breast cancer

Wednesday Bubble: Holy Hot Flash Menopause Woman!

Posted by Liz on Feb 2, 2011 in breast cancer | 5 comments

Bet you never thought you’d hear holy and hot flash in the same sentence! However, it appears that menopausal hot flashes, those bothersome, sweat inducing, embarassment producing, change of clothing inducing symptoms might actually deliver something better than a whole lotta dread. And so, dear readers, after the bad breast cancer news that I delivered on Monday, I’m happy to report some good!

You mean I WANT hot flashes? Well not exactly. But there sure is a interesting paradigm hidden somewhere in the diminishing returns of estrogen, that is, severe, wake you in the middle of the night or interrupt your meeting hot flashes might actually reduce risk for invasive breast cancer.

As we know all too well, menopausal symptoms often occur as estrogen and progesterone levels fluctuate and the ovaries cease to function reproductively.  However, utilizing data culled from a study whose original intent was to evaluate the link between hormone therapy and risks of different types of breast cancer, researchers have actually uncovered some positivity! In this study, women between the ages of 50 and 74 were randomly selected based on confirmed invasive breast cancer and then matched by age to healthy women. All were interviewed about their reproductive history, menstruation/menopause history, use of hormones, BMI, medical history, family history of cancer and use of alcohol.  They were also asked specifically about their experience with menopausal symptoms, including hot flashes, night sweats, vaginal dryness, bladder issues, irregular menstruation, depression, anxiety, emotional distress and insomnia and requested to rate them based on their frequency and severity.

Interesting enough, women who reported menopausal symptoms had a 40% to 60% lower risk of the type of invasive breast cancer that starts in the milk ducts (i.e., invasive ductal carcinoma or IDC) and invasive breast cancer that starts in the glands at the end of the milk ducts (i.e. invasive lobular carcinoma or ILC). Moreover, reduced risk for these cancers as well as the mixed ductal/lobular type was especially pronounced among women who experienced hot flashes with perspiration or whose hot flashes woke them up compared to women who had hot flashes without perspiration or others symptoms with awakening during the night.

The researchers say that they believe that menopausal symptoms may be markers for hormonal changes that precipitate breast cancer. In other words, pronounced the changes in reproductive hormones may actually be related to breast cancer risk. Less clear are the direct connections between individual symptoms and risk. However, they noted that the relationship between symptoms and risk did not change when hormone use, age when menopause began or BMI were factored into the equation.

Clearly, this is only one study so no firm conclusions can be drawn, at least not yet. But with all the bad news about hormone therapy and breast cancer risk, it’s heartening to learn that the hormones that are wreaking havoc on our lives may actually be protecting us from harm.

Holy hot flash indeed!

Hormone replacement therapy…timing is everything, right?

Posted by Liz on Jan 31, 2011 in breast cancer, HRT | 5 comments

Hormone replacement therapy (HRT) continues to be a hot topic in the menopausal world. And no wonder! Because the deeper we dive into the controversies, the more information we seem to learn about its dangers.

If you search for hormone replacement or HRT on this blog, you’ll find that the dialogue has nothing but consistent. And while naysayers may try to accuse me of a personal vendetta against hormones, it’s actually not the case. I started Flashfree for several reasons, the most important being that I wanted to provide enough information about menopause and aging and treatment strategies to enable women to think on their feet, consider the facts and have intelligent dialogues with their peers and practitioners before making any decisions that could affect their health and wellbeing as they grow older. Moreover, although I am a strong proponent of alternative strategies to combat the unpleasantries of dwindling hormones, I still believe strongly in the benefits of certain Western approaches to treating illness. However, I also a strong believer in integrative strategies that combine the best of our knowledge in an individualized fashion; my mantra is ‘treat the individual, not the masses.’ Hence, when I read about the history of the menopause in general and HRT in particular, what I see is disease mongering at its finest, examples of fear and loathing and mostly, a disrespect of women. And I care too much about women’s health to remain silent.

Last Friday, several of my colleagues sent me a link to the following study:

“Breast cancer risk in relation to the interval between menopause and starting hormone therapy.”

This newly-published study in the Journal of the National Cancer Institute is one of the largest to date since the findings of the now infamous Women’s Health Initiative (WHI) study linking Preempro to breast cancer. In it, investigators used observational information culled from over a million postmenopausal women in the United Kingdom to determine how type and timing of hormone therapy might influence the risk of developing breast cancer.

A bit of context is necessary for those of you who are unfamiliar with the major criticisms of WHI, namely that that the women studied were not representative of the normal menopausal population, were older, started hormone therapy later in life (i.e. >5 years from when menopause started) when their risks for disease were greater, and that the type of hormone replacement, namely the progestin component, were not taken into consideration. WHI was also criticized for not focusing on the small percentage of women in the study who took estrogen-only and were not at greater risk for breast cancer. (If you want to read more about that particular issue, check out the write up on data presented at this past year’s San Antonio Breast Cancer Conference.)

In the UK study, the average age of participants was 56.6, considerably younger than the study population in WHI. More than half (55%) of participants reported having used hormones at some point and 35% were current users, and the rest, had never used hormone therapy. Study participants were matched by socioeconomic status, childbirth information, BMI, physical activity, alcohol consumption and smoking to insure that these factors did not influence the study findings.

Overall, 15,759 breast cancers developed and were diagnosed approximately a year and a half after the last point of contact:

• Despite contentions by some experts that starting combination hormonal therapy within 5 years of menopause is safe, women between the ages of 50 and 50 who began HRT less than 5 years after menopause had the highest rates per year of breast cancer — .61% per year — that twice that of women who had never used hormones (.31%).
• Current users of estrogen also demonstrated increased breast cancer rates (.43%) who started hormones within or less than 5 years after menopause started.
• The risk of developing breast cancer was roughly 1.5 times higher among women on combination hormone therapy who started within 5 years than women who started 5 year or more from menopause.
• The risk of developing breast cancer among past users of hormonal therapy tended to decline over time after use of hormones stopped, and within 14 years, were almost equivalent to never users.

Mind you, the study is not without fault and may be criticized on the basis of the fact that it relied on observational information rather than randomized controlled results. In other words, data were collected and then analyzed based on what they inferred.  The research might also be questioned due to the fact that information about use of hormones was reported over a year before cancer was diagnosed, thereby possibly leading to mischaracterization of hormone users/non users and estimates of the risk for developing breast cancer. Nevertheless, the researchers say that taking these factors into account, breast cancer risk among hormone users regardless of type, would have increased by a factor of at least 1.2.

The key take-away message from this new study is that it’s may be impossible to define the safest parameter for using hormone therapy. For certain women, HRT may never be safe. For others who are willing to risk life-threatening conditions for fewer hot flashes, HRT may be worth the gamble. As always, ask the hard questions.

Timing is everything, right? Maybe not when it comes to hormone replacement.

Estrogen only? Fanning the flames of the HRT debate

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

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.

HRT and breast cancer – more red flags

Posted by Liz on Oct 22, 2010 in breast cancer, HRT | 2 comments

More bad news from the Women’s Health Initiative study and hormone replacement therapy (HRT, combined estrogen and progestin) front: not only does combined HRT appear to double the risk for breast cancer in some women, but these cancers are more invasive/agressive and more likely to lead to death.

The WHI findings have been repeatedly criticized by HRT advocates, who claim that the the women who were studied were not representative of the typical menopausal population, e.g. they were older and well past menopause at enrollment. So it is true that the potential benefits of HRT that might have been experienced by younger women were not explored. Indeed, time on hormones and the relationship between hormone use and how far into menopause a woman is can influence risk, as can the progestagen component. (If you want to read more about these specific factors, click on the links.) Nevertheless, what is also clear is that following the 2002 findings and the significant decline in HRT prescriptions, a substantial decrease in breast cancer rates were observed in both the US and Canada, so much so that the Canadian Cancer Society recently recommended that HRT be taken only as a last resort.

And the latest study findings?

In their continuing quest to determine insights into the risk-benefit ratio of HRT, researchers continued to follow and evaluate data from 83% (12,788) original trial participants. They found that HRT increased the incidence of invasive breast cancers by as much as 8% (compared with placebo), and that these cancers were also likelier to spread to the lymph nodes (24% of women taking HRT were found to have lymph node tumors compared to 16% of women taking placebo). Moreover, twice as many women on HRT died as the result of their cancer.

In an accompanying editorial, Dr. Peter Bach, a health outcomes researcher from Sloan-Kettering Medical Center in New York City, suggests that the latest study findings may only be the tip of the iceberg and that “it is possible that the increase in breast cancer deaths due to hormone therapy has been underestimated in the current study and that with longer follow-up, the deleterious effect will appear larger.” Additionally, he notes that “available data dictate caution in the current approach to hormone therapy, particularly because one of the lessons from the WHI is that physicians are ill-equipped to anticipate the effects of hormone therapy on long-term health.” Nor, have short-term approaches to hormone therapy been proven in clinical trials. As Dr. Bach points out, how can practitioners help patients make informed decisions if they are ill-informed themselves and the information, “speculative.” Nevertheless, the North American Menopause Society is taking the opposite stance, stating that ” clinicians can help women put the breast cancer risk into perspective by informing them that the increased risk of breast cancer using estrogen plus progestogen for 5 years is very similar to the increased risk of breast cancer associated with having menopause 5 years later. This increased risk of breast cancer occurs with a woman’s own internal, natural estrogen and progesterone.”

If this study and its accompanying editorial don’t raise a few flags, nothing will. And despite the pro-HRT stance of the North American Menopause Society, I encourage all women to start educating themselves before making the HRT leap. What’s more, be aware that once you start taking hormones, your practitioner might not be able to provide evidenced-based information on how to stop them, should you decide that they are not for you.

Ask yourselves, what is the trade-off here?

(Reuters Health, as usual, has a few more gems from this study that are required reading. You can find them here.)

NewsFlash: Canadian Cancer Society Recommends Against HRT Use Except as Last Resort

Posted by Liz on Oct 1, 2010 in breast cancer, HRT | 2 comments

Researchers and representatives comprising the Canadian Cancer Society are recommending that women avoid taking hormone replacement therapy or HRT for any reason other than relief of severe menopausal symptoms that have not responded to other treatments. Wow! Talk about a newsflash!

The reason for last week’s statement is a new study published online in the Journal of the National Cancer Institute that demonstrates an almost 10% decline in the rate of breast cancer among Canadian women between the ages of 50 and 69 following a drop in HRT use.

Utilizing data on HRT prescriptions, incidence of breast cancer, mammography and HRT use in 1,200 women between the ages of 50 and 69, considered primary users of HRT, to a 9.6% decline in the incidence of breast cancer between the years 2002 and 2004. Comparatively, rates during the period of time just before the time studied, i.e. 1998 and 2001, had declined by less than 1%. Incidentally, the more than 50% drop in use of HRT during this time period directly followed reports from the Women’s Health Initiative Study showing a increased risk of stroke, heart attack and breast cancer among users of HRT. Moreover, researchers found that the decline in breast cancer cases were not the result of fewer women getting mammograms; in fact, mammography rates remained stable during this time period.

The researchers say that their results, which are the first in Canada to examine the potential link between widespread declines in HRT use and breast cancer among postmenopausal women, support the Society’s goal of providing Canadian women with information about how to reduce their risk of developing breast cancer. Although the study findings may possibly be limited by the fact that the rely on self-reports of use of HRT and do not take into consieration how often and for how long HRT was used,  the researchers claim that the results provide meaningful information on factors that influence breast cancer. Now, they need to determine if HRT promotes or causes breast cancer.

When I asked for a statement from lead study investigator Dr. Prithwish De, he said: “The Canadian Cancer Society’s ongoing review of the evidence on HRT and breast cancer since 2003 led us to our current position and the research study findings reaffirm this position. The Society recommends that women avoid taking HRT for any reason other than to relieve severe menopausal symptoms that have not responded to other treatment. We understand that each woman’s experience with menopause is unique. If, after consulting with their healthcare professional, a woman decides to take HRT, it should be the lowest effective dose for the shortest time possible.”

October is breast cancer awareness month. Educate yourselves and those around you.

Hormone therapy and bones – fuggedaboutit

Posted by Liz on Aug 16, 2010 in bone health, breast cancer, HRT | 1 comment

Another HRT-busting post…straight from the archives of  the Ahead-of-Print edition of Menopause. I’m afraid to say that yet, another analysis of the now infamous Women’s Health Initiative Trial, you know, the one that was halted due to links between HRT and significant increases in breast cancer, suggests that hormones might not be so great after all, especially when it comes to bone protection.

The loss of lean body mass as we age contributes to redistribution of fat and  apparently contributes to falls and fractures in the later years. This is one reason why many physicians prescribe hormones. However, in the latest nail in the HRT coffin, it appears that despite earlier reports of significant reductions in fractures among women taking HRT based on body mass index, age and bone mineral density, the ability of hormones to preserve lean body mass is a fallacy. In fact, when researchers looked at almost 2,000 women who had been enrolled in the trial who were assigned estrogen plus progestogen, estrogen alone or placebo, they were unable to find any differences in lean body mass after six years, even though there was some indication of protection at the three year mark. What’s more, the researchers say that although women who took most of their hormone medication before the trial was halted seemed to fall less, it wasn’t because their lean body mass was preserved.

The main point in relaying this bit of information is experts want us to believe that HRT is the panacea for everything that ails as women age –from bone health to heart disease to dementia. And despite evolving evidence to the contrary, they continue to seek reasons why the data are wrong and look for ways to question every negative finding. Some Associations whose mandate it is to defend women’s health, like the Society for Women’s Health Research, take money from companies whose hormone products have been found to cause significant adverse effects in certain populations of women and yet, they continue to lead the charge favoring hormone therapy.

In general, I take no issue with Western medicine or pharmaceutical companies. If you look at my background, I have spent years writing favorably about many products and the research that backs them. But I maintain a standard of transparency and don’t choose to hide who’s paying the bills, And, when it comes to hormone therapy, I continue to smell a rat. Be assured that  I will continue to write about what’s really going on until more women understand how fucked up HRT really is.

If you choose to take HRT and it works in alleviating your flashes, sweats, mood swings, headaches, sex life and the like, more power to you. I support your right and decision to take HRT. But like any drug, be sure you know the facts before you believe the hype. Be certain to be diligent and ask the hard questions, even when the information comes out of seemingly expert sources or associations. Always, always, follow the trail. You might be surprised at what you learn.

This particular trail, the lean body mass trail? It’s a dead end. Fuggedaboutit.

Next.