Menopause Wise

by Dr. James A. Simon

The report from the University of Toronto is welcome news following all the adverse -- even hysterical -- publicity on the risks that hormone therapy may have on Breast cancer. This news will be particularly important to the many women who have family histories riddled with breast Cancer and who carry the BRCA1 mutation. These women often undergo preemptive surgery for Ovarian cancer prophylaxsis (Oophorectomy) and/or bilateral mastectomy to avoid becoming yet another breast cancer statistic in their families.

Unfortunately, these attempts at prevention often result in other catastrophic effects resulting from their early menopausal status. These effects include: early onset bone loss and Osteoporosis, Vaginal dryness with resulting pain with intercourse, urinary Urge Incontinence and recurrent Bladder infections, and premature cardiovascular disease, premature dementia and death. Many of the symptoms can be prevented or delayed by the use of Estrogen therapy. This week CTV reported that “researchers at the University of Toronto and the Women's College Hospital suggested that "hormone replacement therapy (HRT) may in fact be safe for women who carry the breast cancer gene mutation," according to a paper detailed in the Sept. 23 issue of the Journal of the National Cancer Institute. In fact, for women who carry the BRCA1 mutation, taking HRT "was linked with a 42 percent reduction in the risk of developing breast cancer." The finding "questions a commonly held belief that it can further increase the risk of developing the disease." While past research has suggested that "BRCA1 and BRCA2, can greatly increase the chance of developing breast cancer," the new work "suggests that the treatment could actually significantly lower the chance of developing the disease." This conclusion was reached after the investigators "compared the use of hormone therapy in almost 500 women who carried the BRCA1 mutation."

The accompanying editorial by Drs. Rowan T. Chlebowski, M.D., Ph.D., of Harbor-UCLA Medical Center, and Ross L. Prentice, Ph.D., of the Fred Hutchinson Cancer Research Center in Seattle, aptly describe the results as 'some evidence for safety [of hormone replacement], but are insufficient to reliably inform routine clinical practice.'" Moreover, the study results "may be relevant for only three percent of women." However, these authors fail to mention that the average women may benefit similarly, since the best information available (from the Women’s Health Initiative-WHI) suggests that short term use of estrogen (less than 7 years) or estrogen and progestogen (less than 5 years) does not increase breast cancer risk. And while they correctly point out that women with the BRCA1 abnormality represent only three percent of women, they neglect to acknowledge that more than 90 percent of women using estrogen or estrogen and progestogen therapy actually utilize it for less the 5 or 7 years, respectively, that would put them at risk.