Hormone,Replacement,Therapy,An health Hormone Replacement Therapy And Breast Cancer


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You have permission to publish this article electronicallyor 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 andsaid 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 andwith these mood swings, but I don't want to increase my breastcancer risk by taking hormones." Like many women, Janet had heard that a recent study, theWomen'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 nostatistically significant increase in breast cancer risk to women who took HRT. When differences are not significant, an increase in riskmay 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 theincrease was likely to be due to the agent being studied or tothe size of the risk. The actual size of a risk is important in any woman'sdecision making process. In this case the risk was exceedinglysmall -- only 8 in 10,000 women a year -- which is 0.08% or eight hundredths of one percent! Janet was amazed to learn the actualsize of the increase, and said, "You mean I was getting allconcerned for a risk that small!" "And," I pointed out, "even this very small difference inrisk may not be due to hormone use." I explained that breastcancers take an average of eight years to reach about half aninch in size. This means that breast cancers started in the firstyear of the study would not be detected for eight or more years. The study followed women for only about five years, so all ormost 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 cancersto grow more rapidly and therefore be detected sooner than eightyears. 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 toother, 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 thatwomen who use HRT do not have an increase in breast cancer riskcompared to women who don't use hormones, even when hormones areused for twenty years. Also, in another large study in which somewomen were assigned to take Prempro and others not, women whoused 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 thatit 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. Visithttp://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. Informationabout her book, Assess Your True Risk of Breast Cancer, can befound on her web site: http://www.ptkelly.com. Article Tags: Hormone Replacement Therapy, Breast Cancer Risk, Hormone Replacement, Replacement Therapy, Breast Cancer, Cancer Risk, Breast Cancers, Grow More

Hormone,Replacement,Therapy,An

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