As a women’s health physician, breast cancer advocate and author, it’s time we get solid information that encourages hormonal harmony, and doesn’t fan the flames of ill founded fear. Kantrowitz and Wingert offer us an erroneous cancer scare, an old theory recycled, contributing nothing of value. Women are victims of scare campaigns about breast cancer which are doing us harm. As noted in their article, invasive breast cancer rates started dropping in 1999, thanks to more regular mammogram screening, and other factors, some known and others undiscovered. This observed decrease was more than 3 years before women bolted from their hormone replacement therapy (HRT) due to exaggerated (and now we know, wrong) reports about breast cancer rates and estrogen use in menopause. To their detriment women have continued to decrease hormone use annually since the 2002 WHI reports, yet breast cancer rates have not continued to decrease. And in Holland (one of many examples) similar decreases in hormone use are not associated with any decrease in breast cancer incidence. Not exactly a validated hunch.
In fact the 2007 data from the Women’s Health Initiative, the WHI (the largest American study of thousands of menopausal women on PremPro® or Premarin® alone compared to placebo) when analyzed and corrected to reflect disease occurrence in those women who actually took the study pills, revealed no significant difference in rates of breast cancer between the women who took Premarin© and those who took the dummy pills. After 7+ years of taking estrogen-alone, estrogen users had 17% less breast cancer compared to women who took a sugar pill. And these estrogen-alone users wisely continue to take their pills to a much greater degree than the women on the combination therapy, PremPro and others like it. These confident women continuing on their estrogen contribute to the lower rates of breast cancer documented.
And what about the statistic that everyone agrees with? Cancer specialists, radiologists and primary care docs all know that women who are diagnosed with breast cancer while taking estrogen fair a lot better. This is a very significant effect when you look at death rates from breast cancer. Since 2000 most studies of women on estrogen show they have a lower risk of being diagnosed with breast cancer, especially if those with a uterus use bioidentical progesterone along with it. This is the most important information we have today if we are to decrease suffering with this all too common disease.
It is time we got it straight about estrogen NOT being the bad guy when it comes to breast cancer. In addition to lowering breast cancer death rates, estrogen has many positive preventive effects when begun for symptom relief during early menopause. Early estrogen therapy lowers the risks of heart disease, osteoporosis, colon cancer and dementia, as well as lowering breast cancer deaths. These are big benefits that are left out of the fear-engendering mis-information that keeps getting recycled. Taken correctly, estrogen offers a watermelon size benefit and a watermelon seed size risk.
Ricki Pollycove, MD, MS
Author, “The Pocket Idiot’s Guide to Bioidentical Hormones,” 2010, Alpha Press
Founding Director for Breast Health CPMC Breast Center
FACOG, NAMS CMP, ASBD and SFMS member