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Reducing the
Risk
Physicians have long known that taking estrogen alone will
increase the risk of uterine (endometrial) cancer, and that the addition of
progestin — the other major female hormone — will greatly reduce the risk.
So for many years, most women — except those whose
uteruses have been removed — who take estrogen also have been taking progestin.
For a while, there was hope that the progestin would not only reduce the risk of
uterine cancer but the risk of breast cancer.
But
several studies in recent years have led most researchers to conclude that the
combination of estrogen and progestin carries a higher risk of breast cancer
than does taking estrogen alone.
New Study
In this
week’s Journal of the American Medical Association, another such study
appeared, leading three top cancer-risk experts to write in an editorial that
the “addition of progestin to estrogen does not reduce risk of breast cancer and
[researchers] suggest that risk is actually
increased.”
The amount of increased risk varies with
each study but may be as high as 80 percent after 10 years of combined —
estrogen plus progestin — hormone therapy. The experts also hasten to add that
this increased risk has not been finally proven with randomized studies, but the
evidence so far is very suggestive.
What Should Patients
Do?
So what are the millions of women taking estrogen plus
progestin to do?
First, I would stress that no one
should suddenly stop taking these hormones; this is not a medical
emergency.
Second, the data clearly indicate that
women who took these hormones for just a few years and are no longer taking them
are at no added risk. And that means that women who want to take them for a few
years at the beginning of menopause to treat symptoms should not worry about
such short-term use.
Some Alternatives
But
what about those of you who have taken, or plan to take, them for long periods
because you have a significant risk for osteoporosis or heart disease? Even for
you, there may be some good alternatives, including:
Consider significant lifestyle changes in diet
and exercise. Both can greatly reduce the risk for both heart disease and
bone thinning. And stopping smoking would be far more helpful than taking
hormones.
Consider other medications specifically
targeted at lowering cholesterol and/or preventing bone loss. That could
render estrogen no longer necessary. For example, so-called statin drugs can
significantly reduce dangerous cholesterol, and the biophosphates can reduce the
risk for bone thinning.
Consider the new
“designer estrogens,” such as raloxifene and tamoxifen. They may provide the
benefits of estrogen without the risks. (We don’t have final proof of this, but
we may within a few years.)
Careful Evaluation
In
other words, there may be good alternatives for many women to estrogen-progestin
therapy. But all of these decisions should be made only after careful
consideration of each individual woman’s complete situation — family history,
other risk factors, current symptoms, etc.
For
example, a woman with a very strong family history of premature heart disease
and a woman with a very strong family history of breast cancer would think very
differently about taking hormone replacement
therapy.
But quite frankly, many physicians are
simply not equipped — either emotionally or informationally — to help you with
this important decision, so you may have to go to a specialist in women’s health
issues to get the support and advice you need.
Good
luck with a tough decision. 
Dr. Timothy Johnson is the award-winning medical editor for ABCNEWS. His new column will appear every other Friday on ABCNEWS.com. You also can see his reports on ABCNEWS on-air broadcasts including Good Morning America, 20/20, World News Tonight and Nightline. Johnson holds joint positions in medicine at Harvard University and Massachusetts General Hospital in Boston.
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