Then millions of US women threw out their prescriptions for hormone replacement therapy (HRT) in 2002, the rates of breast cancer started dropping almost immediately, according to US researchers. Their findings coincided with a report from the UK that showed women who took HRT after menopause were 20% more likely to develop ovarian cancer or die from it than postmenopausal women who never took HRT.
The US And UK Studies
The breast cancer report looked at the incidence of breast cancer both before and after the news broke from the long-term Women's Health Initiative (WHD) study that HRT might be more damaging than helpful to a woman's health. Between 2001 and 2004, it shows, the overall incidence of breast cancer decreased by 8.6% in postmenopausal women.
The UK study determined that 1,000 additional women died from ovarian cancer between 1991 and 2005 because they were using HRT, and that 1,300 extra cases of ovarian cancer were diagnosed in the same period.
The researchers, from the Cancer Research UK Epidemiology Unit in Oxford, also found that after women stopped taking HRT, their risk of ovarian cancer returned to the same level as those who never used HRT.
For the US study, experts suspect that HRT may have been fueling some breast cancers because that decline began soon after many women stopped using HRT.
"From 1975 to 2000, breast cancer incidence increased rather dramatically. While part of that increase was clearly due to the introduction of screening mammography (due to increased de tection), once you take out that effect, there is still a rather astounding increase of 30%," said Dr. Donald Berry, chairman of the department of biostatistics at the University of Texas M.D. Anderson Cancer Center in Houston.
"While there have been a number of theories put forward to explain the increase, it now looks like some of that increase is due to the use of HRT," Berry said. "When women stopped using HRT, it looked kind of like a market correction and the numbers went back down."
Background
Initially, it appeared as if combination estrogen-progestin hormone replacement therapy was the answer to many ills. Researchers hoped that HRT would lower the risk of such serious illnesses as heart disease and dementia.
However, the WHI study, which included more than 16,000 postmenopausal women, was halted early in May 2002 because HRT was increasing the risk of coronary disease, stroke and blood clots.
After the WHI trial was halted, many women stopped taking hormones. In fact, the use of HRT had dropped by 38% in the US by the end of 2002. In 2001, 61 million prescriptions were written for hormone replacement therapy. In 2002, there were about 47 million prescriptions. By 2003, that number had fallen to 27 million, and by 2004 just 21 million, the study authors noted.
Breast Cancer Rates Dropping
The rate of breast cancer started dropping soon after the WHI results in 2002, according to the new study.
Between 2001—the last full year of combination HRT use—and 2004, rates of breast cancer in the US dropped by 8.6% in postmenopausal women. The rates of estrogen receptor-positive breast cancer—those cancers fueled by the hormone estrogen—dropped by 14.7% in women between the ages of 50 and 69. Yet, rates of estrogen receptor-negative cancers dropped only 1.7% in the same time period, which further suggests that stopping HRT played a role in the decline.
"HRT is probably not something that causes cancer; it probably just fuels existing cancers," explained Berry. "If you feed it, it grows, and if you stop feeding it, it stops growing."
Berry said the Emory researchers looked at other potential causes for the decline in breast cancer rates, including whether fewer women were getting screening mammograms to detect tumors. The researchers also checked for environmental factors and the use of breast cancer drugs such as tamoxifen and raloxifene. But none of these factors had changed significantly enough to cause such a drop in breast cancer rates, the study authors said.
The breast cancer rates leveled off by 2004, to rates not seen since 1987, the study authors said.
Reaction
"Overall, this is very encouraging news," said Dr. Julia Smith, director of the New York University Cancer Institute Breast Cancer Screening and Prevention Program in New York City.
However, Smith said she'd like to know if this drop would affect survival rates in the future. "Have these cancers been eliminated, or are they just below our level of detection now, but will rise up again?" she asked.
Is HRT Ever Safe?
Both Berry and Smith pointed out that if a woman is suffering from menopausal symptoms, such as hot flashes, short-term use of hormone replacement therapy is likely safe.
"You can give low-dose HRT for short periods of time for women who really have a quality-of-life issue," Smith said. She added that individual risk needs to be assessed on a case-by-case basis, but even some women at high risk of breast cancer may be able to use HRT for short-term relief.
"It doesn't make sense to do something in the name of prevention and protection—(withholding HRT)—that ends up hurting the person," Smith said.
Berry said, "If you're taking HRT for long-term health effects, it's not worth it. But, if you're taking HRT for menopausal symptoms and it works for you, it's probably a reasonable thing to continue. I'd stop it occasionally to see if the hot flashes are still there, but short-term use for a year or two probably won't affect your risk in the long run."
