Hormone therapy after menopause may worsen breast cancer

The CBS Evening News recently reported, “For women going through menopause, the decision about whether to take hormone replacement therapy has been controversial and confusing.” In 2009, “40 million prescriptions for hormones were filled here in the US, but there’s new evidence tonight that this treatment may be even riskier than previously thought.”

ABC World News also covered the story, reporting, “The Women’s Health Initiative reports today that among post-menopausal women, the use of estrogen and progestin is not only linked to an increased risk of breast cancer, but the kind that kind of cancers that have higher fatality rates. The safety of more hormone replacement therapy was first questioned in 2002.”

NBC Nightly News, not to be outdone, reported, “Our lead story tonight has to do with an emotional and perplexing topic for millions of American women — hormone replacement therapy; specifically, its relationship to breast cancer.” Chief science reporter Robert Bazell explained that a new study published in the Journal of the American Medical Association “suggests that hormone replacement therapy, estrogen plus progestin, once the most commonly prescribed medication for women 50 and older, not only increases the risk of aggressive breast cancer, but increases the risk that cancers will be more advanced and deadly.”

In a follow-on piece, NBC Nightly News reported, “Some big questions come out of this. What does this all mean?” Dr. Beth Dupree, medical director of the Breast Health Program at Holy Redeemer Health System in Pennsylvania, explained to viewers that women who are using or considering taking hormone replacement therapy to manage the symptoms of menopause need to “weigh the risks and benefits” in the light of severity of symptoms and discuss them with their physicians. Dr. Dupree also added that the “study shows women are dying at a higher frequency and those hormones probably played a role in that.”

On its front page, the New York Times reports, “Hormone treatment after menopause, already known to increase the risk of breast cancer, also makes it more likely that the cancer will be advanced and deadly,” the study found.

Specifically, “women who took hormones and developed breast cancer were more likely to have cancerous lymph nodes, a sign of more advanced disease, and were more likely to die from the disease than were breast cancer patients who had never taken hormones.” Notably, “the treatment studied was the most commonly prescribed hormone replacement pill, Prempro [conjugated estrogens and medroxyprogesterone], which contains estrogens from horse urine and a synthetic relative of the hormone progesterone.”

According to the coverage by the Washington Post, “The study of more than 12,000 women who were followed for about 11 years produced powerful evidence that deaths from breast cancer were more common among hormone-users, apparently because their cancers had already started to spread.”

The Post notes that “for years, doctors recommended that women take hormones to alleviate hot flashes and other symptoms of menopause to protect their hearts and generally remain more youthful. But eight years ago, the federally funded Women’s Health Initiative revealed that hormones’ benefits were outweighed by risks, including heart disease and breast cancer.”

Bloomberg News reports that the present study’s “findings conflict with previous studies showing breast cancers in women taking hormone therapy had a lower risk of death, said Christopher Loder, a spokesman for New York-based Pfizer, in a statement yesterday.” Pfizer is the manufacturer of Prempro. Loder stated, “We stand behind the current, science-based guidance in Prempro’s label, which advises doctors to prescribe the medicine at the lowest effective dose and for the shortest duration.” He suggested that “women should talk to their doctors about how long they should be on the therapy.”

The Los Angeles Times “Booster Shots” blog noted, “As of now, doctors recommend hormone therapy only for women who have severe menopausal symptoms — such as hot flashes — and only for a year or two.”

However, “a study on whether even one or two years of hormone therapy increases the risk of breast cancer is needed, Dr. Peter B. Bach, of Memorial Sloan-Kettering Cancer Center, in New York, said in an editorial accompanying the study.” Bach wrote, “Clinicians who prescribe brief courses of hormone therapy for relief of menopausal symptoms should be aware that this approach has not been proven in rigorous clinical trials and that the downstream negative consequences for their patients are of uncertain magnitude.”

The Wall Street Journal and HealthDay also covered the story for consumers, while healthcare professionals may want to review the coverage by MedPage Today and Medscape.

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