Breast Cancer Risk Factors to Look For on the DUTCH Test

Estrogen Excess and “Estrogen Dominance” 

The DUTCH Test measures nine estrogen related markers: estrone (E1), estradiol (E2), estriol (E3), five Phase I estrogen metabolites (2-OH-E1, 2-OH-E2, 4-OH-E1, 4-OH-E2, 16-OH-E1) and one Phase II estrogen metabolite (2-methoxy-E1). If any of these markers are elevated, it may be a sign of estrogen excess.  

Elevated Androgens

The DUTCH Test measures seven androgen related markers: testosterone, 5a-DHT, 5a-androstanediol, 5b-androstanediol, DHEA-S, etiocholanolone and androsterone. The marker 5a-DHT is the active form of testosterone, however urinary 5a-androstanediol may be a better indicator of androgen activity in the tissues than urinary 5a-DHT. The DUTCH Test measures both markers. 

Poor Phase I and Phase II Estrogen Detoxitication 

It turns out that how one metabolizes their estrogen is extremely important when it comes to breast cancer risk. The DUTCH Test measures five Phase I metabolites (2-OH-E1, 2-OH-E2, 4-OH-E1, 4-OH-E2 and 16-OH-E2). Individuals with elevated 2-OH and 4-OH metabolites may have an increased risk for breast cancer. This is because these estrogen catechols can become reactive quinones that cause DNA damage directly in the breast tissue. The 4-OH catechols tend to cause more DNA damage than the 2-OH catechols, however. The metabolite 16-OH-E1 is thought to have proliferative effects on estrogen receptors and thus 16-OH-E1 may cause an ER+ breast cancer to grow more quickly. For more information check out Dr. Kelly Ruef’s DUTCH case study “Elevated 4OH & Breast Cancer Risk”. 

The DUTCH Test also measures one Phase II metabolite, 2-methoxy-E1. We can compare the ratio between 2-methoxy-E1 and 2-OH-E1 to get an idea of methylation activity. Low methylation activity may cause the 2-OH and 4-OH estrogen catechols to build up in Phase I, thus increasing risk for reactive quinone formation and DNA damage. For more information regarding additional workup when low methylation activity is found on the DUTCH Test, check out Dr. Kelly Ruef’s DUTCH case study “Explaining Methylation on the DUTCH Test”.

Flat Cortisol Slope and/or High Nighttime Cortisol Levels 

Women with metastatic breast cancer who also have a flattened cortisol slope may experience earlier mortality. The DUTCH Test measures free cortisol and cortisone throughout the day and thus enables one to identify if there is a flat curve, or if the nighttime cortisol is elevated. 

Low Melatonin 

One study showed that as urinary melatonin went down, risk for breast cancer went up. This may be because melatonin is a powerful antioxidant and is important for sleep/wake cycles. 

Low or High Pyroglutamate 

Pyroglutamate is a glutathione marker. Glutathione plays an important role in cancer prevention by quenching the downstream reactive quinones of 4-OH and 2-OH estrogen catechols that contribute to DNA damage in breast tissue. 

High 8OHdG 

8OHdG elevates when there is significant DNA damage due to oxidative stress. It can be elevated in cancers, but also in other situations that involve elevated inflammation levels. 

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