Hormone therapy less risky after hysterectomy: study
By Andrew Stern
CHICAGO (Reuters) – Estrogen-only hormone replacement
therapy used to treat symptoms of menopause does not raise the
risk of breast cancer for women who have had a hysterectomy, a
study said on Tuesday.
The finding contrasts with the higher risk of breast cancer
among menopausal women taking estrogen plus progestin — a
combination designed to protect against uterine cancer. In a
hysterectomy all or part of the uterus is removed.
Hormone replacement therapy came under scrutiny when
research called the Women’s Health Initiative study was
terminated early, in February 2004, because of unexpected
findings that women faced heightened risks of ailments
including stroke, blood clots and breast cancer.
Since then, further analysis of the WHI study data and
other studies have generated confusion about the risks and
benefits of hormone replacement therapy.
“This new analysis does not alter the overall conclusion
from the WHI that hormones, including estrogen-alone and
estrogen plus progestin, should not be used for the prevention
of chronic disease,” said Dr. Elizabeth Nabel, director of the
National Heart, Lung, and Blood Institute of the National
Institutes of Health, which sponsored the WHI study.
“The findings still support current recommendations that
hormone therapy should only be used to treat menopausal
symptoms and should be used at the smallest effective dose for
the shortest possible time,” Nabel said.
Women were originally prescribed the hormones to quell hot
flashes and other symptoms of menopause, but there were also
indications the therapy lowered the risks of heart disease,
bone loss and possibly other ailments.
After the WHI study was published, sales of Wyeth’s leading
hormone replacement drugs Premarin and Prempro fell
Illustrating the conflicting findings, a study published in
January on women younger than those in the WHI study concluded
hormone therapy lowered their risk of heart disease compared to
women not on the therapy.
The latest analysis, published in this week’s Journal of
the American Medical Association, covered nearly 11,000 women
participating in the WHI study who had had a hysterectomy.
“There were fewer breast cancers diagnosed for women on the
active study pills” compared to those taking harmless sugar
pills for comparison purposes, study author Marcia Stefanik of
Stanford University said.
“However, when we looked at those tumors, those tumors were
actually significantly larger, and there was a tendency for
them to have spread to more lymph nodes,” she said.
The women taking estrogen had slightly fewer breast cancers
but they had more follow-up mammograms and biopsies performed.
The hormone tends to make breast tissue denser and therefore
more difficult to detect tumors.