New Government (USPSTF) Warning on Hormone Replacement Therapy Risks






 

A new report by a U.S. Government task force (USPSTF) recommends against the use of hormone replacement therapy due to serious health risks.



 

NEW GOVERNMENT (USPSTF) WARNING ON HORMONE REPLACEMENT THERAPY RISKS

As I discuss in my bestselling book, A Cancer Prevention Guide for the Human Race, there is now solid evidence that the most commonly used form of hormone replacement therapy (HRT) is associated with a significant increase in the risk of developing breast cancer, and that risk continues to rise with the duration of HRT use.

Like many cancer experts, I have taken issue with some of the U.S. Preventive Services Task Force’s (USPSTF) recent revisions of longstanding cancer screening recommendations, including, particularly, their 2009 recommendation that annual screening mammograms be started later in life than most experts have recommended (and continue to recommend), and performed less frequently among middle-aged women than most experts have also recommended.  More recently, in 2011, the USPSTF’s blanket recommendation that routine PSA screening for prostate cancer be largely abandoned has not been warmly embraced by me, nor by many other cancer prevention experts, given that we still cannot determine, in advance, which men with prostate cancer will be helped by treatment for this disease and which men will not benefit (and, hence, may actually even be harmed) by being treated because they have an indolent form of prostate cancer that poses no threat to their lives (Does PSA Testing for Prostate Cancer Save Lives?).

Now, the USPSTF is weighing in on another controversial cancer-related issue: hormone replacement therapy. Prior to 2002, more than half of all American women took some form of HRT to treat the common symptoms of menopause, including hot flashes, night sweats, vaginal dryness, and irritability.  As I discuss in my forthcoming book on the tragic history of HRT, The Manufactured Myths of Menopause and Hormone Replacement Therapy: A Legacy of Suffering and Death, the intentionally deceptive multi-decade marketing of HRT drugs as a panacea for the both the real and imagined consequences of menopause, and the skillful (if duplicitous) portrayal of menopause as a pathological disease that renders its “victims” something less than feminine, was only recently revealed to be a collection of gross distortions (to put it mildly) on the part of the dominant manufacturer of HRT medications.  Thanks to the landmark findings of the enormous Women’s Health Initiative study, which was published in the Journal of the American Medical Association in 2002, we now know that long-term HRT use is clearly associated with an increased risk of multiple and serious health problems, including an increased risk of breast cancer.

The USPSTF is now about to weigh-in on the issue of HRT, in a paper that is to be released in the June 4th issue of the Annals of Internal Medicine.  Unlike their other recent controversial pronouncements, however, I actually find the USPSTF’s new recommendations against the routine use of HRT to be very close to my own recommendations, and so I am including their review of the existing clinical research data on HRT in this column.

After comprehensively reviewing the data from 9 different prospective, randomized, placebo-controlled, blinded clinical studies (including the massive Women’s Health Initiative study), the USPSTF study group determined that both estrogen-progesterone (combination) HRT and estrogen-only HRT significantly increased the risk of stroke, potentially fatal blood clots (venous thromboembolic disease), gallstones, and urinary incontinence.  Estrogen-progesterone (combination) HRT was also, once again, shown to be associated with a significantly increased risk of breast cancer, as well as a probable increase in the risk of dementia.  (On the other hand, estrogen-only HRT, which can only be taken by women who have previously undergone hysterectomy, appears to actually decrease the risk of developing breast cancer, while both types of HRT also appear to reduce the risk of osteoporosis-associated bone fractures.)

Based upon the increasingly large amount of available clinical research data, HRT, of any type, cannot currently be recommended for routine long-term use, given the multiple and significant health risks associated with both estrogen-only and estrogen-progesterone forms of HRT.  After decades of intentionally misleading advertising by the manufacturer of the two most frequently prescribed forms of HRT, and the manufacturer’s intentional co-opting of numerous women’s physicians over the years, the true risks associated with the long-term use of HRT have now become abundantly clear.  I will have much more to say about this cautionary tale when The Manufactured Myths of Menopause and Hormone Replacement Therapy: A Legacy of Suffering and Death is published in early 2013….


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.




Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


 

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 







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Hormone Replacement Therapy (HRT) and Breast Cancer Risk

 

Welcome to Weekly Health Update



“A critical weekly review of important new research findings for health-conscious readers”



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OCTOBER IS NATIONAL BREAST CANCER

 

AWARENESS MONTH

 

 

 

HORMONE REPLACEMENT THERAPY (HRT)

AND BREAST CANCER RISK

The rising incidence of breast cancer, year-after-year, over the past 50 years in the United States (and in many other industrialized countries) has been attributed to a variety of factors, including environmental contaminants, rising obesity levels, and increased compliance with annual screening mammograms, among others.  However, one factor that has been given inadequate attention, in my view, is that of hormone replacement therapy (HRT), despite nearly a century of data showing a strong linkage between lifetime exposure to the female hormones estrogen and progesterone and the risk of developing breast cancer.

In 2002, the enormous, randomized, prospective, blinded Women’s Health Initiative (WHI) study published its preliminary results, and prematurely terminated its combination HRT study because of an alarming increase in the incidence of breast cancer in the group of women who had been secretly randomized to receive combination HRT medications for menopausal symptoms.

Despite subsequent updates from the WHI, which have shown, essentially, a doubling of breast cancer risk after more than 5 years of HRT use, there was initially a great deal of resistance to the WHI’s findings (and the findings of other similar clinical research trials) linking HRT use with an increased risk of developing breast cancer.

Now, a new national Canadian public health study offers additional powerful clinical research data linking HRT use with breast cancer risk, and reveals the equally strong link between declining HRT use and the declining breast cancer incidence in Canada.  This study appears in the current issue of the Journal of the National Cancer Institute.

In this study, 1,200 women between the ages of 50 and 69 participated in the National Population Health Survey between 1996 and 2006.  Just prior to the 2002 release of the WHI study’s results, 13 percent of these women regularly used combination HRT.  By December 2004, only 5 percent of the postmenopausal women participating in this study were still taking HRT medications.  During this same period, the incidence of breast cancer in this large group of Canadian women decreased by about 10 percent.  (Importantly, compliances rates with screening mammograms did not change during the course of this clinical research study.)

Thus, between 2002 and 2004, when HRT use significantly declined, the incidence of breast cancer decreased by about 10 percent in Canada.  Moreover, this significant decrease in breast cancer incidence occurred without any change in mammogram rates.

This study, as with other recent studies, adds to the overwhelming research data linking HRT use with an increased risk of developing breast cancer.  As I tell my own patients who are approaching menopause, it is best to avoid HRT altogether.  If you are already taking HRT medications, then ask your doctor to help you in weaning yourself off of these medications.

 

In recognition of Breast Cancer Awareness Month, I urge our tens of thousands of regular Weekly Health Update readers to join in the global fight against breast cancer.  There are numerous organizations and groups, in virtually every community, that are sponsoring fundraising activities throughout October, including the Susan G. Komen Race for the Cure.  Another opportunity to participate (and at no cost!) is to vote for the Dr. Susan Love Research Foundation Army of Women project in the Pepsi Refresh competition!  There are also many other worthwhile and deserving fundraising programs available for everyone to become involved in! 

 

For a deeper evidence-based discussion of the links between HRT and breast cancer risk, order your copy of my new book, A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!


 


 

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity




Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author




For a different perspective on Dr. Wascher, please click on the following YouTube link: 

Texas Blues Jam



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month.  (As of 9/16/2010, more than 1,000,000 health-conscious people have logged onto Weekly Health Update so far this year!)  As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.



 

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All Forms of Hormone Replacement Therapy (HRT) Increase Breast Cancer Risk

 

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”


ALL FORMS OF HORMONE REPLACEMENT THERAPY (HRT) INCREASE BREAST CANCER RISK

One of the most common questions that I am asked is if there are any safe forms of hormone replacement therapy (HRT) for women who are experiencing severe symptoms associated with menopause.  Since the release of the preliminary results of the pivotal Women’s Health Initiative study, in 2002, which clearly showed that standard combination HRT (containing the two primary female sex hormones) was associated with a significant increase in the risk of developing breast cancer, a number of alternative “safer” forms of HRT have been proposed.  These alternative forms of HRT have included transdermal estrogen patches (which are placed on the skin) and other forms of “bioidentical” HRT hormones. 

Advocates of transdermal estrogen patches note that the adverse effects of estrogen-based HRT pills on cholesterol, as well as their association with an increased risk of life-threatening blood clots, may be lower with transdermal patches when compared to oral HRT medications. 

Proponents of “bioidentical” HRT, in which the active ingredient is the same chemical form of estrogen (estradiol) that is manufactured in the ovaries prior to menopause, have also made abundant health-related claims for this form of  HRT when compared to the more commonly prescribed cocktail of mixed forms of estrogen derived from the urine of pregnant mares.  Unfortunately, there is almost no solid clinical research evidence available to support these claims that “bioidentical” HRT is safer, or more effective, than the more commonly prescribed “conjugated equine estrogens.”  (Within the estrogen-sensitive cells of a woman’s body, estrogen receptors really don’t care much whether estrogen-like hormones come from horse urine or from the human form of estrogen; nor do they care whether or not estrogen-like hormones enter the body in the form of a pill versus being absorbed into the bloodstream through a transdermal patch.)

As the Women’s Health Initiative study’s breast cancer risk findings were far more robust for the combination HRT pill that has been commonly prescribed for menopausal women (because estrogen-alone HRT increases the risk of uterine cancer, as well…), many patients, and their doctors, have held out the hope that low-dose estrogen-only HRT might be a safer alternative to traditional combination HRT.  However, a recently published research paper from the enormous European EPIC public health study casts serious doubt about the assumption that alternative forms of HRT are safe from the standpoint of breast cancer risk.

This research paper, which has been published in the International Journal of Cancer, is an update of the huge European Prospective Investigation into Cancer and Nutrition (EPIC) study, in which 134,744 postmenopausal women throughout Europe were evaluated.  After nearly 9 years of follow-up, on average, 4,312 new cases of breast cancer were diagnosed within this extremely large group of patient volunteers. 

When compared to women who had never used HRT, the women who were currently using combination HRT during the course of this clinical study experienced a 77 percent increase in the relative risk of developing breast cancer (similar to what has been shown in the Women’s Health Initiative study, and in other similar prospective clinical research studies).  However, the greater contribution of this study to our understanding of the risks of HRT was the finding that estrogen-only HRT also increased the risk of breast cancer, as there was a 42 percent increase in the relative risk of breast cancer among the women who were taking various forms of estrogen-only HRT.  Moreover, this increased breast cancer risk among users of estrogen-only HRT was the same for both oral and transdermal forms of estrogen-only HRT.

The results of this giant, multi-national prospective public health study are of great importance, as it is many times larger than most of the studies that have preceded it, including the Women’s Health Initiative study.  These results from the ongoing EPIC study emphasize the point that I have made to patients for almost two decades, now:  The biology of the receptors in cells that respond to estrogen, and other estrogen-like molecules, has been well understood for decades now.  Any substance that stimulates these estrogen receptors automatically sets off a cascade of biochemical reactions with the same end biological result.  We have long known that prolonged exposure to estrogen (whether from a woman’s own ovaries, or from HRT medications) increases the risk of breast and uterine cancer, and also increases the risk of blood clots, gallstones, and other serious illnesses.  (More recent data has also implicated combination HRT in the development of cardiovascular disease and dementia in women.)

Based upon the findings of this very large prospective public health study, my advice to women remains the same as it has been for almost 20 years.  If you are going through menopause, do not use HRT medications.  If you are already using HRT medications, then ask your doctor to help in weaning you off of them.  If you are one of the approximately 3 to 5 percent of postmenopausal women who have unbearably severe hot flashes, or other severe symptoms of menopause, and you are currently using some form of HRT medication, then work with your doctor to reduce the dose of your HRT medicine to the lowest possible level that adequately treats your symptoms.

 

For more information on HRT and cancer, please click on the following links to my previous columns on this topic:

Hormone Replacement Therapy (HRT) & Ovarian Cancer

Hormone Replacement Therapy (HRT) & Breast Cancer; Stool DNA Testing & Cancer of the Colon & Rectum

Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection

Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention

Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death

Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?

To learn more about the critical role of hormone replacement medications and the risk of cancer, look for the publication of my new landmark book, “A Cancer Prevention Guide for the Human Race,” in the summer of this year.



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg



I and the staff of Weekly Health Update would like to take this opportunity to thank the more than 100,000 new and returning readers who visit our premier global health information website every month.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.



 

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