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HRT Debate Not Over Yet

Experts say treatment still has value despite latest finding on link to breast cancer

TUESDAY, Dec. 26, 2006 (HealthDay News) -- The recent news that a precipitous decline in the incidence of breast cancer in the United States might be due to women turning away from hormone replacement therapy has some experts worried that the link between the two might have been overstated.

"This is exciting news about the incidence going down, but I think it's very confusing as to whether or not it's related to hormone use," said Dr. William Rayburn, an associate professor of obstetrics and gynecology at Texas A&M Health Science Center College of Medicine. "This has simply muddied the water more."

Similarly, the International Menopause Society (IMS) called on experts and the public "to be very cautious when interpreting the new data on trends in breast cancer incidence in the United States" and said that hormone therapy "has a very minor potential for harm, but may carry substantial benefits."

At the same time, experts continued to urge caution when considering the use of hormone therapy.

"The only reason a woman should take hormone replacement therapy today is to alleviate the symptoms of menopause," added Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "It doesn't prevent heart disease. In fact, it increases the risk of heart disease, breast cancer and stroke."

Last week, researchers at the University of Texas M.D. Anderson Cancer Center announced that the incidence of breast cancer in the United States had dropped more than 7 percent, and that this drop came just after millions of women started avoiding hormone replacement therapy (HRT) following the publication of the results of the landmark Women's Health Initiative (WHI) in 2002. That study was halted after researchers found elevated health risks among HRT users, most notably for breast cancer and stroke.

Since then, a debate has raged about the utility and safety of HRT, with health officials advising women to take HRT only when needed and for as short a period as possible.

The latest news may spur some additional women to abandon HRT, but the numbers are not likely to change much, experts said.

"We have seen fewer patients on HRT since the WHI trial, but the study last week isn't necessarily going to decrease the numbers even more," said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. "I don't think we'll see a dramatic decrease necessarily from the study last week, because we saw that decrease already with the WHI."

According to Bloomberg News, women moved away from the hormone therapy products Premarin and Prempro (made by Wyeth Inc.) after the 2002 WHI results were announced. Now the company is selling lower-dose versions to be used for shorter intervals.

"All of us involved in postmenopausal care are going to field another round of very confused patients, and it's going to reinforce what we've been doing since the WHI came out," Rayburn added. "We began rethinking our philosophy on prescribing, and I think it's healthy for us to remember that estrogen or estrogen plus progesterone are drugs, and drugs have risks and should be utilized only for the appropriate indications after patients have been provided a full disclosure of risk and benefits."

Women with severe menopausal symptoms are likely to continue with hormone therapy.

"There's still a certain number of patients who say, 'I cannot live like this, I need medications, I will accept the risk,' " Wu said. "They see a night and day difference with HRT. The ones that are asking for it are pretty desperate ones, and the desperate ones have been asking for it since WHI."

More information

For more on HRT, visit the U.S. National Library of Medicine.

SOURCES: Jennifer Wu, M.D., obstetrician/gynecologist, Lenox Hill Hospital, New York City; William Rayburn, M.D., associate professor, ob/gyn, Texas A&M Health Science Center College of Medicine, and medical director, Scott & White Clinic, College Station; Jay Brooks, M.D., chairman of hematology/oncology, Ochsner Health System, Baton Rouge, La.; Dec. 19, 2006, International Menopause Society statement; Bloomberg News
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