Deja vu all over again

There’s been a lot of talk in the mainstream media this week about the latest findings on hormone replacement therapy (HRT) and cancer. The coverage typically goes something like this: first, the talking head says the latest research shows a link between use of certain types of HRT and ovarian cancer. Next, they tell you that the “authorities” say women should continue to take HRT anyway.

I’ve seen this scenario played out again and again this week on the television news – and every time I am dumbfounded. I know I shouldn’t expect any better – but the cursory coverage and the condescending advice just makes my blood boil.
Facts show the risks are significant

As I’ve written before, the decision to take HRT or not is very controversial – and very personal. Each woman has to make up her own mind. But to do that, you need accurate, complete, unbiased information – not a one-sentence summary and a pat on the head. In a few lines, the mainstream media has dismissed these new findings as irrelevant. But when you look at the actual study, the facts tell a different story.

The Swedish study, published in the Journal of the National Cancer Institute, studied a group of 4,554 women. They were continuously recruited between October and December of 1995, when they were between the ages of 50 and 74. Of those 4,554 women, 655 had epithelial ovarian cancer, the most common type, which affects the cells that line or cover the ovaries.

Based on the women’s responses to questionnaires, they divided HRT users into four groups: women who took estrogen only (ERT); women who took estrogen combined sequentially with progestins (HRTsp); women who took estrogen combined continuously with progestins (HRTcp); and women who used low-potency estrogens like oral or vaginal estriol, dienestrol, or low-dose estradiol. There was also a group of women who had never taken any form of HRT.

Why so many different types of HRT? Years ago, when the idea of replacing hormones after menopause was first introduced, all HRT was ERT – estrogen replacement therapy. Then they discovered that ERT increased women’s risk of uterine cancer. (Sound familiar?) So they added progestin to the mix, supposedly to mitigate that danger. Today there are two varieties of this combination therapy: sequential progestin therapy, in which progestin is taken in addition to daily estrogen only during a certain period each month, and continuous progestin therapy, in which the same dose of estrogen and progestin is taken each day.
Combination therapy may be more dangerous than estrogen alone

Yet when the researchers compared the women’s HRT histories with the incidence of ovarian cancer, they found that sequential combination estrogen/progestin therapy was actually the most dangerous of all. Women who had taken sequential combination therapy for 10 years or more had more than TWICE the risk of ovarian cancer when compared against women who had never used any form of HRT. (There was no increased risk from continuous therapy.)

The researchers aren’t sure why sequential therapy caused such a dramatic difference where continuous caused none, but they note that it’s not necessarily a sign that continuous is safer. After all, earlier research has shown that continuous combination therapy can increase the risk of breast cancer.

Granted, even the study’s authors urge caution in interpreting these findings. As they write in their conclusion, “We advocate cautious interpretation of our results and do not recommend changes to current HRT prescribing practices.” They call for further studies to see if their results can be replicated.

The “authorities” may not “recommend” changes – but that doesn’t mean women can’t make a change. Many already have, substituting natural estrogens for synthetic or treating the side effects of menopause with herbal remedies. It’s such a huge topic that HSI is planning a special report on natural ways to address menopause. Look for more information about this HSI Special Report soon. In the meantime, if you take HRT, talk to your doctor about these newly discovered risks. Then you can be your own authority, and decide for yourself what’s best for you.

To Your Good Health

Jenny Thompson
Health Sciences Institute

Source: Journal of the National Cancer Institute 2002;94:497-504

Copyright 1997-2002 by Institute of Health Sciences, L.L.C.