Test for estrogen receptors if you DON'T have breast cancer?

June 11, 2024 3:05 AM

I went to a psychiatrist because, after a hysterectomy and removal of ovaries, I have a lot of possibly hormone-related symptoms (hot flashes, irritability, anxiety) and he suggested I go to a gynecologist and get an estrogen patch prescribed. But

I told him I am afraid of going on hormone replacement therapy because I am afraid of breast cancer (Note: I am in my early 70's and was quite surprised when removal of ovaries resulted in these symptoms. I didn't know I had been producing this much estrogen for this "new menopause" to be happening. Apparently I was wrong).

He said that I could be tested for estrogen receptors and, if I am estrogen-negative, then adding estrogen is not going to pose a breast cancer risk (for estrogen-driven cancer (obviously)). So I made an appointment with a (new) gynecologist (my old one retired) to get this alleged test.

But now I"m Googling tests for estrogen receptors, expecting to find something about a blood test, and all that's coming up is testing actual breast CANCER tissue to see if it's estrogen receptor positive or negative! I am coming up with NOTHING else. And now, thinking about it, it seems ABSURD that there would be a blood test for estrogen receptors. Is this true? What IS true?

Is my psychiatrist an IDIOT?

posted by anonymous to Health & Fitness (7 answers total)

I wouldn't go to a gynecologist for psych advice or to a psychologist for gyn advice, you know? His advice to go to a gynecologist was probably good.
posted by trig at 3:11 AM on June 11 [10 favorites]

I think something has got lost in the communication. There’s no blood test you can do that quantifies whether if you got cancer it would be estrogen receptor positive.


Incidentally, the breast cancer risk from modern menopause hormone therapy is probably less than the risk of having a few glasses of wine every week. This may make you more comfortable with HRT or less comfortable with alcohol.
posted by chiquitita at 3:14 AM on June 11 [10 favorites]

A good gyno can talk through multiple options for treating your symptoms, and the relative breast cancer risks of each.
posted by Ausamor at 6:14 AM on June 11 [2 favorites]

I wouldn’t say your psychiatrist is an idiot, but I would say, like trig, that they were talking outside their area of expertise and may very well not have known as much as they thought they knew about this.

Seconding, though, that it’s probably a good idea to consult a gynecologist. I hope they’re able to help with your symptoms because getting new symptoms after you’ve been without them for a long time sounds very unpleasant. Speaking as a person who has been happily menopausal for a number of years.
posted by Well I never at 7:27 AM on June 11

Your psychiatrist may have confused the testing he recommended with other testing that in fact can be done proactively when deciding about HRT risks. Because of my risk factors (breast cancer history in my family and Ashkenazi Jewish heritage), genetic testing was recommended for me before going on HRT. It looked at a panel of a few dozen genes related to cancer risk. Afterwards, I could start HRT knowing I personally don't have especially elevated cancer risk -- but of course the regular level of risk associated with it does still apply.
posted by daisyace at 7:45 AM on June 11 [3 favorites]

We all have estrogen receptors throughout our bodies (female, male, everyone) and estrogen works by binding to those. HRT works this way, too. If the receptors were absent, the synthetic estrogen in HRT would not have anything to bind to.

When we talk about estrogen receptor positive breast cancer, that means the tumor cells are driven by estrogen and will die without it - normal cells won't die without it. As far as I know, there isn't a test that guarantees a person is immune from developing ER+ breast cancer.
posted by Knowyournuts at 7:55 AM on June 11 [2 favorites]

The reason the websites you are seeing are talking only about cancer is because some people’s cancers include specific mutations that let the tumor grow more when exposed to estrogen. The cancer’s DNA is different from the person’s DNA, because it includes mutations, and the specific nature of these mutations will determine whether estrogen is dangerous. So you can’t just test your own DNA, before you get cancer, to look for estrogen receptors; you definitely -have- estrogen receptors, as noted above, but it’s only the mutations which would lead to cancer that would make them dangerous.

However, there are certain genetic variants which make you much more likely to develop cancer (possibly of the estrogen-receptive-positive type, that I don’t know.) These you absolutely can test for, as others have mentioned above.
posted by wyzewoman at 8:05 AM on June 11 [3 favorites]