Ricki Pollycove, MD, MS
Your Watch Dog on Women’s Health
Shocking, fear inducing headlines scare us again today with the release of the sub-analysis from the Million Women study. The current breast cancer scare press release, “Breast Cancer Risk in Relation to the Interval Between Menopause and Starting Hormone Therapy” Valerie Beral, et al, Jan. 28, 2011, in The Journal of the National Cancer Institute. The authors give us a huge mass of data, including some non-significant trends in relative risk numbers which frighten us but are actually so small they are barely detectable differences. We need to insist on medical news providing us with absolute risk data when sharing information from clinical trials.
Crunching the numbers one arrives at a tiny absolute risk difference of 0.006 between the no-hormone therapy women and those who used HT of various types over 7.2 years in the million women study. In fact the numbers are so small that our FDA considers them very rare and not a significant individual concern. And if you are impressed by numbers, consider the average risk of breast cancer in American women, by age 80, is roughly 12.15%, [SEER data base] with rates of death from breast cancer much lower still (less than 2 % of us will die of breast cancer) as compared to the huge majority who suffer and will die from heart disease, with death rates approaching 50% in the first year after a heart attack. 267,000 women die each year from heart attacks, which kill six times as many women as breast cancer. Take a look at the information on the Women’s Heart Foundation web site and help motivate the sisterhood. [Women and heart disease facts ] .
What we need to focus on, what we can individually do a lot about, is lowering our risks for heart disease and breast cancer by attending to the factors that are known to increase or lower risk. To improve the health of women as we age let’s be proactive and do our diligence to pay attention to these quality of life lowering, death rate increasing health problems. To quote the past president of the North American Menopause Society, Cynthia Stuenkel, MD, UC San Diego School of Medicine, “…almost everything we do to care for women should be geared toward helping them live a healthier lifestyle that will ultimately lead to a healthier heart.” And the 2010 compelling review of hormones and the heart supports the role of judicious use of hormones early in the menopause if we are to make the greatest difference in keeping blood vessels healthy. [A “window of opportunity:” The reduction of coronary heart disease and total mortality with menopausal therapies is age- and time-dependent. Hodis HN, USC Keck School of Medicine, Mack WJ, Brain Res. 2010 Oct 25.] The sooner women support menopause with estrogen the lower the rates of blood vessel inflammation that cause heart disease.
The gorilla in the room is heart disease, with breast cancer a challenging threat to lowered quality of life, but not the death threat of cardiovascular disease. As much as breast cancer is prominent in our consciousness and circles of women friends, it is an infrequent cause of death. And there is something that we, individually and as a population of women at every age, can do to lower risk. To quote Howell A and Harvie M, “It seems likely that part of the marked increase in the incidence of breast cancer is related to increases in dietary calorie intake and reduction in exercise over the past century.” [Should lifestyle modifications be promoted to prevent breast cancer?] Same contributors to heart disease rates increasing. So the best thing we can do is to modify our lifestyles as younger women, avoiding obesity, lowering rates of breast cancer as well as significantly decreasing the heavy toll of heart disease.
Get the facts and cure your fears. We can live optimally healthy lives as active, engaged women. But we need to commit to healthy levels of activity, lowered fat nutrition, upping the fresh fruits and veggies and not smoking cigarettes, of course.