Healthy Skepticism Library item: 13063
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: news
Corbett Dooren J.
Cancer Risk Rises Slightly After Hormone Therapy Ends
The Wall Street Journal 2008 Mar 5
http://online.wsj.com/article/SB120466125045011067.html?mod=yahoo_hs&ru=yahoo
Full text:
A follow-up study involving women taking a combination of the hormones estrogen and progestin showed they may have a small, increased risk of cancer nearly three years after they quit taking the hormones, while increased cardiovascular risks initially seen were no longer apparent.
The study appears in this week’s Journal of the American Medical Association. Doctors said the findings don’t change the current advice for women using hormones: Use the lowest dose for the shortest time to relieve hot flashes and other symptoms faced by women entering into menopause.
One of the main hormone studies in a larger, federally funded group of studies known as the Women’s Health Initiative study was halted in 2002 when data suggested women taking a combination of estrogen and progestin had a higher risk of breast cancer than women in the placebo group, or women not taking hormones. Further analysis also showed women in the hormone group had higher cardiovascular risks. The study was designed to look at the impact of hormones on heart disease, bone fractures and cancer. It involved 16,608 postmenopausal women ages 50 to 79 when they entered the study.
The average age of women in the study was 63, about a decade older than the typical woman who starts hormone therapy, which has caused doctors to question whether the overall WHI findings are relevant.
Additional data published last year that covered women in their 50s who were part of WHI showed those taking the combination hormone estrogen-progestin or estrogen alone had a 30% lower risk of dying than women who didn’t take hormones, while women taking estrogen alone had a lower risk of severe coronary artery calcium, which is a risk factor for heart problems.
About 15,700 women in the original study are being followed to assess health risks and benefits since hormone treatment was stopped.
Researchers, led by Gerardo Heiss at the University of North Carolina, Chapel Hill, said that after an average 2.4 years of follow-up, women in the hormone group had about the same number of heart attacks, strokes and blood clots compared with women in the placebo group, suggesting the increased risk seen among women on hormones dropped after hormone therapy was stopped. However, the research showed a small increased risk of cancer among women taking hormones compared with the placebo group.
“It’s of modest magnitude,” Dr. Heiss said. “It’s not something to be alarmed about, but it’s something to be aware of.”
Specifically, cancer occurred at a rate of 1.56% per year among women in the hormone group compared with 1.26% per year among women in the placebo group. Dr. Heiss said the increase was mostly driven by an increase in breast cancer, although the rates for individual cancers weren’t statistically significant, meaning they could be due to chance.
Since the initial findings from WHI were released in 1992, sales of hormones have dropped sharply. Wyeth, a hormone maker, has seen sales of products such as Prempro and Premarin fall from about $2 billion annually in 2002 to about $1 billion annually. Also, doctors have cut starting hormone doses to about half of those used in the Women’s Health Initiative.
“We don’t believe this article provides any new guidance,” said Gary Stiles, Wyeth’s chief medical officer. “Hormone therapy remains a good and viable choice for treating menopausal symptoms.”
Nanette Santoro, the division director of Montefiore Medical Center’s Institute for Reproductive Medicine and Health in Hartsdale, N.Y., said current information on hormones is “conflicting data that’s complex to explain” to patients. She said other studies are under way that are looking at risks and benefits of hormone use in younger women than those looked at as part of WHI, as well as whether estrogen delivered through a patch has a different risk-benefit profile than estrogen given orally.
She said most women enter menopause from the ages of about 47 to 51 and within about five years after their last menstrual period, they no longer experience hot flashes and other symptoms related to the drop in reproductive hormones.
