Cancer News
Hormone Therapy Worsens Breast Cancer, Study Finds
Hormone treatment after menopause, already known to increase the risk of breast cancer, also makes it more likely that the cancer will be advanced and deadly, researchers are reporting.
The treatment studied was the most commonly prescribed hormone replacement pill, Prempro, which contains estrogens from horse urine and a synthetic relative of the hormone progesterone.
In recent years women have been urged to minimize hormone use, and the new findings lend that advice even more weight, according to the first author of an article published this week in The Journal of the American Medical Association.
Many doctors assume that women can safely take hormones for four or five years for menopause symptoms like hot flashes and night sweats, said Dr. Rowan T. Chlebowski, the first author and an oncologist who treats breast cancer patients at the Harbor-UCLA Medical Center in Torrance, Calif.
“I don’t think you can say that now,” he said. “I know some people have to take it because they can’t function, but the message now is that you really should try to stop after a year or two.”
Dr. Chlebowski said it was not known whether there is any length of time for which these hormones can be taken without increasing breast cancer risk.
The new information comes from the continuing follow-up of 12,788 women who were in the Women’s Health Initiative, a major federally financed study that compared women taking hormones with a group taking placebos. The study was halted in 2002, three years ahead of schedule, because researchers found that the hormones were causing small but significant increases in the risk of breast cancer, heart disease, strokes and blood clots in the lungs.
The 2002 study had a huge impact. Before it came out, there was a widespread belief that hormones would reduce women’s risk of heart disease and generally keep them youthful, sexy and healthy. For many doctors and patients, the study shattered that faith.
Six million American women had been taking hormones, but the number quickly fell by about half. The breast cancer rate also began to decrease soon after, and many researchers attribute the decrease to the drop in hormone use.
The new report increases the average follow-up time to 11 years from the original 5.6 years. It is the first report from the Women’s Health Initiative that includes death rates from breast cancer related to hormone use.
The researchers found small but significant increases in several harmful effects in women who took the hormones. As the study previously showed, women taking hormones are more likely to develop invasive breast cancer. Their rate of the disease was 0.42 percent per year, compared with 0.34 percent per year in the placebo group.
Among women with breast cancer, those who took hormones were more likely to have cancerous lymph nodes, a sign of more advanced disease — 23.7 percent, versus 16.2 percent in the placebo group.
More women who took hormones died from breast cancer — 0.03 percent per year, versus 0.01 percent per year in the placebo group. That translates to 2.6 deaths per 10,000 women per year among those taking hormones, twice as many as the 1.3 deaths per 10,000 in the placebo group.
Among women who had breast cancer, those who took hormones also had a higher death rate from other causes — 0.05 percent per year, versus 0.03 percent per year. In other words, there were 5.3 versus 3.4 deaths per 10,000 women per year — 1.9 extra deaths in hormone users.
It is not known for sure why the women taking hormones had more advanced tumors. But previous research has found that hormone treatment can cause delays in diagnosis by increasing breast density, making tumors harder to see on mammograms.
The more advanced state of the tumors in women taking hormones may help explain their increased death rate from breast cancer. Dr. Chlebowski said that in theory, the hormones may also help breast cancer and other cancers to grow and spread — which makes them more deadly — by stimulating the formation of blood vessels that feed tumors. He said that a report last year from the Women’s Health Initiative also found that although hormone treatment did not increase women’s rate of lung cancer, hormone use was linked to a higher death rate among women who had the cancer.
Another author of the new study, Dr. JoAnn E. Manson, a professor of medicine at Harvard Medical School and Brigham and Women’s Hospital, said women should not take the hormones at all unless they really need them, for moderate to severe symptoms like hot flashes and night sweats that disrupt sleep and really ruin their quality of life.
“It would be wonderful if there were effective options for women with moderate to severe hot flashes and night sweats that provided quality-of-life benefits without risks,” Dr. Manson said.
At the same time, she said, the new information should not necessarily alarm women who have taken the hormones, because the new report found only 1 to 2 additional breast cancer deaths per 10,000 women per year among those taking hormones.
Dr. Manson said it was the women who took hormones the longest who had the real increase in risk.
“The data suggest it is cumulative long-term use,” Dr. Manson said. “Women should avoid long-term use. I think that’s the bottom line.”
She said that women who want treatment should take the lowest possible dose that eases their symptoms.
Noting that many women are taking other hormone formulations in hope of avoiding Prempro’s risks, Dr. Manson said little was known about the drugs and more research was urgently needed.
“We really need to know what the health effects are,” she said.
She said more research was also needed to find out whether women who took hormones early in menopause had the same risks as women who started the drugs later.
An editorial accompanying the journal article said that the researchers had probably underestimated the increase in deaths from breast cancer due to hormone therapy, and that “with longer follow-up, the deleterious effect will appear larger,” even though the women are no longer taking the drugs.
The editorial writer, Dr. Peter B. Bach, a physician at Memorial Sloan-Kettering Cancer Center in New York, said that although the increase in cancer in the study might seem small, it becomes large when multiplied out over the population. He also questioned the advice being given to women, to consult their doctors about risks and benefits, and to take the lowest possible doses of the hormones for the shortest possible time. Like Dr. Chlebowski, he said there was no data to determine whether there is any safe interval.
“The fallback is that doctors and patients should be deciding this on a one-to-one basis, weighing risks and benefits,” Dr. Bach said in an interview. “How do you do that when you don’t know what the risks are? It’s a data vacuum. You can’t counsel your way through a clinical decision when you don’t have information.”
He added, “If you care about preventing this disease and keeping women from suffering and dying from it, then it’s hard to look at these drugs and not have serious concerns about them being used, even for what are intended to be relatively short periods of time.”
Stars Make Strides Against Breast Cancer
The Lincoln Stars hockey team and the American Cancer Society are pleased to announce that over $15,000 was raised for the “Making Strides Against Breast Cancer” campaign over the past weekend. The Stars wore specially-designed Breast Cancer-themed jerseys for their game against the Waterloo Blackhawks on Friday, October 15th at the Ice Box. The jerseys were sold in a live auction immediately following the conclusion of the game to benefit the American Cancer Society (ACS).
In addition, “Breast Cancer Awareness” t-shirts were sold at the game to raise additional funds. In total from the jersey auction and t-shirt sales, the Stars raised $15,150 for the American Cancer Society.
“We are so proud to partner with the American Cancer Society for the third season in the ‘Making Strides Against Breast Cancer’ campaign. Through the generosity of our fans, we’re able to raise funds in the fight against cancer and hopefully save lives,” said Jen Morand, Director of Corporate Sales and Marketing for the Lincoln Stars.
The event was sponsored by Art FX Screenprinting & Imaging, 92.9 The Eagle, Texas Roadhouse and FastFrame Lincoln.
Wyeth Wins Latest Trial Over Drugs’ Cancer Risk
A federal jury has sided with Wyeth Pharmaceuticals in the latest lawsuit that accused the drugmaker of not disclosing a link between its hormone replacement therapy and a higher risk of breast cancer.
A Little Rock jury deliberated briefly Tuesday before siding with Wyeth, which argued that it adequately warned doctors and patients of the risks associated with its Prempro and Premarin drugs.
Margaret Wilson and her husband, Billy Wilson, sued the drugmaker after she developed breast cancer after taking Prempro for 4½ years. The suit was one of thousands pending nationwide over the hormone replacement therapy.
Pfizer Inc. bought Wyeth for $68 billion in 2009.
Novak diagnosed with breast cancer
Actress Kim Novak has been diagnosed with breast cancer.
Novak, best known for her starring role in the 1958 classic Vertigo, is undergoing cancer treatment and is expected to make a full recovery, according to her manager, Sue Cameron.
“It was caught early by a routine yearly mammogram and is undergoing treatment,” Cameron told The Hollywood Reporter.
“All her doctors say she is in fantastic physical shape and should recover very well.”
Novak, 77, has also featured in notable films including Picnic, Pal Joey and Bell, Book and Candle.
She last appeared in Liebestraum in 1991, but her scenes were cut following a dispute with director Mike Figgis.