Researcher: Estrogen-only therapy may prevent breast cancer in some women
Estrogen-only hormone replacement therapy may benefit younger postmenopausal women who do not have a uterus, a Canadian researcher said Thursday at the annual meeting of the San Antonio Breast Cancer Symposium.
Dr. Joseph Ragaz, an oncologist at the University of British Columbia, presented a re-analysis of the Women’s Health Initiative — which originally concluded that both long-term estrogen-only and estrogen-plus-progestin hormone replacement were too risky for most women.
But Ragaz said his take on the data suggests that using only estrogen — for women who do not have a uterus and do not need progestin — protects against breast cancer. He found that subsets of women, such as younger postmenopausal women and those with no strong family history of breast cancer or benign breast disease, had a lower risk of breast cancer after using estrogen-only therapy and reaped other health benefits, such as a lower risk of heart disease.
Ragaz says studies are needed to determine whether estrogen produced by the body, called endogenous estrogen and which is known to fuel cancer growth, and outside sources of estrogen (called exogenous) have different effects on breast-cancer risk.
“Our conclusion, which is potentially a new paradigm, is that we see a dual effect,” Ragaz said. “On a research level, we have to identify the mechanisms or biology that would distinguish exogenous-estrogen benefits from the carcinogenic effects of the endogenous estrogen.”
The study was called “provocative” by Dr. Judy Garber, an associate professor of medicine at the Dana-Farber Cancer Institute. But she said the idea called for further study and that the current guidelines for women regarding hormone therapy shouldn’t change.
Women Fail to Get Annual Mammograms as U.S. Physicians Debate Frequency
Half of U.S. women ages 40 or older failed to get an annual mammogram for breast cancer last year, said researchers concerned that women are confused by the debate about the effectiveness of the screenings.
The study, sponsored by Medco Health Solutions Inc., reviewed records for 1.56 million patients from January 2006 through December 2009. About 207,000 new cases of invasive breast cancer in women will be diagnosed and almost 40,000 women will die from the disease this year, according to the Atlanta- based American Cancer Society.
As death rates from the disease decreased over the last 10 years, the debate over how frequently to get a mammogram has grown. The cancer society recommends that women ages 40 or older get screened every year. In November 2009, the U.S. Preventive Services Task Force advised women 50 or older to undergo a mammogram only once every two years, and patients younger than 50 to get one only if they carry risk factors for the disease.
“As controversy becomes public and there’s so much back- and-forth, it becomes confusing for women,” said Milayna Subar, lead author of the study reported today at the San Antonio Breast Cancer Symposium, in a telephone interview. “This study shows the need to put programs in place to educate women and remind them to do it.”
Medco, based in Franklin Lakes, New Jersey, is the largest U.S. pharmacy benefit manager by number of prescriptions. Subar, a physician, heads the company’s Oncology Therapeutic Resource Center, which seeks ways to suggest health improvement for members of the health plans it serves.
Hormone Therapy
The mammogram research was among studies presented today including new findings on the use of hormone therapy, and on the risk of death for obese women with a type of breast cancer.
Mammography has been shown to reduce death rates 20 percent to 30 percent among women 40 or older, according to the National Quality Measures Clearinghouse, an agency under the U.S. Department of Health and Human Services. The decrease stemmed from earlier detection through screening and from improved treatment, the cancer society has said.
Sixty-five percent of the study’s 708,290 women ages 50 to 64 — considered the “must-do group” — had a mammogram at least twice during the four-year period, Subar said.
“That still leaves 35 percent not getting mammograms even every other year,” she said. Fifty-seven percent of the 406,746 women ages 40 to 49 had a mammogram on average at least twice during the four-year period, and 47 percent had one screening on average every year.
Estrogen and Cancer
In a second study presented today at the San Antonio symposium, researchers reported that giving estrogen alone to older women who don’t have a uterus may reduce rather than increase their risk of breast cancer.
The study found a 20 percent reduction in breast cancer for older women who took estrogen alone, compared with a placebo, for postmenopausal hormone therapy. The study, from scientists who re-examined data from the Women’s Health Initiative trial, looked only at women who didn’t have a uterus.
Millions of patients had already stopped taking hormone replacement therapy after 2002 when the Women’s Health Initiative found a higher risk of breast cancer in postmenopausal women getting hormone treatment with both estrogen and progestin. The trend of avoiding estrogen-only treatment needs to be reversed, said Joseph Ragaz, the lead researcher for the new analysis.
Thousands of Lives
“We will be saving thousands of lives every year if we use hormone replacement therapy for menopause,” said Ragaz, a medical oncologist and a clinical professor at the University of British Columbia in Vancouver. “Women will not only have quality of life improvement by handling menopause more easily, they will also have substantial benefits on bone fractures, colon cancer and now breast cancer.”
Ragaz said estrogen-alone therapy should be given only to women who don’t have a uterus, because the hormone raises the risk of uterine cancer. Women who have undergone surgery to remove their uterus, called a hysterectomy, are typically candidates for estrogen-only therapy.
Ragaz and other researchers looked at 10,739 women without a uterus who were part of the estrogen-only trial of the Women’s Health Initiative. Half received a placebo and the other half, the drug Premarin, made by Pfizer Inc.’s Wyeth unit.
While women getting estrogen showed a 20 percent lower risk of breast cancer, the reduction was 30 percent to 40 percent in patients who had a low risk at the start of the study, Ragaz said. Those included women with no strong family history of breast malignancy.
Adds to Research
The analysis adds to research suggesting estrogen alone can lower breast cancer risk and that the hormone may have a place for treating menopausal symptoms, said JoAnn Manson, a principal investigator for the Women’s Health Initiative, a 15-year program organized by the U.S. National Institutes of Health.
“Estrogen still has a clinical role in the management of moderate to severe hot flashes and other menopause symptoms, especially in women who are closer to the onset of menopause,” said Manson, chief of the Division of Preventive Medicine at Brigham & Women’s Hospital in Boston and a professor at Harvard University.
Another study presented today at the San Antonio meeting found that women who are obese and have a type of breast cancer fueled by estrogen are more likely to die of the disease than their slimmer peers.
Obesity Risk
Adult women with body mass indexes of 30 or above are 42 percent more likely to die of estrogen-receptor positive/HER-2 negative disease, the study found. Two-thirds of all breast cancers are fed by estrogen, according to the National Institutes of Health.
Today’s study suggests that breast cancer patients who are already overweight or obese should make an effort to avoid further weight gain, said study author Joseph Sparano, the associate chairman of the oncology department at Montefiore Medical Center.
“We may need to pay greater attention to nutrition, and include a nutritional evaluation for someone who has breast cancer,” said Sparano, who is also a professor of medicine at the Albert Einstein College of Medicine, in a telephone interview.
Body mass index, or BMI, is a measure of weight and height, with a 5-foot 4-inch woman weighing 175 pounds having a BMI of 30. BMI of 30 or more is considered obese, while a BMI of 25 to 29.9 is considered overweight, according to the National Institutes of Health.
Third of Population
About a third of the U.S. adult population is obese, according to the Atlanta-based Centers for Disease Control and Prevention.
The study examined 3,484 people, of which 2,115 had breast cancer that was hormone-receptor positive, HER2-negative. HER2- negative cancer doesn’t produce a protein called HER2, which is a sign of a type of aggressive breast cancer generally treated with Roche Holding AG’s Herceptin.
It may be that obese women have more estrogen, since fat cells play a role in synthesizing it, Sparano said. It may also be related to insulin levels, since higher levels of the hormone have also been associated with increased breast cancer risk, he said.
The rise of binge drinking women
As a nation, when it comes to booze and women, we’ve failed. I’m not being judgey here, I mean we literally received a big fat “F” in that category on the latest women’s health report card. The culprit is binge drinking: The percentage of women who have “had five or more drinks on at least one occasion during the past month” has gone from 7.3 percent in 2007 to 10.6 percent this year, according to the National Women’s Law Center’s annual report, “Making the Grade on Women’s Health.”
No surprise here. We’ve been following the rumblings over the trend of lady bingers for some time now, and the question often seems to be, as a 2008 New York magazine article put it: “should gender equality extend to drinking?” My answer is: yes and no. I’m more likely to order a beer and a shot of whiskey than a cosmo. I like to go against stereotypes like that. It is cocky and perhaps foolish — but, then again, the same can be said for my male friends when it comes to drinking. I might be driven by some vaguely third-wave feminist desire to “keep up with the boys” — but plenty of “the boys” are driven to keep up with each other, lest they appear unmanly. This is binge culture, and it isn’t strictly male or female anymore. We’re all full of bluster and far too much booze.
That doesn’t mean the impact is equal, though. A female friend wrote to me in an e-mail, “I’m of the opinion that, yes, gender equality means you get to drink however the eff you want and you don’t have to be confined to ‘dainty’ drinks and expected to drive the boys home or whatever. But with great binge-drinking comes great responsibility, you know? I’ve had to do a serious gut check in the past year about this because excess drinking affects women differently.” It’s true: Women’s bodies are not only generally smaller than men’s but they also metabolize alcohol differently. I’ve boasted that I could drink my male friends under the table, and I have at times through sheer force of will. Not even my iron will can force my liver to process booze differently, though.
Of course, it isn’t just physiological sex differences that raise concern here, it’s also sex, as in sex. The researchers find binge drinking troubling for many reasons, but especially so because hard-boozing women experience “more sexual-assault problems,” Michelle Berlin, an associate professor at the Oregon Health and Science University School of Medicine, tells the New York Times. These are the unfun facts: Alcohol is processed differently by women’s bodies, and it’s associated with higher rates of sexual assault. We should be able to be real about this without blaming women who are raped while intoxicated. (Unfortunately, this continues to be a really tough concept for some to grasp.) We should also be able to acknowledge the simple fact that women, like men, can make dumb sexual decisions while drunk.
If we must talk about binge-drinking in terms of feminism, it seems to me that a real victory would mean recognizing the impact hardcore boozing has on both sexes, and with a little more perspective. After all, binge drinking is much higher among men than women. Men are more likely to drive drunk (although young women are increasingly driving under the influence). Boozing college-age males are more likely than women to: land in the hospital, be physically assaulted, be involved in an accident where someone is injured, and break the law, according to a U.K. study. As I wrote in response to the New York magazine piece a couple of years back, “young women’s sometimes confused struggle for equality in their day-to-day lives … can result in their acting the part of stereotypical men, in ways that don’t seem particularly halthy for either sex.”