Last week Beane got some more news to worry about. A study published in The New England Journal of Medicine reported that women who took estrogen, with or without the female hormone progesterone, had a 30 to 40 percent higher risk of breast cancer than those who did not take any hormone treatments. The results were not as simple as they seemed. Women who took hormones for less than five years – or who had stopped taking them for two years – showed no increase in breast cancer, according to Graham A. Colditz of Harvard Medical School and Brigham and Women’s Hospital. But after five years on the hormones, he said, there was “a marked increase in the incidence of breast cancer.”
The report, part of the ongoing Nurses’ Health Study, looked at new cases of breast cancer occurring between 1978 and 1992 in 121,700 women. But it does not settle the issue for academic researchers – or for women like Beane. Over the last 20 years, more than 50 studies have been published on hormone-replacement therapy, and a majority have found no increased risk of breast cancer. Estrogen also has significant benefits for menopausal women; it literally saves lives. Heart disease kills almost six times as many women as breast cancer does; estrogen can cut that risk in half. It may also protect against fatal colon cancer. There’s nothing (including exercise and calcium) like it for staving off osteoporosis, the thinning of bones after midlife that’s responsible for 1.3 million fractures annually in U.S. women, and some 30,000 deaths.
“There are risks either way,” says Dr. Barbara Stewart, a primary-care physician at Boston’s Beth Israel Hospital. “No one’s going to make the perfect decision now, because we don’t have all the facts.” In her practice, Stewart says she encourages most of her patients at least to consider taking hormones. They must weigh family history and other risk factors, she says, but in most cases, “women’s risk of dying is from heart disease, not from breast cancer.”
Caught between conflicting studies, many women make their choice and don’t look back. The day the Harvard study was reported in the news, says Dr. Lila Nachtigall, professor of obstetrics and gynecology at New York University School of Medicine, “I got only two phone calls – out of 3,000 patients taking estrogen.” Nachtigall, who has studied 168 patients on hormone therapy for 22 years, has found “zero increase” in breast-cancer risk. And at the University of Southern California, where medical oncologist Dr. Avrum Bluming is conducting a pilot study on hormone therapy for women who have had breast cancel now in remission, “women are beating down the door to get in,” he says.
The research continues. The Women’s Health Initiative, a prospective study of 25,000 women designed by the National Institutes of Health, should provide definitive results on hormones and heart disease, cancer and osteoporosis over the next 12 years. “It’s not going to help me,” declares Boston University librarian Vicky Slavin, 49, who recently – and reluctantly – began taking hormone-replacement therapy when she learned her bone density was low. “But I’m glad it’s going to help my daughter.”
Reduces risks of heart disease, which kills many more women (250,000) than breast cancer (46,000) does
Protection against osteoporosis
Alleviation of acute menopausal symptoms, including hot flashes, insomia, vaginal dryness and thinning (which make sex painful)
Possible increased risk of breast cancer
Potential enlargement of uterine fibroids
Increased riskd of endometrial cancer when taken without progesterone
Monthly bleeding during menopause when progesterone is added for part of each monthly cycle as protection against uterine cancer
Unpredictable bleeding for several months when estrogen and progesterone are taken continuously throughout the cycle
