Bea wrote: <<<<  I had
no idea we still produce estrogen after menopause.  Is this the estrogen
which comes from our adrenal glands or some place like that?  >>

Hi Bea, I don't know or can't recall the answers to all of your questions, but
my understanding is that the adrenal glands can turn aromatase into estrogen.
(I think that's the way it works).  Estrogen can also come from body fat as
well.  However, once the ovaries stop producing estrogen, one is considered
menopausal.
Bea, the difficulties you report when talking to your oncologist are not
uncommon.  Treatment of cancer is NOT an exact science, unfortunately.  In
addition new information and new recommendations are coming out all the time.
I was quite naive when I was dx'd.  As far as breast cancer is concerned I
thought one either had it or didn't.  I had no idea there were different kinds,
let alone so many variations amongst each.  I had no clue what ER +/- meant.  I
didn't even know the signifiicance of positive nodes (which was probably a good
thing or I might have been quite depressed--my pathology report was 'bad'
news--and not done as much as I did from the start (which may have given me  a
more positive edge).
I have spent much of the past 33 months learning as much as I could about
breast cancer and its treatment.  I receive my primary treatment through a
non-profit HMO.  Although I know I could get an outside second opinion at their
expense we have done it on our own.  It has not been easy but it became a
priority for us.
One thing I've learned is that by increasing my knowledge about what breast
cancer is about--and so much still is not known--in fact more may not be known
than is known--I have been able to make better informed decisions.  It is very
difficult and feels very insecure when one is asked to make major life
decisions regarding treatment when you have no knowledge or understanding about
what is going on.  Knowledge IS power.  At the same time, most oncologists
treat different types of cancer patients.  New research is being published
regularly in all areas of cancer.  I subscribe to one web site which lists the
journals accepted for publication each week on breast cancer alone.  The
numbers range from about 50 to 100 new articles each week--again for breast
cancer only.  I have no idea how many articles come out re. other cancers.  It
is almost impossible for an oncologist to keep up to date on everything--there
is no time to do that and treat patients, unless of courxe, they have NO life
outside of their profession (and event then it is not possible).  There is just
too much.
In addition, publication of most recent research findings has resulted in
recommendation changes regarding treatment.  Previously, Tamoxifen was the
first choice of hormonal treatment recommended for ER+ women who did not have
metastatic disease.  That recommendation has somewhat changed.  In addition,
not all ER+ women respond the same to any given treatment.
Cancer is not like a routine bacterial infection--where one gets a standard
treatment which usually 'cures' what is going on at that time.  A cancer cell
is a mutated cell.  It responds somewhat like a fetus in the way our body
learns to tolerate it.  Chemo is given with the intention of eliminating it or
them.  Sometimes that works completely.  Other times it works partially or not
at all.  There is no way to tell.  In addition, the cancer cells within us may
continue to mutate.  What works on some may not work on all.  What worked
previously may not work in the future.
Cancer is now being looked at a disease which may not have a cure but CAN be
managed long-term (such as diabetes).   HOpefully, someday there WILL be a cure
but they (researchers) are not there yet.

That question has puzzled me, too.  The therapies work in controlled
trials, but the theory confuses me thoroughly.  As a physician, I'm
supposed to understand it, which makes my incomprehension somewhat
domoralizing.

Arimidex stops all estrogen production, ie ovaries, adrenals, fat.
Tamoxifen is nowdays given to premenopausal women and only blocks
ovarian estrogen production.
Post menopausal just means non longer having a menstrual cycle, ie the
ovaries are no longer active. This can happen naturally somewhere
between 45-55 years of age or suddenly at any age, eg after chemo.

Tam is good stuff but Arimidex even better, esp if you're not sure of
your menopausal state.

Yes, unless you're on HRT!

Bea,

I've been post-menopausal for about 14 yrs or so, and it's my
understanding that the body still has some estrogen, but not from the
ovaries. Also, I believe that the amount of fat one has contributes to
the level of estrogen. But mainly, I wanted to agree with you about
oncologists and the lack of real information that they seem to relate to
their patients. The onc I'm going to now is 72 yrs. old and is very well
thought of for his clinical abilities, but he is definitely from the era
when the doctor gave the orders and the patient obeyed without question.
He offers no information, seems to ignore or brush off quetions, and
basically tells me nothing. If I hadn't gone around getting copies of
the reports of my tests/scans in Sept. I would not have even known that
I had pleural effusion and partial collaspe of my lung. He made no
mention of it. I consequentially got better and he listens to my lungs
and say they sound clear. It was also found at that time, that I had a
blood disorder which needed treatment before anything else.

I'm not one that wants a lot of pills or less-than-necessary treatments,
but I certainly would like some informative conversation about a
life-threatening disease. But, Noooooo, I learn most everything from
internet support groups and some very knowledgable people who have life
experiences. But I guess this is a different topic than your original
question. Still, it triggered my "hot" button.

I should also say that I've come to have great respect for the thoughts
and practical knowledge that many people outside the medical profession
share. By now I listen to docs with a somewhat skepical ear.

Kathie

This is unquestionably true

You are not ER+. it is your cancer which is ER+

They don't.  They say both happen at the same time, not that one causes the
other.

The risk of cancer increases with age in a complicated but progressive
manner.  I think the main increase in bc risk comes slightly before the
menopause on average.  I do not understand why this happens, and I am not
sure if anyone does.  We also find that cancers grow slower in older women,
and the mechanism below goes towards explaining that.

Once you have got bc, for whatever reason, there is a fair chance that the
cancer cells' DNA will be altered in such a way that it produces a lot more
estrogen receptors than it should (and so is ER+).  To become a malignant
one of the things it has to do is bypass the normal controls on growth, and
this is one way it can achieve that.  By having excess receptors it can be
stimulated into abnormal growth by normal levels of extrogen.

The estrogen does not cause the cancer, it enables it to grow.  So, for
these cancers, removing the estrogen slows or halts the growth of the
cancer.

The adrenal gland produces androgens which are converted to estrogen by the
enzyme aromatase at various sites around the body.  This process continues
after the menopause.

I believe there is s blood test to determine unconditionally whether or not
you are post menopausal, without reference to periods.  I seem to recall it
measures follicle stimulating hormone, but I don't know much about it.

Maybe he hadn't checked your menopausal state and doesn't want to explain
his earlier thoughts.  I wouldn't worry too much about this, Arimidex sounds
like a good place to start if you are confident that you are post-menopause.

I might worry that there was something else he might have missed.  It
doesn't exactly inspire confidence if he can't explain his reasoning.

Tim