A recent report raises concerns once again about the link between hormone replacement therapy and breast cancer. Our FOF experts weigh in.
Posted on October 26, 2010
Last week, the New York Times featured this headline on it’s front page: Breast Cancer Seen as Riskier With Hormone. The article, written by reporter Denise Grady, goes on to say:
Hormone treatment after menopause, already known to increase the risk of breast cancer, also makes it more likely that the cancer will be advanced and deadly, a study finds. Women who took hormones and developed breast cancer were more likely to have cancerous lymph nodes, a sign of more advanced disease, and were more likely to die from the disease than were breast cancer patients who had never taken hormones.
The new information comes from the continuing follow-ups with 12,788 women who were in the Women’s Health Initiative, a major federally financed study that compared women taking hormones with a group taking placebos. The study was halted in 2002, three years ahead of schedule, because researchers found that the hormones were causing small but significant increases in the risk of breast cancer, heart disease, strokes and blood clots in the lungs.
We’ve featured several stories on menopause and hormone therapy on Faboverfifty and we were alarmed to see this most recent report. Should we start telling women to throw their hormones down the toilet? We reached out to some of our favorite FOF health experts, many of whom have advocated hormone use in the past. Below, their reactions to the story:
Alan M. Altman MD, Perimenopause, post menopause, natural hormonal therapy and women's sexual function and dysfunction specialist.
“This is mostly already published data from 2004. The only change is a very small increase in mortality from breast cancer in the women taking Prempro. This increase amounts to ONE WOMAN per 10,000 women per year! There is minimal statistical significance to this and no clinical significance whatsoever, hence, too much is being made about such a minimal increase. Additionally, when you talk about the specific small increase in risk, you also have to talk about the potential benefits that may accrue while being exposed to the potential risk. These benefits have been previously reported in the Women’s Health Initiative (WHI) study http://www.nhlbi.nih.gov/whi/ as well as numerous other studies.
It's also important to remember that they only studied one estrogen product (oral Prempro) and only one dose for everyone. None of the other estrogen products were studied. Second, you can’t make a statement about what a woman should or shouldn't take by looking at a single study. You have to look at all the potential risks AND benefits. They need to be placed in the appropriate context. Remember, every study is a piece of a puzzle and sometimes it takes 50 pieces or more to complete this puzzle and obtain the truth. Unfortunately the media treats each puzzle piece as a completed puzzle and that confuses the public causing unnecessary hysteria and mass fear.”
"This is 'déjà vu' all over again. The WHI has presented a rehash of data on breast cancer first presented six years ago with a few small additions. There is no mention of the long term benefits of hormone therapy that help decrease the risk of death in order to balance these risks and put them in context. There is no mention of the WHI's own data showing decreased heart attack, osteoporotic fracture, diabetes and colon cancer in women who start the appropriate hormones at the appropriate time--within 10 years of their final menstrual period. The WHI researchers are once again overstating the risks and thereby frightening women into throwing their hormones down the toilet.”
"The study found the increased risk translates into 2.6 vs. 1.3 deaths from breast cancer each year for every 10,000 women taking hormones. There was no increase in breast cancer risk with estrogen alone (without progestin) among women with hysterectomy over an average of 7 years of randomized treatment. The current new lower doses of hormone and natural progesterone as opposed to synthetic progestin are not included in this study.
HT has always carried risk. Making the choice to use HT is very individualized. Bottom line: Anyone taking HT must consider their risk factors -- stroke, deep vein thrombosis, heart disease, breast cancer, uterine cancer, history of blood clotting.
The current HT recommendation is the lowest dose for the shortest amount of time taken around the time of menopause. We are all different. We must work closely with our healthcare providers to determine whether hormone therapy is an acceptable choice.
“This is not a huge increase in breast cancer. If you look at the data one way, you think, “oh my, it’s double the risk of beast cancer!” But if you look at the overall risk, it went from 1.9 to 2.9, an increase of just one woman out of every 10,000.
We do so many other things in our lives that put us at risk, you have to put it in perspective. It’s also worth noting that many of the women in that study started taking hormones in their 70s. It didn’t separate out women who are newly menopausal from women who were far from menopause. The typical woman who seeks hormonal treatment is within 10 years of menopause. Data from those women show a 30% decrease in mortality overall with the use of hormones.
The bottom line: You don’t have to panic. You need to go and have a talk with your physician or seek counsel from a menopause expert and find a plan that works for you.”