New Breast Cancer Risk Found With Hormone Replacement Therapy
Lead author Catherine Schairer, PhD, an epidemiologist with the National
Cancer Institute, tells WebMD she does not support completely abandoning
long-term HRT based on her research. "I think one study is never
definitive. There need to be other studies confirming these results. On the
other hand, I feel reasonably confident of my results. I think a woman may
still consider the use of estrogen alone if she has a uterus. If a woman still
feels she wants HRT, she should be carefully monitored. She should at least get
what is recommended in terms mammograms and clinical exams."
While Walter Willett, MD, DrPH, and his colleagues at the department of
epidemiology and nutrition at the Harvard School of Public Health call
"strong" the "evidence that the addition of progestin to estrogen
increases the risk of breast cancer," they write in an accompanying
editorial that the cause-and-effect remains unproven. Still, they urge a
pointed review of the reasons why menopausal women would be placed on hormone
therapy, and they admonish clinicians and patients for overlooking lifestyle
Felicia Cosman, MD, urges a measured response to the research.
"I think it would be a mistake for women who are taking estrogen to stop
taking it based on this study," Cosman says. "Women should not
indiscriminately go on estrogen because they go through menopause. If they and
their doctors feel that the heart disease data and the osteoporosis data and
the preventive effects for Alzheimer's disease data are strong, and they have a
history of those diseases, then I think it is reasonable" to be on HRT
long-term. Cosman, who is clinical director for the National Osteoporosis
Foundation and an endocrinologist and director of osteoporosis programs at
Helen Hayes Hospital in New York, reviewed the study for WebMD.
"What I don't like, and I see this every day, is women who've been on
estrogen for years for no specific reason," Cosman says. "I ask them
why, and they say, 'I don't know, my doctor put me on it.' The conclusion is
that we all should have a reason for being on hormones. And if we take them, we
should be on the lowest possible dose of [progestin]."
Schairer and her colleagues stop short of offering guidelines for HRT use,
but Willett and his colleagues at Harvard attempt to sort out this
controversial and perplexing issue. They write that short term use to quell
menopausal symptoms, with a two to three-year course of treatment, "should
not be influenced by fear of cancer risks." Secondly, for women without a
uterus, the combination therapy is unwarranted anyway, because there is no need
for the progestin and its beneficial effects on the uterus.
But for the third group of menopausal women with a uterus, who comprise the
vast majority of HRT users, the questions of benefit vs. risk doesn't have such
tidy answers. "[R]educing the risks of fractures and heart disease will
rarely provide sufficient justification because avoidance of smoking,
performance of regular exercise, and consuming a good diet are effective
preventive measures," they write. They point out that there are many new
medications that can be used for heart disease and osteoporosis prevention that
were not available in the past.