Researchers are once again pointing to strong evidence that the use of hormone replacement therapy, or HRT, to treat the symptoms of menopause may cause breast cancer. At the San Antonio Breast Cancer Symposium on Saturday, study authors presented their analysis of data from 15,387 women who participated in the Women's Health Iniative study of combination hormone therapy (estrogen plus progestin).
They reported that risk of breast cancer increased upon beginning use of the therapy and fell when women stopped taking the pills. At the highest risk point, women who were using the therapy had twice the breast cancer risk of a matched group of women who were not.
With this strong evidence in hand, the researchers concluded that women should be encouraged to use HRT "only if needed for menopausal symptoms, and for the shortest time possible." HEALTH BLOG Even women who took HRT for short periods of time were shown to have heightened breast cancer risk. Why, then, are these researchers and the federal government and doctors all over the US still pushing these pills at all?
In the first place, why are the normal changes that occur in women when they stop menstruating referred to as "symptoms," as though menopause were a disease? Could it possibly be a strategy to encourage women that something is going wrong in their bodies that needs medical attention?
Sure, there are discomforts associated with hormonal changes. Menstrual cramps can be debilitating too, but I doubt that anyone would advise their teenage daughters to take pills that might cause cancer in order to alleviate their pain.
Hot flashes are normal. Some women are impacted more than others -- but they are not the symptom of a disease state, and they will never kill anyone. Hormone replacement therapy might.
Women should educate themselves about menopause and ways to relieve associated discomforts without taking pills that could lead to life-threatening disease.
There are natural approaches that may be useful -- for example, plant-based estrogens and supplements such as black cohosh. In general, physicians and other health authorities are hesitant to recommend them, saying they're unproven and might entail health risks of their own.
Of course, there's little incentive to spend millions of dollars to research these cheap and widely available alternatives -- they offer no potential profits for pharmaceutical companies.
Women who are interested in pursuing alternative routes to relieving their menopausal discomforts should learn for themselves how diet, exercise and other lifestyle choices may help. They might also want to consult an alternative health practitioner about acupuncture treatments, herbal supplements or other natural therapies.
It's time to stop relying on the advice of mainstream medical professionals and government officials who cannot seem to divorce themselves from the interests of the big pharmas. Join the discussion! Send your comments to Daily News Central.
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COMMENTS From Khalid Mahmud, M.D.
As an oncologist well versed in the subject, I would like to emphasize that this is merely an extension of the 2002 WHI study of women receiving PrmPro, a combination of Premarin and Provera. These are drugs chemically different from the natural hormones that exist in a woman's body. All "experts" produced by the media who insist that these are the same things as natural hormones are dead wrong. There are multiple side effects of these drugs, particularly Provera, which have been well documented in the literature, and may lead to complications such as heart attack, stroke, other thromboembolic phenomenon and cancer.
On the contrary natural progesterone has been shown to have anti-breast cancer activity. One large study of French women published in 2005 [the International Journal of Cancer; 114:484-454], clearly demonstrated that women receiving Provera had a 40% increased in the risk of breast cancer, but those who received natural progesterone had a 10% decrease. Natural progesterone [identical to that in the human body] has been available for 60 years, but ignored by the U.S. medical community. Given the U.S. industry interest, it may take another 60 years before studies like this may appear in the U.S. In the mean time women should seek out healthcare professionals who have really studied and learned to use natural hormones in natural ways. From Elaine A:
About 15 years ago I read the Harvard Nurses Study which basically said that women taking hormone replacement therapy were at a higher risk of ovarian cancer.
I had spoken to four gynecologists prior to this about the hormones they prescribed for me, altho' I had NO symptoms going through menopause. Neither did my mother 93 and my grandmother passing at 85.
Every doctor I spoke to pressed me to continue with the HRT. I had taken them for six years and decided on my own to stop taking them. I am 73 and so glad I listened to my intuition! From J Atkinson:
Until, my doctor took me off, of H R T, because, of the risk of breast cancer, I had taken it for over twenty years, I was very upset when he took me off, because I felt wonderful the whole time I was on it, always well, full of energy and and full of the joys of spring, but since coming off of H R T I've aged very quickly, never been well , just have never felt the same. From Anonymous:
As a professional health care journalist who has researched breast cancer and hormone therapy quite extensively, I am amazed at the media's perennial failure to mention the role of bio-identical hormone therapy, or BHRT, as an effective means of preventing breast cancer and restoring women's health without the heinous side effects of HRT. Most searches, however, will reveal ominous reports to the contrary, obviously funded by pharmaceutical companies that stand to lose billions from the use of BHRT - as this article so accurately points out. Albeit true, the vague directive for women to "educate themselves about menopause" will only lead the majority to the Internet and women's magazines, all glutted with misinformation about breast cancer, BHRT and HRT, thanks to writers' relying on FDA, AMA, big pharma and similar sources for their research. Millions of baffled women paying outrageous health care premiums are desperately relying on this propaganda for the "education" they should be receiving from brainwashed doctors beholden to a system earning excessive profits from their patients' unnecessary pain, anguish and expense. Today's reporters and writers must read in between the lines to uncover the truth behind the "facts" and ask tougher questions of doctors and medical sources since we, not the high-priced physicians, are now responsible for this educational healing that the medical profession ought to provide. Perhaps it is the doctors who require the greatest education of all. From Mary, a woman interested in her own healthcare:
It's all about results based on use of combined estrogen-progestin in PEMPRO. PEMPRO. A single drug prescribed for this study and then these fear envoking generalities made for all women by the outcome of this single drug. It's another reason women must become better educated about our own health care. So women..do your research. Spend some time reading. One size in clothing does not fit us all; why should we expect only a single HRT to be available. Any why the fear of PEMPRO or nothing. I'm sorry but if it was Cialis or nothing the Viagra people would be screaming. In fact, if it were a matter of I'm sorry all you ED gentlemen...but "hey, it's natural so get used to it...or chew on this plant leaf, you'll feel better" There should have had comparison research (to natural estradiol and natural progesterone) done years ago. Is there a fear of class-action suits from this? If only this one drug was used in this study and it was found that all these women got cancer and then when it was halted the rate of cancer dropped off...wow. I'm surprised that hasn't come up. From Efthimia T. Leonardi, PhD:
Why are docs prescribing HRT? Because the "natural remedies" don't work for many people. Further, teh WHI was a deeply flawed study. Most women in the study were well into their 60s and 70s and were prescribed HRT later in life, not during the onset of menopausal symptoms. Please go and read the baseline characteristics of the patients in the original study population. They were old and thus already at increased risk From Jane:
I took HRT for 5 years and got breast cancer. My physician only stopped the prescription after I called her & told her of my diagnosis.
It is 14 years since I had mastectomy, radiation, chemo, and tamoxifin and I still do not know whether the cancer will return. From Carl Grey:
Why do so many people equate all estrogens as bad for women?
The WHI used Premarin, made from Horse Urine and Prempro-Horse Urine plus a progestin that the rest of the world has rejected as fairly dangerous.
Other estrogens, i.e., transdermals are made from soy.
Does it take a government study to see that their might be a difference between urine from an animal or a plant based drug?
When you lump all estrogen as bad becausae of the WHI, you benefit Wyeth because they can use that in the law suits against Premarin and say that they did not know that all estrogen was a causative factor?
I am not an attorney, but women need estrogen for way more than hot flashes, but certainly not for life. Read up on estrogen and why the rest of the world uses estrogen but not like the US.
The scientists and physicians that developed and prescribed Premarin in the 60's-90's were 90% men.
Is there a connection there that women should consider before throwing out all estrogen vs the drug made by the Fen-Phen company?
Let's consider some facts here:
1. The majority of the women in the WHI study were obese.
2. The majority of those women were smokers.
3. The estrogen drug in the study was made from Horse Urine.
4. The other drug, Prempro, is rarely used in any other country than the US, but sold by Wyeth in the US.
5. Many European studies (much larger in size), using a plant based estrogen, have not produced the same negative results as the WHI.
6. U.S. Dr's have ignored the studies in Europe for years and continued to prescribe oral horse urine vs. the safer soy based products ands the male OBGYN's are just now starting to try them, and only because they are fearful they are now going to be sued.
7. Women need estrogen for much more than hot flashes- i.e., brain function, tissue strength, memory, heart function, etc.
8. Women may need estrogen supplements for a few years, possibly 2-5 years. What women don't need is a drug derived from horse urine, made from the same company that pushed Fen-Phen when they knew it's dangers. Why do women want estrogen prescribed by a male OBGYN who doesn't know anything about women's bodies, but believes that the answer to women's health is to surgically remove any problem they have?
The best thing for women's health is coming, and it's the fact that the majority of new OBGYN Med school grads are female. From Dr. Craig Chandler, Board Certified Obstetrics and Gynecology
I only send a comment because your article starts with "News You Can Trust". Unfortunately you are not supplying news just rhetoric and down right lies. The WHI study is very flawed, and does not take into account the age of the patients in the study. Vitamin and alternative pill manufactures make millions on there stuff and they are held to no standard at all. Drug manufactures are highly regulated. Herbal supplements have been studied, and the lack of quality is down right amazing. The variation in what the product contains from manufactures is astounding and the difference in one pill to the next is even more disturbing. If you want plant estrogens all of the western drugs are made from plant estrogen except for Premarin which is made from horses. If you want plant estrogens at the dose provided by the health food store I suggest going to you doctor and getting a sample, crush it into hundreds of small pieces and take a piece a day. You will be getting the same amount of estrogen as with a supplement and not making either company rich.
Birth control pills, as you suggest causing cancer have been proven over and over in large controlled studies NOT to cause breast cancer and actually reduce the incidence of ovarian and uterine cancer by many fold, so yes I would suggest taking hormones to control mensural symptoms ( I am an expert).
On the last note I do think you got some things right. You should take a little medicine as possible for every ailment. Don't take HRT unless you have significant symptoms. You should be cautious of herbals and megadoses of vitamins, because they are more dangerous than most people think. Ephedrine is my favorite example, hundreds of teens died taking this herbal remedy before the government made it illegal. Exercise and a healthy lifestyle are good for all stages of life. Hope this helps. Almost everyone providing medical services does so to help their patients. Making the profession into a bunch of greedy idiots just makes you look illegitimate and biased. Doctors are not allowed to profit from prescribing certain medications, so why would we be so interested in making drug companies millions?
All this is falling on deaf ears I am sure, at least until YOU get sick. If someone you love does gets breast cancer, if detected early the cure rates are very good. Despite your harsh words I am sure hundreds of health care professionals will come to your aid and do the very best to extend you life on this earth. From JE, medical student
Kathy,
So that you are aware, it is certainly taught in medical school that we listen to our patients and that we be open and enougaging toward effective alternative therapies. I for one have frequently and positively counseled patients on alternative therapies and their risks and benefits. This is not however what the crux of my response pointed to and I am sorry that you missed the point of my posting. While an examination of alternative medical treatments for perimenopause is useful and may definitely be effective for some women, I was disappointed that Ms. Jenkins did not divulge ALL of the findings of the Women's Health Initiative (WHI) -- the study that she cites and utilizes as the basis for her argument. Rather, Ms Jenkins presented an incomplete picture of the WHI findings, out of context and omitting important corollary findings. Such reporting does a disservice to readers who may be less informed that yourself and may take what Ms. Jenkins reports at face value without knowing all of the facts (see my previous posting). The fact of the matter is that hormone replacement therapy (HRT) is not as clear-cut an issue as Ms. Jenkins would lead her readers to believe. Moreover, while your personal experiences are definitely noteworthy, they are the experiences of one woman. Alternative therapies are great for many patients, but they are NOT without their own significant risks and side-effects (they are not FDA regulated so none of this infomation appears on the packaging). The efficacy and side effects of any therapy, whether "alternative" or "mainstream" should be rigerously tested before its results are presented to the public in their ENTIRTY. From Pat S:
I have been on HRT for 14 years. I am on as low a dose transdermal patch as possible to just prevent symptoms. I also take a natural progesterone capsule and testosterone as needed for libido. The problem I have when my estrogen level becomes too low is severe palpitations. I tried to go without the estradiol and the palpitations became so bad I felt ill from them. As soon as I brought the level back up to my normal dosage, the palpitations stopped. I am sure most women do not have this problem but for me I feel it is a toss-up between the heart problem and breast cancer. Should I quit using the HRT and take heart medication? Who knows. In addition to that problem, also without the HRT, my eyes and skin become drier than they are now, I have headaches, hot flashes and I don't sleep well. I am sure there are others like me, albeit they are probably few and far between. From Kathy Chiavola:
This article is right on. At age 56, last summer, I experienced terrible hot flashes, sleepless nights, rapid pulse, emotional swings, etc. I researched non prescription options and began taking black cohosh, dong quai, chia seed, borage seed oil and cod liver oil tabs every day. After three days of that regimen I noticed improvement and after five days, nary a "symptom". I've been "symptom" free for five months, even after discontinuing the cohosh and dong quai.
My doctor was very interested in what worked for me and encouraged me to keep it up. Too bad they don't teach this in medical school. From Larry Francis, Bartlesville, OK:
Evidently, you haven't heard that reduced stress will relieve tension headaches, but we take medications for that. Exercise and a proper diet can keep your arteries clear, but we are encouraged to take statins. The problem with hot flashes and other "symptons" of menoopause is that they can be extremely uncomftable and the women experiencing some of the worst will do most anything to be rid of them.
Maybe an alternative medication can be developed so that you don't have to use HRT. But telling women to use natural approaches while she is living is a 300F oven is probably not any more realistic than telling our teen generation to exercise and eat proper diet to get rid of obesity. From JE, medical student:
I am not sure what Ms. Jenkins credentials are, I doubt however that she is a physician.
The Women's Health Initiative and other studies have in fact only demonstrated an increased risk of breast cancer in women taking Hormone Replacement Therapy (HRT) when it is taken for 5 or more years. Accordingly, gynecologists are advised by the American College of Obstetricians and Gynecologists (ACOG) to prescribe the lowest effective dose for the shortest period of time necessary -- but less than 5 years -- to relieve symptoms of perimenopause (specifically, vasoreactive symptoms and urogenital atrophy). These same studies that Ms. Jenkins cites show that the increased risk of breast cancer with HRT is actually reversed after HRT is discontinued. I would advise Ms. Jenkins to do all of her homework before providing her readers with incomplete information. Read up on ACOG's recommendations and read the entire study that you cite and you will see that HRT, though it may have some drawbacks, is a viable and often advisable therapy -- even for our own daughters.