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    Hormone Replacement Therapy: What Now?

    A Precarious Position

    Unfortunately, a new study published last week in the January 26 issue of the Journal of the American Medical Association has found that estrogen/progestin therapy comes with a price of its own: It increases the risk of breast cancer. Following more than 46,000 women over 15 years, National Cancer Institute researchers found that women who took the hormone combination were 20% more likely to develop breast cancer than women on estrogen therapy alone, and 40% more likely than women taking no hormones at all. The longer a woman took hormones, the greater the chance of breast cancer. While this study is not the first to find that the combination therapy increases breast cancer risk, it's by far the largest. And experts are taking the results very seriously.

    So what's a woman to do? Is it time to toss progestin altogether?

    That would be unreasonable, said Meir Stampfer, MD, professor of epidemiology and nutrition at the Harvard School of Public Health, and co-author of an editorial accompanying the study. He points out that progestin was added to the mix for very good reasons; without it, breast cancer risk would lessen, but the risk of uterine cancer would rise.

    A Very Personal Decision

    Instead, experts say, the new finding makes it more crucial than ever for women to look closely at their own family history, lifestyle, risk of particular diseases -- and deepest fears -- when making the hormone decision. Depending on how those factors stack up, women might come to very different decisions about hormone therapy -- all of them acceptable.

    If a woman's primary goal is to relieve menopausal symptoms, for instance, researchers say she shouldn't feel concerned about taking the combo for a few years. "I feel very comfortable saying that fear of breast cancer should not discourage women from using drugs in the short term if they have severe menopausal symptoms," said Catherine Schairer, PhD, an epidemiologist at the National Cancer Institute and lead author of the study. "Any increase in risk would be slight."

    Long-term use, though, is more problematic. If a woman's main concern is to stave off heart disease or osteoporosis, she may be able to get most of the benefits while minimizing risk by delaying the start of HRT until close to age 60, when the likelihood of those ailments climbs more steeply, says Laura Esserman, MD, director of the University of California, San Francisco/Mount Zion Breast Care Center.

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