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Hormone Replacement Therapy And Breast Cancer
You have permission to publish this article electronically
or in print, free of charge, as long as the byline is included. A
courtesy copy of your publication would be appreciated.
HORMONE REPLACEMENT THERAPY AND BREAST CANCER:
THE RISKS IN PERSPECTIVE
Janet M., a fifties-something woman, entered my office and
said as she sat down, "I've read that if I take hormones I'll
increase my breast cancer risk. I'm going crazy without sleep and
with these mood swings, but I don't want to increase my breast
cancer risk by taking hormones."
Like many women, Janet had heard that a recent study, the
Women's Health Initiative (WHI), definitively showed that hormone
replacement therapy (HRT) increases breast cancer risk. Janet,
like most people, didn't realize that this study found no
statistically significant increase in breast cancer risk to women
who took HRT.
When differences are not significant, an increase in risk
may well be due to other factors, not the one being studied, such
as HRT use. As often happens when a medical story is reported,
the emphasis was on the increase in risk, not whether the
increase was likely to be due to the agent being studied or to
the size of the risk.
The actual size of a risk is important in any woman's
decision making process. In this case the risk was exceedingly
small -- only 8 in 10,000 women a year -- which is 0.08% or eight
hundredths of one percent! Janet was amazed to learn the actual
size of the increase, and said, "You mean I was getting all
concerned for a risk that small!"
"And," I pointed out, "even this very small difference in
risk may not be due to hormone use." I explained that breast
cancers take an average of eight years to reach about half an
inch in size. This means that breast cancers started in the first
year of the study would not be detected for eight or more years.
The study followed women for only about five years, so all or
most of the breast cancers found were probably present in an
undetected state before the study began.
Janet asked if HRT use might have caused some breast
cancers
to grow more rapidly and therefore be detected sooner than eight
years. This is unlikely. A number of studies find that breast
cancers in women who were using HRT were not larger and were not
dividing more rapidly than breast cancers in non hormone users.
Since breast cancers grow more slowly in older women and the
average age in this study was 63, breast cancers in this group
would tend to grow more slowly and so take even longer than the
eight year average to be detected.
Women in the WHI study used a particular type of hormone
Prempro. The results of this study therefore do not apply to
other, newer approaches in which more natural hormones are used
and a woman's menstrual cycle is more closely approximated.
Janet was surprised to learn that many studies find that
women who use HRT do not have an increase in breast cancer risk
compared to women who don't use hormones, even when hormones are
used for twenty years. Also, in another large study in which some
women were assigned to take Prempro and others not, women who
used Prempro had no significant increase in breast cancer risk.
As Janet left, she said, "I can see now that when I hear
about a study I need to know how big a risk is and not just that
it is increased. I'll also ask how long a study it was. This
discussion has given me a whole different perspective."
Understand and manage your cancer risk. Visit
http://www.ptkelly.com and sign up for our free teleforum.
Patricia T. Kelly, Ph.D. is a medical geneticist who
specializes in providing information about cancer risk to
individuals and health professionals. She is affiliated with
Saint Francis Memorial Hospital in San Francisco. Information
about her book, Assess Your True Risk of Breast Cancer, can be
found on her web site: http://www.ptkelly.com.
About the Author
Dr. Kelly is a medical geneticist who has been a Diplomate of the American Board of Medical Genetics since 1982. In 1993 she became a Founding Fellow of the American College of Medical Genetics. She received her Ph.D. in genetics from the University of California, Berkeley.
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| BreastCancer.org - Breast Cancer Treatment Information and Pictures |
| Breast Cancer Information from a Nonprofit Organization. |
| www.breastcancer.org |
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| The Breast Cancer Site |
| Founded to help offer free mammograms to underprivileged women nationwide. With a simple, daily "click" visitors help provide mammograms to those in need. |
| www.thebreastcancersite.com |
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| Susan G. Komen Breast Cancer Foundation |
| The Susan G. Komen Breast Cancer Foundation is dedicated to education and research on breast cancer causes, treatment and the search for a cure. |
| www.komen.org |
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| Breast Cancer Information from National Breast Cancer Foundation Inc |
| Breast cancer information including early signs and symptoms of breast cancer, myths, early detection, breast cancer research and more from National Breast ... |
| www.nationalbreastcancer.org |
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| BreastCancer.Net: http://www.breastcancer.net |
| A clearinghouse for the latest news and information on the prevention, detection and treatment of breast cancer. |
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| Breast Cancer Treatment with Traditional Chinese Medicine |
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| Breakthrough Breast Cancer |
| Breakthrough Breast Cancer is the UKs leading charity committed to fighting breast cancer through research and education. |
| www.breakthrough.org.uk |
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| MedlinePlus: Breast Cancer |
| Search MEDLINE/PubMed for recent research articles on Breast Cancer: • Breast Cancer ... Select services and providers for Breast Cancer in your area. ... |
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| Breast Cancer Research | |
| Online and print journal covering topics of basic and clinical research relevant to breast cancer. Research articles are free to all users. |
| breast-cancer-research.com |
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| National Breast Cancer Centre - Evidence based information for ... |
| The National Breast Cancer Centre of Australia providing information about breast cancer for consumers and health professionals. |
| www.nbcc.org.au |
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| Canadian Breast Cancer Foundation: Run for the Cure: Select Language |
| Charitable organization which raises money to advance research, education, diagnosis and treatment. |
| www.cbcf.org |
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| Breast cancer - Wikipedia, the free encyclopedia |
| That is why you will see breast cancer patients wearing braces, ... [5] Men can also develop breast cancer, but their risk is less than one in 1000 (see sex ... |
| en.wikipedia.org |
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| End Breast Cancer from Care2.com and TBCF! |
| Help stop Breast Cancer by clicking daily - free! Supports efforts by The Breast Cancer Fund. |
| breastcancer.care2.com |
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| National Breast Cancer Foundation |
| The ultimate goal of the National Breast Cancer Foundation (NBCF) is to raise enough money to fund a cure for breast cancer. As Australia’s leading national ... |
| www.nbcf.org.au |
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| Y-ME National Breast Cancer Organization |
| Support and information about the condition from this non-profit entity. Headquartered in Chicago, Illinois. |
| www.y-me.org |
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| Breast Cancer Home Page - National Cancer Institute |
| Information about breast cancer treatment, prevention, genetics, causes, screening, clinical trials, research and statistics from the National Cancer ... |
| www.cancer.gov |
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| What You Need To Know About™ Breast Cancer - National Cancer Institute |
| Information about detection, symptoms, diagnosis, and treatment of breast cancer. NIH Publication No. 05-1556. |
| www.cancer.gov |
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| Breast Cancer Campaign - Researching the cure |
| Breast Cancer Campaign is the only charity that specialises in funding independent breast cancer research throughout the UK. |
| www.breastcancercampaign.org |
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| NBCC - NBCC - National Breast Cancer Coalition |
| The National Breast Cancer Coalition Fund is a grassroots organization dedicated to ending breast cancer through the power of action and advocacy. |
| www.natlbcc.org |
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