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Estrogen After Hysterectomy Lowers Cancer Risk?

Experts Say the Decision to Use Hormone Replacement Is a Still Complicated One

Findings ‘Clearly Very Reassuring’ continued...

Women taking estrogen also had a 63% reduced risk of dying from breast cancer compared to women on the placebo. Overall, there were six deaths in the estrogen group compared to 16 in the placebo group.

In an email, Anthony Howell, MD, a professor of medical oncology at the University of Manchester in the U.K., says the study findings are “clearly very reassuring for women.”

“However, they have to be counselled concerning the very small increased risk of deep vein thrombosis [blood clot in a vein] and pulmonary embolism [blockage of blood to the lungs], which is seen with any hormones such as the oral contraceptive pill,” says Howell, who wrote a comment on the findings but was not involved in the research.

Breast Cancer Benefit May Not Apply to All

Several other important warnings also apply.

The first is that estrogen did not appear to help some women. Those were women at higher risk for breast cancer because they had a family history or history of having benign breast disease. Estrogen may even increase the risk of breast cancer in women who already have other risk factors.

“For women who are most in need of a breast cancer reduction strategy, this approach isn’t going to work,” says researcher Garnet L. Anderson, MD, principle investigator of the Women’s Health Initiative Clinical Coordinating Center in Seattle.

“These agents should not be used for breast cancer prevention, even though we clearly show a lower risk of breast cancer in these women taking hormones,” says Anderson, who is also a member of the Fred Hutchinson Cancer Research Center.

The second important consideration is that the study tested a kind of estrogen called conjugated equine estrogen, which is sold under the brand name Premarin. In recent years, that formulation has become less popular. More women have moved toward using estradiol, which is chemically closer to the body’s own estrogen. But researchers say they aren’t sure if the two kinds of estrogen work the same way.

“Conjugated equine estrogens are very complex pills,” Anderson says. “There are a lot of different estrogen compounds in them. We really don’t know what the active agents are. To make a leap to another form is really hard to say.”


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