Breast-Cancer Drop Attributed to Less Hormone Therapy

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A recent decline in breast cancer rates is being attributed to the declining use of hormone replacement therapy. Just how risky is hormone replacement therapy, and what should women do if they are already taking it?

ROBERT SIEGEL, Host:

There's more news now that might make women think twice about hormone replacement therapy. A study released yesterday suggests that a significant decline in breast cancer rates between 2002 and 2003 may be due to fewer women taking the therapy. But does that mean all women should stop taking hormones? Experts say, probably not.

Here's NPR's Joe Palca.

JOE PALCA: In 2002, a major study of hormone replacement therapy was stopped early, because results showed women taking the hormones were at greater risk for breast cancer than those who didn't. At the time, many women abandoned the treatment. Once upon a time, maybe three decades ago, people thought hormone replacement therapy was the fountain of youth for women going through menopause.

DEBORAH ARMSTRONG: It was going to make your skin younger, and it was going to prevent heart disease. And, you know, in every way, shape or form, you are going to feel like you were still 30 years old.

PALCA: Deborah Armstrong says it wasn't too long before problems began to emerge. Armstrong is a medical oncologist at the Johns Hopkins Kimmel Cancer Center in Baltimore. She says early formulations of the therapy increased a woman's risk of endometrial cancer.

And yesterday's breast cancer results seem to underscore the risk revealed in the 2002 study that was stopped early. Armstrong works primarily in cancer prevention, but she says even so, there are times when hormone replacement therapy makes sense.

ARMSTRONG: Probably the one clear indication for using it is women who have serious hot flashes, particularly those that interrupt sleep, and so clearly affect functioning and quality of life.

PALCA: And women who do use it for that reason shouldn't be alarmed by the latest news, says epidemiologist JoAnn Manson of Harvard's Brigham and Women's Hospital.

JOANN MANSON: For some women, particularly the women who have moderate to severe menopausal symptoms, the benefits of short-term hormone therapy will outweigh the risk.

PALCA: And Manson says the length of time a woman is taking the therapy makes a big difference.

MANSON: It's clear that longer duration of use of estrogen, particularly, together with a progestin, will increase the risk of breast cancer. There's less evidence that short-term use, for two, three years, will increase the risk.

PALCA: But even here, it's important to keep in mind the size of the risk.

MARY DALY: A 50-year-old woman has a very low risk of getting breast cancer in the next five years.

PALCA: Mary Daly studies cancer risk at the Fox Chase Cancer Center in Philadelphia. She says hormone replacement therapy is just one of several factors that nudge up a woman's risk of breast cancer.

DALY: Hormone replacement therapy, never having had a child, being overweight after age 50, all of those things carry about the same relative risk.

PALCA: And that's reasonably small?

DALEY: Yes, reasonably small.

PALCA: And even if you do all the things that have been shown to lower your breast cancer risk, keeping your weight down, having lots of kids before age 20, getting plenty of exercise and getting of your hormone therapy, Daley says that still doesn't mean you definitely won't get breast cancer.

DALY: You do what you can do, and then you have to live your life to the fullest.

PALCA: It's a hard sentiment to argue with.

Joe Palca, NPR News, Washington.

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