History
The 63 y/o woman had no personal history of cancer, but multiple blood-related family members had cancers of breast and other tissues. She had been on BiEst prior to the specimen collection.

Description of Results
Her estrogen metabolic markers showed a low rate of 2-hydroxylation relative to the rate of 16-hydroxylation. Note that the homone metabolite concentrations are well above the range for post-menopausal women w/o HRT, showing the effect of hormone replacement. This illustrates how HRT can affect cancer risk through the heightened production of pro-carcinogenic 16-hydroxyestradiol. The problem is inadequate stimulation of hepatic P4501A1 hydroxylating enzymes that function to clear estradiol and estrone as the 2-hydroxy derivatives.

Recommendations
Start 300mg/d diindolylmethane (DIM) or indole-3-carbinol (I3C) and retest at 3 mo. Encourage daily use of brassica vegetables, and add 1 tbsp ground flax seed daily. Inclusion of moderate amounts of soy products (not isolated soy protein) can help. Investigate status of omega-3 fatty acids and antioxidants and add as indicated.

Other Comments
The ideal in disease prevention is to identify modifiable causative factors. This case illustrates the use of laboratory evaluation for cancer prevention before any clinical evidence is present.