects, bio-identical hormones were investigated as an alternative therapy.

Prior to taking the bio-identical hormones, a functional genomic test was recommended to identify any SNPs (single nucleotide polymorphisms) that might affect the detoxification and removal of estradiol and its metabolites, some of which are considered carcinogenic.

The results showed several genes affecting estrogen metabolism were either impaired to absent, which can result in an excess production of bad estrogen (4-OH estrone) and deficient production of good estrogen (2-OH estrone). This metabolic shift toward bad estrogen increases the probability of estrogen induced cancer and may explain the side effects she had to oral HRT.

Bio-identical hormones were administered (troches) and within three weeks the incidence and severity of her migraine headaches dramatically reduced to the point that she no longer needed her migraine medications. She also took several nutritional supplements known to affect estrogen metabolism with the goal to improving the relative production of good versus bad estrogens. An assay (urinary estrogen metabolite test) confirmed levels of both the good and bad estrogens to be within the acceptable reference ranges.

In conclusion, bio-identical hormones improved this woman’s quality of life, yet were balanced with specific nutrigenomic recommendations based on functional genomic testing.

References:

Endogenous Steroid Hormone Concentrations and Risk of Breast Cancer among Premenopausal Women.
Eliassen, AH.
Journal of the National Cancer Institute 98: 1406-1415 (2006)

Relative imbalances in estrogen metabolism and conjugation in breast tissue of women with carcinoma: potential biomarkers of susceptibility to cancer.
Rogan, EG. et al.
Carcinogenesis. 24: 697-702 (2003).

Pharmacogenetics of Breast Cancer: Towards the Individualization of Therapy
Chang JC, SG Hilsenbeck, SAW Fuqua
In Pharmacogenetics of Breast Cancer: Towards the Individualization of Therapy Edited by BL Jones Informa Healthcare New York p 1-9 (2008).

A comprehensive review of the safety and efficacy of bioidentical hormones for the management of menopause and related health risks.
Moskowitz, D.
Alternative Medicine Review 11: 208-223 (2006)

Chromosomal aberrations in humans induced by urban air pollution: influence of DNA repair and polymorphisms of glutathione S-transferase M1 and N-acetyltransferase 2.
Knudsen, LE, H Norppa, et al.
Cancer Epidemiology Biomarkers Preview 8: 303-310 (1999).