Estrogen only? Fanning the flames of the HRT debate

Posted by on Dec 13, 2010 in breast cancer | 6 comments

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A study presented at the esteemed San Antonio Breast Cancer Symposium last week has fanned the flames about the benefits versus risks of hormone replacement for menopausal symptoms. In this study, which ironically was pulled from the site press release highlights after experts questioned its merit, researchers did a reanalysis of data from the Women’s Health Initiative trial, the infamous 2002 study that was halted after Preempro was shown to increase breast cancer risk. Their findings? That women who had participated in the estrogen only arm of the study, had had benign breast disease, had had hysterectomies and had family histories of no breast cancer actually had significant reductions in breast cancer incidence. What’s more, 75% of women who did not have benign breast disease at the study’s start also had a reduced risk of developing breast cancer.

So, this is good news, right?

Well, estrogen alone can only be used by women who have had hysterectomies; estrogen plus progestin is used in women with intact uteri in order to avoid uterine cancer. This means that only a subset of women with menopausal symptoms are eligible to use estrogen alone. Moreover, as a physician blogger points out, the findings run counter to most data that show that estrogen use is actually associated with an increased risk of breast cancer. He also notes that abstracts that are accepted as posters at major medical meetings often have flawed or spotty data; in fact, in my years as a medical writer, I’ve often run across abstracts that ultimately disagree with published works.

The bottom line here is that despite the news, using estrogen alone to treat menopausal symptoms might only be an option for a very small percentage of women and may still place them at risk for cancer. At the end of the day, prescribing hormone replacement therapy continues to challenge the Hippocratic Oath: first do no harm.

6 Comments

  1. 12-13-2010
    Womens Voices says:

    Great post! The study was one that really needed to be broken down – it’s important to remember that Estrogen alone can be given only to patients who have had the uterus surgically removed, since it is well known that without a progestin, estrogen promotes endometrial cancer.

    Dr. Pat Allen breaks it down here (http://womensvoicesforchange.org/estrogen-therapy-revisited-does-it-decrease-breast-cancer.htm) and concludes that it really needs further evaluation.

    Reply
    • 12-13-2010
      Liz says:

      Thank you! After reading the headlines, it became apparent that these results could be quite confusing to many women. Thanks also for your post!

      Reply
  2. 12-13-2010
    Jody Schoger says:

    Liz,
    Thanks so much for this post. I was completely taken aback but the release of this study, not only because headlines are counterintuitive to what we know, but due to the fact that the finding actually applies to so very few women.

    The difficulty lies when findings that really need further study are right up there in the headlines with those that ARE.

    The bottom line – anything that alters hormone balance and its complex, intricate machinery – is going to carry a risk cloud. No easy way around that ever.

    Again, thanks for taking the time to wade through the information.

    Jody

    Reply
    • 12-13-2010
      Liz says:

      Sure thing Jody. I wasn’t going to write about this but had a bit of inspiration! 😉

      Reply
  3. 4-26-2011
    Laura Lourde says:

    I was greatly interested in these posts and if anyone out there has any information for HRT for someone with a clotting issue I would greatly appreciate it.

    Thanks for posting!
    Laura

    Reply

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