Three’s a charm…breast cancer, lung cancer deaths and ovarian cancer
More news on the hormone therapy horizon. Not only has HRT been shown to increase breast cancer risk and death from lung cancer, but now researchers are reporting that it also increases the risk of ovarian cancer. Wow – three’s a charm, eh? And yet, many in the medical community continues to support its use in perimenopausal and menopausal women.
In this latest study, published in the Journal of the American Medical Association, researchers evaluate data from 909,946 Danish women between the ages of 50 and 79 who had not previously developed hormone sensitive cancer or had had hysterectomies.
Compared to women who never took hormones, current hormonal therapy users had 1.38 greater incidence of all types of ovarian cancers and and 1.44 greater incidence of cancer affecting the surface of the ovaries (i.e. epithelial ovarian cancers) regardless of type of hormone therapy, administration or duration of use. Notably, risk declined with years since stopping hormone therapy.
Ovarian cancer accounts for about 4% of all cancers in women in the US. Yet, it is one of the most lethal types and often symptomless in the early stages. Roughly half of the women it affects die within five years. In this study, hormone therapy increased the risk for developing ovarian cancer by 38%.
Like any, this study had limitations that might have affected the results, such as not adjusting for age during menopause, or use of birth control pills (which have been shown to reduce ovarian cancer risk). Still, it is one of the largest studies to date examining this issue and the results do not fare well for use of hormones during menopause.
If I seem a bit angry about this; I am. Repeatedly, data show that hormone replacement, albeit an effective solution for declining hormones and their effects, is dangerous. I wonder how many women need to get sick or die before someone takes notice and removes hormones from the market.
Read MoreNews Flash: Hot hot hot
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Think that hormone replacement therapy is going to get rid of those hot flashes forever? Think again. Indeed, researchers have discovered that the majority women who start hormone therapy because of hot flashes and then stop, may experience a recurrence of symptoms!
In this study, which appears in the Ahead of Print edition of Menopause, 1,733 women between the ages of 53 and 54 completed a validated questionnaire looking at menopause, hormone therapy and vasomotor symptoms. Among the women who submitted completed surveys (~73%), 242 had previously used hormones and 69% indicated that they had vasomotor symptoms before starting therapy. Regardless of how long hormone therapy was used, symptoms returned in 87% women who stopped, even if they had completed menopause (although hot flashes were reportedly less frequent and bothersome).
The bottom line: Research has shown that disease risks, e.g. breast cancer, increase when hormone therapy is used more than five years. So clearly, remaining on hormones to address returning symptoms is not a wise option. Rather, safer and equally effective alternatives are needed to address return of symptoms as well as aid in disease prevention.
Read MoreWednesday Bubble: Just say “no”
Gonna burst that hormone bubble at least one more time. Seems that the synthetic hormone Livial, which is billed as an alternative to HRT, significantly increases the risk of breast cancer recurrence. Ouch!
Livial is a selective tissue estrogenic regulator (SERM), which mimics estrogen’s activity with regards to strengthening bones. The agent has mostly been marketed in Europe for treatment of hot flashes, night sweats and bone loss, as well as a treatment for osteoporosis.
In a study reported in the current issue of The Lancet Oncology, researchers evaluated the effectiveness of 2.5 mg/day of Livial compared to placebo in more than 3,000 women with a history of breast cancer. Although the agent had a positive effect symptoms and bone density, the trial was stopped six months early because women taking Livial had a 40% increased risk of having their breast cancer return.
The researchers state that the likely reason for this increase is that Livial interferes with the protective effect of different cancer drugs and might stimulate dormant tumors to become active again.
Clearly, Livial should not be used in women with a history of breast cancer. Then again, with data definitively showing an increased risk of cancer and heart disease with use of hormone therapy, why take a chance to begin with?
What are your thoughts? Is estrogen worth the risk for a few less symptoms? Or are you better off taking an alternative route?
Read MoreTalking the talk: hormone therapy
Is your healthcare provider more or less likely to suggest hormone therapy (HT, estrogen only) when you see them for menopausal symptoms? What’s more, how do you know?
Results of a study in the Ahead of Print edition of the journal Menopause suggest that certain factors do influence prescriber habits.
Researchers measured how often 249 primary care (i.e. internists and family practitioners) and ob/gyns prescribed HT to their patients (ages 45 to 80) in a given year based on electronic pharmacy data. In addition to examining information on the providers themselves, data on perceptions of patients’ views on the Women’s Health Initiative trial results (WHI, which examined the link between HRT and heart disease), provider views on the WHI study and how prepared they felt to counsel patients were also analyzed. 57% of the providers in the study were women.
The findings? How often HT was prescribed appeared to vary by geographical location and the number of years a provider had been at a specific organization (which may reflect the age of the provider). More than half of those surveyed believed that they had expert knowledge about data coming out of recent HT trials.
In fact, primary care providers who felt that they had this degree of knowledge were significantly more likelier than their colleagues who did not to recommend hormone therapy. In contrast, ob/gyns who were more likely to prescibe HT were those who believed that they well prepared to counsel their female patients on hormone therapy. These practitioners also tended to believe that the results of the trials had been exaggerated.
Regardless of specialty, younger patients and patients who did not have other diseases that may exacerbate risk were most often prescribed HT.
So, what do these study results mean exactly?
The researchers write that HT prescribing may be “driven by factors outside of evidence-based medicine,” such as prescriber self-perception and age. If this is true, then the lack of provider bias could potentially influence prescribing habits and in turn, exposure to HT.
As the researchers say, “women, who when inquiring about HT risk and benefits, deserve unbiased and well informed counseling to make informed decisions.” And that it “is likely that some doctors need additional training to ensure this level of advice.”
For you, this means to be sure to be prepared when you make that first appointment to discuss therapeutic options for troublesome menopausal symptoms. Do the homework before you enter your provider’s office so that you are ready to ask the right questions.
In addition to the link provided above, which discusses the WHI data in detail, I encourage you to visit the following sites for unbiased information about menopause and its treatment:
The bottom line is that if your provider is talking the talk, be sure that you know why you’re going to walk the walk.
Read MoreBreast cancer risk and HRT – what matters most?
Data from the San Antonio Breast Cancer Symposium last month provided definitive evidence that HRT increases the risk of breast cancer by 26% in menopausal women. However, does route of administration (e.g., patch, oral) or type of HRT matter?
According to a study in the journal Breast Cancer Research and Treatment, route of administration does not matter. But the progestagen component does.
Data were extrapolated from 80,377 postmenopausal women living in France and participating in E3N (a study designed to investigate risk factors for cancer) between 1990 and 2002. At the study’s start, the average age of participants was 53 years. HRT types included estrogen only and estrogen plus progesterone, dydrogesterone combinations or other types of progesterone.
Over the study period 2,354 cases of invasive breast cancer occurred. Compared with women who never used HRT, women using estrogen alone had a 1.29-fold increased risk of developing breast cancer. However, breast cancer risk varied significantly depending upon the type of progestagen:
- Risk was significantly lower with estrogen-progestagen HRTS containing progesterone or dehydrogesterone than with estrogen combinations involving other types (e.g., nomegestrol acetate, norethisterone acetate, medroxyprogesterone acetate)
- The aformentioned combinations Ii.e. estrogen plus progesterone or dehydrogesterone) were associated with no or only a slight increase in breast cancer risk (1 fold greater or 1.16 fold greater, respectively).
- The results remained the same when analysis was restricted women whose age at the start of menopause could be most accurately determined.
Although the effect of progestagen remains somewhat unclear, and factors such as experimental conditions, length of time taking them and dose can influence results, the researchers did conclude that some HRT combinations may be safer than others.
Researchers also emphasize that further study is needed, and that medical experts are still unsure how HRT combinations affect other disease risks, such as heart disease, stroke and colorectal cancer.
Meanwhile, if you are taking HRT, talk to your health practitioner and find out which progestagen you’re taking. Better safe than sorry, right?!
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