One indisputable conclusion has emerged from the growing body of research on hormone replacement therapy and breast cancer:
Women don’t know what to believe anymore.
Last month, many felt whipsawed by a much-trumpeted Harvard study that found long-term, postmenopausal hormone use increased the risk of breast cancer.
“We got lots and lots of calls,” said Alexandra Comber, office manager for a Cherry Hill, N.J., physician near Philadelphia. “One woman who had been taking it called and said, ‘That’s it. I refuse to take it.”’
Wednesday, the publication of yet another highly regarded study deepened the confusion. The study by Seattle researchers found that taking hormones after menopause did not increase the risk of breast cancer. In fact, it found women on hormones for eight years or longer had, if anything, a “lower” risk of breast cancer than those who had never used them.
Dr. Marie A. Savard, who directs the Center for Women’s Health at the Medical College of Pennsylvania/ Hahnemann, said yesterday’s study “should be the final straw for women to recognize there will never be a standard recommendation because each of us represents an individual set of risks and benefits.”
Both specialists and general practictioners are going out of their way to educate patients so they can make informed choices. Physicians are explaining the research, reviewing family histories, suggesting tests to pinpoint patients’ individual risks and asking them to confront their fears.
Bradley Fenton, a Philadelphia internist (and Savard’s husband), said he frequently discusses hormone replacement therapy with patients, even though most have already debated it with their gynecologists.
“They really want an answer that’s clearcut,” he said. “I tell them, we can try to rationalize this, but you’ve got to tell me what your gut feeling is.”
Joseph L. Maccarone, the Cherry Hill urologist/gynecologist whose office received a flurry of calls after the Harvard study, said: “I find women are raising the issue a lot more. And even if they don’t, I bring it up at every visit with every patient.”
As women’s life expectancy has extended far beyond menopause, hormone replacement therapy - estrogen alone or with progestin - has become popular for two reasons. It relieves menopausal symptoms such as hot flashes and sleep disturbance, and research has shown it prevents heart disease and osteoporosis.
Still, questions about cancer persist. Progestin became a standard part of the hormone regimen in recent years, after scientists linked estrogen alone to uterine cancer. Now, in addition to the possibility that estrogen use increases the risk of breast cancer, there is the possibility that progestin makes the risk worse.
More than 30 epidemiological studies have explored the relationship between breast cancer and hormones. The bottom line? “There is still considerable uncertainty,” said an editorial accompanying Wednesday’s study in the Journal of the American Medical Association.