Getting Answers After HRT Linked to High Cancer Risk

VIDEO: A report says hormone therapy increases risk of death from breast cancer.
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An ongoing Women's Health Initiative study released results last week showing postmenopausal women who took a combination of estrogen and progestin therapy had a higher chance of getting aggressive forms of breast cancer and may even be at a higher risk of death because of the disease.

"World News" asked viewers to respond to the Oct. 19 story and they did in the hundreds.

Below are some of the main questions and concerns about hormone replacement therapy and answers from Dr. Marie Savard, an ABC News medical contributor.

What are some of the alternatives to using HRT?

A number of non-hormone treatments have been tried to treat the vasomotor symptoms (such as hot flashes/drenching sweats) of menopause, including soy foods, the herb black cohash, acupuncture and prescription medications such as the antidepressant Effexor and the anti-seizure medication Neurontin.

Although the prescription medications have been tested in clinical studies and found effective for women, the alternative treatments such as soy foods, black cohash and acupuncture have all been inconsistently effective in most small studies. In my practice, I have found that although nothing works as well as estrogen to manage hot flashes, most women are willing and eager to try a number of these non-hormonal treatments and view taking estrogen as a last resort.

The good news is that for most (but not all) women hot flashes will eventually subside.

How dobio-identicals work? Are bio-identical hormones a safer alternative to use? Are bio-identical better, less dangerous than synthetic hormones?

When the Women's Health Initiative study was stopped because the risks of Prempro were thought to outweigh the benefits, a lot of women turned to "bio-identical" hormones, primarily soy-based hormones made primarily by compounding pharmacies. These hormones purportedly customize the hormone dosages to suit any given woman's needs and thus the term "bioidentical."

The problem with bioidentical hormones is that the preparations mixed by the compounding pharmacists have never been tested for safety or efficacy in large studies and there is no reliable way to test a woman's hormone levels to determine exactly what she needs.

Ironically, proponents of the bio-identicals made by compounding pharmacies often claim that these preparations are safer because they are "natural." That's such a reassuring word but they are still hormones and there's no reason to believe they are any safer than pharmaceutical hormones, which have been subject to rigorous testing.

What advice can you give women who did not have hormone theraphy during menopause, but still got breast cancer, and are now being treated for other cancers with hormone therapy?

Women with a diagnosis of breast cancer or who are at very high risk of breast cancer are usually advised not to use estrogen therapy. Indeed, the hormone treatments such as Arimidex and Tamoxifen work by reducing or blocking estrogen effects in the breast and are therefore often referred to as "anti-estrogen" hormones. They often cause hot flashes and drenching sweats similar or even more annoying than symptoms of natural menopause.

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