Approximately 14,000 fewer women developed this disease in 2003, as compared to previous projections, said doctors from the University of Texas M.D. Anderson Cancer Center. "It's better than a cure," because these are cases that never occurred, said Dr. Rowan Chlebowski of Harbor-UCLA Medical Center in Los Angeles. This news was presented at the annual San Antonio Breast Cancer Symposium by researchers from M.D. Anderson Cancer Center, National Cancer Institute and Harbor UCLA Medical Center.
Background:A report published in the Journal of the American Medical Association by the Women's Health Initiative (WHI) in 2002 showed that use of HRT caused heart problems, and might cause breast cancer, while providing better bone health and lower rates of colon cancer. Use of estrogen plus progestin HRT fell from 22 million prescriptions each quarter down to 12.7 million in the last quarter of 2003.
HRT has been given to women who experience menopausal symptoms of hot flashes, night sweats, mood swings, vaginal dryness and a range of other conditions. HRT can be given as a pill or cream, and can be a combination of estrogen plus progestin, or it can be estrogen alone. Prempro, a combination of estrogen and progestin was the form of estrogen therapy cited in the WHI report.
The use of HRT has become controversial since the publication of the WHI report, and women who are menopausal are urged to discuss its use with their doctors. Experts are now working on the safest dosage and duration of HRT use. The American Cancer Society says of HRT: "If you need it, take the lowest dose possible for the shortest time possible."
The Women's Health Initiative was a very large study that examined the role of treatment and the effects of HRT in post-menopausal women. Data was taken from MEDLINE (1966-2001), HealthSTAR (1975-2001), Cochrane Library databases, and the Heart and Estrogen/progestin Replacement Study (HERS).
More Studies Confirm the Results:Other research agrees with the report presented in San Antonio. Researchers at Northern California Cancer Center and Kaiser Permanente's Division of Research also found that in California, where the use of HRT was greater than in other U.S. states, new cases of breast cancer declined in 2003 after the 2002 WHI data was published. "Hormone therapy use dropped 68 percent between 2001 and 2003, and shortly thereafter we saw breast cancer rates drop by 10 to 11 percent. This drop was sustained in 2004, which tells us that the decline wasn't just a fluke," said Dr. Christina A. Clarke, the Northern California Cancer Center scientist who led the study.
The American Cancer Society did their own study of the data and came to the same conclusions. ACS chief medical officer Dr. Len Lichtenfeld says, "The decline in hormone use may have slowed the growth of cancers that already were in development. But there could be other explanations for the lower breast cancer rate, too. This could be due to lifestyle changes or some other unknown factor, but when you consider that this country doesn't appear to be getting healthier, that raises the concern that there may have been some other explanation for that decrease. Examples could be fewer mammograms in general, and in particular for the increasing number of uninsured or underinsured women, or perhaps because of decreased access to mammogram facilities."
How Does This Affect You?If you are currently taking HRT, you should discuss this news with your doctor. A lower dose, given over no more than five years may not be harmful. But natural remedies may be preferable, since those generally carry less risk of breast cancer.
Since the greatest drop in cases was for estrogen-receptor positive tumors, if that type of breast cancer is present in your family history, you may want to consider not taking any HRT. Estrogen provides fuel to those types of tumors, encouraging the growth of the cancer cells. Depriving the tumors of estrogen may cause the cancer to regress or to stop cell growth.
If you are over 40 and have never taken HRT, the ACS still recommends having an annual mammogram and clinical breast exam, in addition to doing your monthly breast self-exam. Keeping an eye on your breast health is always a good investment in a healthy future.
American Cancer Society. "Breast Cancer Cases Drop" News. Last revised date: 2006/12/14. American Cancer Society. Breast Cancer Cases Drop
San Antonio Breast Cancer Symposium. "Decline in Breast Cancer Diagnoses Follows Decline in Hormone Therapy Use, Recent Data Confirms " SABCS News. Last revised date: 2006/12/14. SABCS News. Decline in Breast Cancer Diagnoses Follows Decline in Hormone Therapy Use, Recent Data Confirms
IMS Health Services (data on HRT sales) IMS Health Services
JAMA. Postmenopausal Hormone Replacement Therapy. Last revised date: 2002/08. Heidi D. Nelson, MD, MPH; Linda L. Humphrey, MD, MPH; Peggy Nygren, MA; Steven M. Teutsch, MD, MPH; Janet D. Allan, PhD, RN JAMA. 2002;288:872-881. Postmenopausal Hormone Replacement Therapy.