For years, questions have lingered about the long-term effects of hormone replacement therapy. But now that studies appear to clearly link the drop in new breast cancer rates to women's decreased use of HRT, the wonder has turned to worry for those who used the therapy for years and especially for the group still taking hormones. In a New England Journal of Medicine report released April 19, researchers revealed that national breast cancer rates fell almost 9 percent between 2001 and 2004.
"That's a very, very clear indication, the first in several years, showing that hormone replacement therapy really increases the incidence of breast cancer," says Dr. Luis Meza, hematology/oncology specialist and president/founder of Southwest Oncology Associates in Lafayette. "And now, after those studies, the incidence of breast cancer has gone down tremendously."
In the past, women commonly used hormones to decrease menopausal symptoms such as hot flashes and mood swings, as well as to prevent more serious conditions including osteoporosis, strokes and heart attacks. That all changed following a Women's Health Initiative study in July 2002 showing an increased risk of breast cancer, cardiovascular events, and urinary incontinence in women using HRT. After the WHI report, postmenopausal patients stopped taking hormones in droves, drastically reducing prescriptions for popular therapies Premarin and Prempro from 61 million in 2001 to 21 million in 2004, with the largest drop from 2002 to 2003. Not coincidentally, say researchers, the overall incidence of breast cancer fell 7.2 percent in 2003. About 200,000 cases of breast cancer had been expected that year; the drop meant that about 14,000 fewer women actually were diagnosed with the disease, according to a December report by the National Cancer Institute.
Some were skeptical when that report tied the drop to hormone use. But the April numbers, which add 2004, prove this was no fluke because the numbers did not jump back up. At this point, they seem to have stabilized.
Senior investigator Donald Berry, Ph.D., of the world-renowned University of Texas M.D. Anderson Cancer Center in Houston, and his research team discovered that the breast cancer decrease started in mid-2002, almost as soon as women jumped off the therapy, and occurred only in women over age 50. As more women abandoned the therapy, the rates continued to fall in 2003. From 2001 to 2002, breast cancer incidence dropped from 138 to 135 cases per 100,000 women, and in 2003, it dipped to 126 cases per 100,000 females. For women with the most common form of the disease ' estrogen receptor positive (tumors that need estrogen for growth) ' cases fell almost 15 percent among women ages 50 to 69. While scientists considered other scenarios for this decline in new breast cancer cases, including changes in reproductive factors, mammography rates, diet alterations, and environmental issues, they concluded that HRT was the most likely culprit.
Experts point out that these studies do not prove a definitive link between HRT and breast cancer as they are based only on population statistics. To prove causation, scientists must conduct a randomized clinical trial. Subjects in the WHI study, which first confirmed the link, are still being monitored. Later this year, WHI researchers anticipate releasing a follow-up report.
In the meantime, this study will undoubtedly have an impact on how women feel about HRT. Currently, breast cancer is the most frequently diagnosed cancer among American women and the second leading cause of cancer deaths in females. Nationwide, about 180,000 new cases are expected to occur in 2007. Worldwide, that figure jumps to almost 1 million.
According to the American Cancer Society, an estimated 3,262 Louisiana women will be diagnosed with breast cancer this year. Of these, 137 cases are expected to occur in Lafayette. The projected 2007 death rate from this cancer is 699 for women statewide and 29 in Lafayette.
But while these daunting statistics alone may be enough to tempt local women to dump their hormone pills into the nearest trash can, that might not necessarily be a good idea. Meza says that HRT is still a viable option for some patients but must be determined on a case-by-case basis. "It's a tricky business," he says. "What I'm doing with my own patients is I am trying to find the reason why women are taking HRT. I want to know exactly the reason ' for instance, if a patient is feeling extremely miserable, and is ready to start World War III, having some severe psychological problems, or the hot flashes are intolerable. Then, I have to spell it out for her ' 'Look, you know, the incidence of breast cancer is increased with HRT.'"
For patients who want to continue with hormone therapy, Meza recommends close monitoring through diagnostic testing, including mammograms, ultrasounds and even MRIs. "HRT is a very, very controversial issue, and I like to negotiate with my patient and make sure that she understands the risks and that she has to be under constant observation," he explains. "But, I try not to encourage, too much, the usage of hormones because it definitely increases the incidence of breast cancer."
Luckily, alternatives to HRT do exist for menopausal and post-menopausal women. Meza prefers to treat symptoms individually. For example, he says that several medications are available for treating hot flashes and osteoporosis. He suggests diet and exercise for prevention of cardiovascular disorders. "It just depends on what you are looking at as an alternative for estrogen," he says. "But, you have to take the medications on an individual basis."
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Black Friday shopping begins; Pope visiting Turkey; oil prices decline and more national and international news for Friday, November 28, 2014.
Friday's Blogs from the Bog!
Casual cool for Thanksgiving
Shop Lafayette goes strong
The fight to clean up Lafayette Parish could get some added ammunition with two ordinances up for votes Tuesday by the City-Parish Council targeting litter-bugs.
A divided 3rd Circuit Court of Appeal reversed a Lafayette district judge’s ruling absolving the co-owner of a New Iberia accounting firm of liability in an embezzlement case.
Our View: It’s reasonable, temporary and invests in Lafayette’s future.
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By striking a deal to lessen the blow of health insurance changes on state workers, school employees and retirees, Gov. Bobby Jindal's administration lowered the volume of criticism but gave itself and local school boards a new budget headache.
With the airport tax coming up for a parishwide vote in about a week, the Broussard City Council and its mayor have come out in support of the proposal.
Protesters rallied peacefully in several Louisiana cities in the wake of the Missouri grand jury decision not to indict a police officer in the fatal shooting of Michal Brown.
Three bedroom in Port Barre or two bedroom in Opelousas
The U.S. rep billed LSU for work allegedly performed on the same days Congress voted on major legislation and held important committee hearings on energy and the ACA.
“I am only getting a little nervous about two projects — the proposed Sasol GTL facility [not the new ethylene plant] and the proposed G2X facility — both in Lake Charles. They need a hefty difference between oil and natural gas prices to make sense.”
Abysmally low participation by the public has prompted the council to scuttle the 2014 survey with plans to simplify it and try again next year.
The village now says the ordinance will likely be overturned and authorities will more vigorously enforce existing leash laws.
Lower oil prices also might slow the growth of oil production in parts of the U.S., Canada and elsewhere because it will no longer be so profitable.
Bill Cassidy cast an early ballot Tuesday, seeking to draw renewed attention to a race that has fallen off newspaper front pages and away from people's minds as they plan holiday meals and shopping schedules.
A Lafayette woman faces up to 20 years in prison for running up more than $1 million in unauthorized charges to her company credit card.
Signs that our state’s banking industry is undergoing a downsizing in 2014 were further confirmed today with the FDIC’s latest figures showing a third straight quarter in which Louisiana lost more banks and earned less money.
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State police say a 47-year-old Lafayette man, who collected more than $83,000 in disability benefits, is accused of operating two businesses out of his home at a time when he claimed he had no income.
Battered all night by Baltimore's relentless pass rush, Drew Brees could feel his protection collapsing and Terrell Suggs getting ahold of him as he urgently unloaded a pass to the right flat toward tight end Jimmy Graham.
After a convincing defeat at the polls on Nov. 4, Earl “Nickey” Picard has decided to let bygones be bygones with his former right-hand man Brian Pope, announcing his support for his former employee’s runoff bid to become Lafayette’s next city marshal.
Saturday the athletic department did everything possible to ensure the 2014 Ragin’ Cajun seniors remembered fondly their last home game. Rain and lightning never arrived but turbulence did in the form of the Appalachian State Mountaineers.
Even stranger than the Republican Party’s decision to hold a “unity rally” earlier this month for Congressman Bill Cassidy in a Baton Rouge bar, Huey’s Bar, was the fact that the establishment was named after Louisiana’s most famous Democrat.
Bar Code is not a gay bar.
After failing to pass a medical marijuana bill last year, state Sen. Fred Mills, R-Parks, is telling supporters he will return in 2015 with legislation that focuses on different applications like oils and pills.
Voters, obviously, are not yet tuned into the 2015 ballot, despite the intriguing races it will host.