For about 25 million menopausal women, hormone replacement therapy offers relief from the discomforts of hot flashes and night sweats, even though its use has been associated with a slightly elevated risk of some cancers.
Now another reason why women may want to rethink hormone replacement therapy or HRT.
Tracking more than 16,000 post-menopausal women, researchers at UCLA gave half hormone therapy and the other half a placebo. The hormones consisted of a combination of estrogen and progesterone.
Five years later, among the women in the hormone group - 199 women developed breast cancer. 150 in the non-hormone group did.
And among those in the hormone group, 35 percent had abnormal mammograms versus 23 percent in the non-hormone group. Those lead to breast biopsies in 10 percent of hormone group women versus 6.1 percent in the placebo group.
An increase in breast density from hormones may explain why the mammograms show more abnormalities.
This may mean its time to rethink the standard mammogram as a diagnostic tool.
Digital mammograms are already found to be more useful in women with dense breasts and some women in high-risk group use MRIs. But there are no answers on what alternatives can improve the accuracy of a diagnosis.
“We should also ask whether we should be developing more imaging technologies” beside the mammogram, Dr. Rowan Chlebowski, an investigator with the Los Angeles biomedical Research Institute at Harbor-UCLA Medical Center and the study’s author said.
“This is really definite evidence that hormones interfere with breast cancer diagnosis. We have other imaging techniques, and this could be a signal that we need more of that research.”
However, in a prepared statement, Chlebowski said, “these findings represent a concern for post-menopausal women who are considering hormone therapy. They should take the results of this study into consideration and consult with their physicians before undergoing even short-term hormone therapy.”
Doctors already knew that women on HRT had tougher to read mammograms because of denser breast tissue.
Thousands of women have disabling symptoms of menopause. Many choose “natural” or bioidentical hormones such as those being promoted by former TV star Suzanne Somers. But the FDA says not much is known about them and in January warned makers against health claims.
The truth is traditional doctors don’t spend much time studying alternatives.
Chlebowski tells U.S. News and World Report that the devil you know is probably better than the devil you don’t. “I don’t think there’s any reason to think they’d behave differently in the breast than synthetic hormones” he tells Deborah Kotz of U.S. News.
For those women Chlebowski says HRT maybe worth the risk of an abnormal mammogram or breast biopsy.
The study did not look at women who were taking estrogen therapy alone.
The Women’s Health Initiative, that this was part of, had to be halted in 2002 when the participants showed an increase in the risk of heart disease, stroke and breast cancer. For younger women who started at the beginning of menopause the risks were minimal.
Writing in the blog on U.S. News, contributor Neil Raden says- “Rowan Chlebowski's "study" is just more sifting of the largely flawed Women's Health Initiative. There is nothing new here. First of all, there are not only different substances in "hormone replacement therapy," there are different protocols - by mouth, transdermal, etc. Dosing schedules in a rhythm or not, or the levels. Which ones are taken together. All the WHI can prove is that some rather old women (most over 60) show these patterns when taking drugs from Wyeth - Premarin or Prempro. It's bad enough that our tax dollars go to these tainted studies, it's even worse when the media reports them and gives them more credibility than they deserve.
The "devil you know argument" is a terrible approach when it comes to people's health.”
Dr. Jeffrey Dach of Hollywood Florida, an anti aging doctor says The Women’s Health Initiative study published in JAMA July 2002 showed that Provera, a chemically altered form of progesterone causes increased risk of cancer and heart disease, while the natural, human bioidentical progesterone does not.
This study appears in the Monday issue of the Archives of Internal Medicine. #