Wednesday Bubble: Playing Russian Roulette – Hormone Replacement & Ovarian Cancer
Do we really need to burst another hormone therapy bubble? Or have you heard enough yet? If you are anything like me, I remain puzzled by those in the pro-HRT camp that keep on insisting that the data are incorrect and that hormone replacement therapy (HRT) is safe. Just last week I received a press release stating the following:
“Medical Experts Report Reduced Risk of Life-Threatening Diseases in Women Who Undergo Menopause Hormone Therapy…Menopause experts Drs. Lovera W. Miller and David C. Miller, claim in their new book, Womenopause: Stop Pausing and Start Living (O Books 2010), that Menopausal Hormone Therapy, or MHT, can help reduce the risk of serious health conditions such as heart disease, stroke, breast cancer, diabetes, and even depression and dementia. The Millers present new evidence that puts to rest the controversial statement by the Women’s Health Initiative (WHI) in 2002 that declared MHT (formerly known as Hormone Replacement Therapy, or HRT) was harmful and could lead to the same health risks that the doctors say it now helps prevent.”
The Miller present new evidence that puts to rest the contention that HRT is harmful. Really?!
Ironically, the very same day, I received word of data presented at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference this week demonstrating that both combination hormone replacement therapy (estrogen plus progestin) and estrogen-only hormone therapy increases the risk for developing ovarian cancer. Previous studies have linked the use of estrogen only hormone therapy to ovarian cancer so these findings are important.
This latest bit of information comes out of a European study of almost 127,000 women, 424 of whom developed ovarian cancer after 9 years of followup. Among current users of hormones during the start of the study, 69% used combination HRT and 18%, estrogen-only hormone therapy. Key findings included:
- Increasing duration of use of any hormones was linked to an increased risk for ovarian cancer; women who used hormone therapy for 5 years or more had a 45% increased risk compared to women who had never used any hormones.
- Current use of any types of hormones was associated with an overall 29% increased risk for ovarian cancer.
- Type of hormone (combination versus estrogen only, regimens, how administered, as well as body-mass-index, smoking, oral contraceptive use and pregnancy history did not significantly affect risk.
In an accompanying news release, the lead investigator is quoted as suggesting that the link to ovarian cancer is consistent with recommendations that if women are going to choose to take hormones, that they take them for the shortest period of time possible.
This study joins the evolving database of evidence demonstrating that hormone replacement therapy, whether it’s combination estrogen/progestin or estrogen-only, can be a risky proposition in certain women. Want to read more trigger pulling data?
- HRT & Breast Cancer… more and even more and don’t forget
- HRT & Death from Lung Cancer… and more
- HRT & Heart Disease… and more
I don’t know about you but this woman is staying clear of HRT, hot flashes or not.
Read MoreNewsFlash: Canadian Cancer Society Recommends Against HRT Use Except as Last Resort
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.
Wednesday Bubble: The HRT patch – is it safer?
Remember the diva and the doctor sitting on the roof espousing the benefits of the HRT patch? Well, it turns out that some of these patches might not be so safe after all. Results of a study of over 75,000 women published in the British Medical Journal, show that the use of high-dose transdermal (through the skin) HRT patches increases stroke risk by as much as 88%.
Granted, transdermal or through the skin delivery bypasses the liver, which typically makes patches safer than their oral counterparts. However, if the drug isn’t safe, well, then the patch might not be either.
In this latest bit of news, researchers evaluated women between the ages of 50 and 79 who had participated in the ongoing Study of Women Across the Nation (SWAN). Every woman who had had a stroke were matched for comparison to four women in the study, with similar characteristics, who had not. The women were further divided into groups based on their use and type (i.e. oral or patch) of HRT, including estrogen only, estrogen plus progestogen, progestogen only, and the estrogen alternative, tibolone (which is not available in the US).
The researchers say previous and recent studies suggest that oral HRT, including estrogen only or estrogen plus progestogen, is associated with a 30% increased risk of stroke. However, stroke risk differs between high- and low-dose patches. Overall, they report that:
- Low-dose patches do not appear to increase stroke risk, at least in the short-term (they say that they cannot rule out an increased risk with long-term use)
- High-dose patches, regardless of whether or not they are estrogen only or estrogen plus progestogen, appear to increase stroke risk by anywhere from 25% to 88%
- Risk was the highest among women who had used oral HRT before trying transdermal HRT, although this risk appeared to decline the longer the time period between stopping oral and starting the patch
- Findings remained even after adjustments were made for factors that might influence results, including age
What the findings mean
Despite claims to the contrary, it does not appear that HRT offers much protection against heart disease during and after menopause. What’s more, the HRT patch may not actually be safer than oral HRT, at least in so far as the high-dose HRT patch goes. Although the researchers state that they were unable to distinguish between types of stroke when evaluating the SWAN study data, they say that these data show the need to look further into how HRT is delivered, especially as use of the HRT patch becomes the norm.
As I’ve written previously, if your doctor suggests you try HRT for menopausal symptoms, it behooves you to ask the hard questions. While you may save your sleep, mood and a few articles of clothing, you may be placing yourself at a higher risk for cancer, heart disease and other serious conditions.
Read MoreWednesday Bubble: Nuts!
Last month my friend Mollie Katzen spoke to me about the importance of incorporating more good fats into your diet, including nuts. Well, it turns out that nuts are a lot better for you than many of us realize, especially those of you who are thinner and have higher LDL-cholesterol levels (the “bad” cholesterol that can build up in the arteries and form fatty deposits known as plaque). In fact, results of an extensive analysis of 25 studies shows that individuals who are thinner and have higher initial cholesterol levels and who eat about 2.4 ounces or (~2 servings) of nuts (e.g.almonds, cashews, peanuts, pecans, pine nuts, pistachio nuts, macademia nuts, hazelnuts or walnuts) daily can significantly lower their cholesterol over time.
In this analysis, which was published in the Archives of Internal Medicine this week, researchers examined data collecte4d from 583 men and women with either normal or high cholesterol levels and whose body-mass indices ranged from 17 to 49. The findings showed that compared to nutless diets, nut diets reduced total cholesterol by as much as 5% and LDL by as much as 7%. People with high triglyceride levels experienced declines by as much as 21%. Although different types of nuts had similar effects on blood fats, the most dramatic effects were seen among people who were thinner, ate more Western-type diets (i.e. higher in saturated fats) had higher LDL cholesterol levels.
What this implies is that nuts can help lower blood fat and cholesterol levels and in turn, help prevent heart disease. Although the studies included in the analysis did not last longer than 8 weeks, the researchers did note that the benefits of eating nuts can be expected at least in the short-term. For menopausal women in particular, this is fantastic news, not only because nuts are an excellent protein and energy source, but because the transition is associated with a dramatic increase in cholesterol and turn, heart disease.
The bottom line? Don’t go nuts….but start getting those nuts into your diet!
Read MoreWednesday Bubble: the soy controversy
Do they or don’t they?
Soy isoflavones have been touted as beneficial in everything from improving body composition and lowering breast and colorectal cancer, to addressing menopausal hot flashes and moods. You can read about some of these findings on Flashfree. This week, Reuters Health reported that eating foods rich in soy protein (i.e. 25 grams of soy protein and 60 mg isoflavones) daily did not provide favorable responses from blood fats, implying that soy has little benefit in terms of lowering cholesterol levels and in turn, promoting heart health.
Are you confused yet?
Increasingly, women are turning to soy and other compounds as alternatives to estrogen and hormone replacement therapy, which mounting evidence shows can be associated with a broad range of risks including increased breast, lung and ovarian cancer to heart disease. And yet, findings from clinical trials examining soy are often contradictory, making it difficult to come to any firm conclusion about its benefits.
What’s the problem? Well, researchers say that part of the problem is poorly designed studies, small number of study participants, wide range of ages and years from menopause, studies that don’t examine the pros and cons of an agent or strategy for a long enough period of time (i.e. longer than a year). In other cases (as I’ve argued previously), the study design does not account for certain factors that are critical to a therapeutic strategy, for example, the opportunity to clearly focus an intervention so that individual factors are accounted for (this was borne out by findings from a trial that examined and provided evidence for the role of acupuncture in easing hot flashes).
There’s good news though! Researchers finally appear to be getting their act together on the soy fron. They’ve announced that they are conducting a well-designed, large trial of soy phytoestrogens. Called SPARE (Soy Phytoestrogens as Replacement Estrogen), this new study will be looking at the effects of 200 mg soy versus sugar tablet daily — namely on bone health and symptoms — in 248 menopausal women over a two- year period. They will also be taking daily calcium carbonate plus vitamin D (in ranges of 500 mg to 1000 mg calcium and 200 to 400 IU vitamin D, depending on previous intake).
The study is specifically geared towards looking at spine bone density, but will also be looking at hip density, thyroid levels, menopausal symptoms, mood changes, depression, and quality of life, as well as any changes in blood fats. Study participants are between the ages of 45 and 60 and are within five years from menopause. What’s more, the researchers have also included a large percentage of hispanic women, which allows them to focus on how soy affects this minority group (Notably, the large multiethnic population of women in this study includes Asians, Blacks and Caucasians.)
The researchers say that they hope that the results of SPARE will provide a range of information that is especially relevant to Boomers reaching menopause. They also note that the dose of soy isoflavones being studied is much larger than what’s been studied in previously and are roughly twice that typically consumed in the Asian diet.
I realize that this post is pretty scientific. But what makes it most relevant is that it appears that researchers are finally starting to design studies that might actually show benefit of some of the alternative strategies we have available to us on the market. For those of you who insist on calling these alternatives “snake oil,” all I can say is ‘stay tuned.’
This bubble might finally be shattered; perhaps all that is needed is a better understanding of what it needs to test these substances appropriately.
Read MoreArchives
Tags
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.