Getting Answers After HRT Linked to High Cancer Risk

Oct. 28, 2010 — -- 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.

Over-the-counter progesterone cream would generally not be recommended for a woman diagnosed with breast cancer and I am not certain from your question why you are on progesterone cream and how it is helping you. Some women use progesterone cream, which does not require a prescription during the peri-menopausal period (the months to years leading up to menopause; a time when estrogen and progesterone levels can be erratic) to treat the symptoms of hot flashes, irregular periods and mood changes.

Is the risk higher for women of natural menopause as opposed to women of surgical menopause? What is the risk for women who are on Premarin and have had a hysterectomy?

The study reported in the segment was describing only women who had not had a hysterectomy and who were therefore on a combination of estrogen and progestin (Prempro). The Women's Health Initiative (the original research reported in the segment) also studied women with hysterectomies who were taking estrogen only in the form of Premarin.

Women with a hysterectomy do not need progestin, which is solely given to prevent the uterine lining build-up that estrogen can cause. These women taking estrogen only after their hysterectomy did not have an increased risk of breast cancer in the very same study. Indeed, their risk of breast cancer was slightly lower than women on the placebo or sugar pill but not considered statistically significant.

This finding gets much less attention but does lead many physicians to suspect that it is primarily the daily use of the synthetic progestin in the Prempro combination that contributed to the breast cancer risk. Most women, after a hysterectomy (women who have not had cancer), are advised to take estrogen at least up until the age of natural menopause, about 52.

On the other hand, some physicians recommend continuing estrogen for longer as it has been found to reduce osteoporosis and fracture risk and to reduce colon cancer risk, as well. Your physician can help you decide when and if you should taper off estrogen based on your personal and family history.