HRT and cancer risk

Breast cancer and HRT news clip from January 2008. Bottom line: Women on HRT (combined estrogen/prog) are 300X more likely to develop cancer in the breast lobes (a more rare variety that develops deeper within the breast).

Will Women Give Hormone Maker a Second Chance?

"Can Wyeth win back the 40 million Premarin and Prempro users it's lost since 2002 -- along with $1 billion a year in profits -- with a new menopause drug? Or will the once-bitten women who have filed more than 5,000 lawsuits claiming the hormones gave them cancer feel fooled twice?" asks Martha Rosenberg at AlterNet.org, in this look at Wyeth's hope of marketing Pristiq as the first nonhormonal treatment for menopause symptoms. Basically, instead of synthetic hormones, now they're pushing anti-depressants as the ultimate cure for hot flashes.

File this one under, "If at first you don't succeed, try, try again".

Older Women Less Likely to Use HRT

Older Women Less Likely to Use HRT

According to a recent study by the Canadian Institute for Health Information, fewer older women in Canada are using hormone-replacement therapies (HRT) to treat symptoms of menopause, turning instead to natural remedies. As reported in the Vancouver Sun and other media outlets, researchers have found that only five per cent of women in five provinces who are 65 years and older use hormone-replacement therapies -- a drop from 14 per cent six years ago (when a report found the risks of using the menopause therapies outweigh the benefits).

From the Vancouver Sun piece, here's some HRT background and the specific stats contained in the study:

The first reports that estrogen-only hormone-replacement treatment could put women at higher risk of endometrial cancer began to emerge in the 1970s, leading to the development of combination therapies containing both progestin and estrogen hormones. Later studies, such as the 2002 Women's Health Initiative study, then uncovered important additional risks with the combination therapy, such as higher chances of developing coronary heart disease and stroke.

In Alberta, Saskatchewan, Manitoba, New Brunswick and Nova Scotia, the use of hormone-replacement therapies declined each year between 2001-2002 and 2006-2007. The highest average annual rate of decline, 30 per cent, occurred in the two-year period after the publication of the Women's Health Initiative.

My gut reaction to this news? Bravo to those women reviewing the evidence, making choices, and following their own path healthy aging, despite attempts by the pharmaceutical industry to have them fall in lock-step with the drumbeat of HRT. In increasing numbers, we are awakening.

One note: The article indicates that many of the women declining HRT turn to natural methods of menopausal symptom relief instead. I would love to see some follow-up as to what these natural methods are -- and what are the results? Are most, all, some of the women taking BHRT (bioidenticals) or something else?

For those new to this topic of "HRT: good or bad?", here are some links to a few older posts written by Sue that go into this topic -- as well as some sites I've found helpful in my own quest for hormonal balance...

From My Menopause Blog
Breast Cancer and HRT: As HRT use falls, so do breast cancer rates.
Review of The New Menopause Book: Sue points out this book -- written by someone trained in both Eastern and Western medicine -- as a good starting point for women who want to understand the complexities of HRT research. I agree- it's a great book!

My own recommendation:
Womentowomen.com: Comprehensive women's health site for natural approaches to menopausal support. Two must-read articles, especially for those just beginning to consider the possibilities, include Perspectives on HRT Risk and Test Your Menopause I.Q.

Should women really “have no fears” about using HRT?

Wendy at Menopause - the Blog posted a great summary of what went down at the recent Global Summit on Women's Health. As you've probably already read or heard in the news, attendees at the health conference deemed HRT to be safe for perimenopausal women. But, as Wendy so astutely points out, the Global Summit meeting of experts was held “with the assistance of unrestricted educational grants” received from three pharmaceutical companies that manufacture and market hormones; Wyeth, Bayer-Schering and Novo Nordisk Femcare.

Says Wendy, "This diminishes, in my view, the value and integrity of the panel’s recommendations and they unfortunately missed an opportunity to move the HRT debate forward despite the research, analysis and debate that took place."

Visit Menopause the Blog for the entire entry and to leave your comments to Wendy's provocative questions about the relationship between pharmaceutical sponsorship and medical integrity. It's an important point to ponder.

HRT and Stroke Risk

Another new HRT study -- this one finds middle-aged women who take hormone replacement therapy to ease menopausal symptoms increase their risk of stroke.

Here's the scoop... According to researchers at Harvard Medical School, the overall risk of stroke is low for women in their early 50s just entering menopause and the heightened risk may be minimal if they follow recommendations to take lower doses of the hormones for the shortest possible time.

Using data from 121,700 female nurses participating in the Nurses' Health Study, which began in 1976, researchers found women taking estrogen had a 39 percent increased risk of stroke compared to women who did not take the hormone.

Here's more from the Reuters article:

Women taking an estrogen-progestin combination to protect against ovarian cancer had a 27 percent higher risk of stroke.

There were 360 strokes among women who did not take hormone therapy and 414 strokes among those who did.

The percentage increase in stroke risk was similar for women regardless of whether they were in their early 50s and newly menopausal, or older. But because the starting point for stroke risk among the younger women was lower -- 3.8 strokes per 10,000 women per year -- the percentage increase represented fewer additional cases of stroke.

"It added to up to two more cases of stroke per 10,000 women per year taking hormone therapy," Dr. JoAnn Manson of Harvard Medical School, who worked on the study, said in a telephone interview.

The numbers referenced in this study might not be a clincher for anti-HRT folks (or pro-HRT depending on how you break it down), but once again I'm left wondering what kind of diet/exercise regime the women not taking HRT followed. I know the nurses' study is a following study -- researchers check in with the women from time to time, but I'm not sure if a specific diet is prescribed for all participants to follow. It seems like no small thing to control the study for dietary intake.

Here's the study I would like to see... women who choose to take HRT vs. women who follow a holistic program of dietary change/exercise/nutritional supplementation (a la the WomentoWomen.com program). Let's see how these populations match in terms of stroke risk, cancer rates, etc. and then maybe some important decisions about HRT and its effectiveness/risk will be revealed once and for all.

Breast Cancer a Black and White Issue?

I read an article today that related the news that breast cancer rates among white women have dropped considerably since 2002 (the year news broke linking HRT with breast cancer and heart disease). While this is good news overall and definitely further evidence for why NOT to treat menopausal symptoms with HRT, women in other ethnic groups looked at in this study have not seen the same dramatic lowering of breast cancer rates. This is especially true among African American women.

Though the researchers did not theorize why African American and women of other minority groups have not experienced the same drop in rates as white women, I'm wondering if socioeconomics could be a co-factor in all this. If looked at according to income level and quality of life, would poor/low-income women -- regardless of race and ethnicity -- have the same drop in breast cancer rates as those women in higher socioeconomic groups? I'll have to dig a little further into this, but according to what I read, the study was NOT controlled for socioeconomic status. According to this article, poor white women have the same or higher rates of cancer when compared to minority women.

Access to quality healthcare is one of the leading reasons for the disparity of cancer among women of varying socioeconomic levels, but the more reading I do about environmental impact on personal health (especially breast tissue health), the more I believe that there is a strong link between cancer and exposure to environmental toxins and pollution. Women in inner city settings and unsafe jobs (especially large scale agricultural work and industrial jobs) are especially at risk to come in contact with harmful chemicals (though dangerous toxins even lurk in everyday objects like water bottles). For women, it is especially important to be aware of "endocrine disruptors", chemical ingredients and pollutants that can mimic estrogen in the body and impede the work of the body's endocrine system. Here's a link to an eye-opening article about this topic that's worth reading.

WSJ Health Mailbox -- HRT

The Wall Street Journal's Health Mailbox includes a Q and A about HRT. The WSJ take is that it's all about timing -- starting HRT during perimenopause or early menopause poses fewer risks according to their interpretations of health studies. It's an informative read but the answer doesn't step out of the "HRT: good or bad?" box to examine non-pharmaceutical methods of hormonal balance. See womentowomen.com for a holistic take on relieving menopause symptoms.

Here's the questions that was posed and a link to the WSJ:

Q: Your article on estrogen and memory loss states that there are many unanswered questions about hormone replacement. Presumably one of the biggest is what are the risks of staying on HRT indefinitely.

I'm one of those women who tried to get off estrogen following the Women's Health Initiative Memory Study in 2004. I found myself very disoriented. I quickly went back to hormone replacement and the symptoms disappeared.

I started HRT when I was 46 years old. I'm now 61 and my doctor wants me to stop because she says the risk of breast cancer, heart attacks and strokes increase substantially for women taking HRT after age 60. If a woman started HRT during menopause or peri-menopause, how long it is safe to stay on?

HRT and Cadiovascular Health

Researchers continue to push for ways to legitimize the use of HRT. Here's information about a new study about HRT and its use to improve cardiovascular health in menopausal women. In Researchers hypothesize that if synthetic HRT is started earlier (before blood vessels have a chance to deteriorate), the increased amount of estrogen will have a chance to keep blood vessels healthy. From the article:

"The jury is still out on this," says Dr. Sandra Davidge, the Canada Research Chair in Women's Cardiovascular Health at the University of Alberta. "This question still requires a lot of investigation, but what we're seeing is that the timing of the hormone replacement is probably critical to any potential cardiovascular benefits."

The benefits of HRT were very publicly called into question in 2002 with the release of the Women's Health Initiative study. The study, which made front-page news, reported that women on HRT actually had an increased rate of heart disease.

The results, says Davidge, pushed researchers to take a harder look at the timing of HRT. She notes that the heart and blood vessels have specific receptors, or contact sites, for the sex hormone molecules that are lost with menopause. Many of those in the Women's Health Initiative study received HRT years, or even decades, after menopause.

"In many of these cases, the estrogen was probably given too late," Davidge says. "If you give estrogen to aged blood vessels it might not be protective and it might have detrimental effects. But if you give it to women at the onset of menopause it probably has benefits."

That's the conclusion of research, funded by the Canadian Institutes of Health Research, in Davidge's lab on the role of estrogen in maintaining blood vessel health in animal models of menopause.

"We've found in our lab that estrogen acts as a powerful antioxidant and also suppresses some of the proteins that cause inflammation, thereby having a positive effect on the arteries," she says.

This raises the possibility that HRT might be effective in extending cardiovascular health if it's given at the onset of menopause, before the blood vessels have deteriorated."

Instead of pushing HRT on women, maybe it would make sense to look into foods that naturally boost estrogen (ie, soy) and think about gradually increasing amounts of this in the diet as women enter perimenopause.

Some more perspective on HRT and women's cardiovascular health:

Perspectives on the risks of HRT

Preventing Heart Disease: the Natural Approach

Birth Control Options for Women 40+

A new study discusses whether or not birth control pills are a good contraceptive choice for women over 40:

A review of the current science of contraception and women 40 and older was published recently in the New England Journal of Medicine. The author, University of Florida gynecologist Dr. Andrew Kaunitz, noted that the risk of dangerous blood clots rises sharply at age 40 for women who take birth control pills containing estrogen.

The risk is even greater for overweight women, who also are more likely to have high blood pressure and diabetes.

But the dosage of estrogen in current birth control pills has been dramatically reduced. The pill is now considered a safe alternative for lean, healthy, older women Kaunitz and other experts said.

"It may not be well known that the current low-dose formulations are a reasonable option for healthy women in their 40s," said Dr. JoAnn Manson, a Harvard endocrinologist who wrote a book on menopausal hormone therapy.

The pill may be preferable for some women, because it can help control irregular menstrual bleeding and hot flashes and has been shown to reduce hip fractures and ovarian cancer, wrote Kaunitz. He has received fees or grants from several companies that make oral contraceptives.

But middle-aged women who are obese, smoke, have migraines, high blood pressure or certain other risk factors should be steered toward IUDs or progestin-only treatments like "mini-pills," experts said.

I hope that more studies explore this issue. The fact that taking the new "low estrogen" pill is touted to not only act as a contraceptive but also reduce hot flashes and menopausal symptoms is a red flag that despite the low doses of estrogen, this is still a form of HRT. Also, note that the lead researcher Kaunitz has been paid by oral contraceptives companies. Another red flag.

For the holistic point of view on perimenpausal women's contraceptive choices, here is a well-researched article from Women to Women: Women:http://www.womentowomen.com/menopause/bcpperimenopause.aspx#arebcpssafe