Fw: Estrogen, Ovarian Cancer Linked Finding Toughens Choices on Post-Menopause Hormone Use

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From: " ilena rose " <ilena@...>

Sent: Thursday, March 22, 2001 12:25 PM

Subject: Estrogen, Ovarian Cancer Linked Finding Toughens Choices on

Post-Menopause Hormone Use

>

> Estrogen, Ovarian Cancer Linked Finding Toughens Choices on Post-Menopause

> Hormone Use

>

> By Okie

> Washington Post Staff Writer

>

> Wednesday, March 21, 2001; Page A01

>

> Women who take estrogen for 10 years or longer after menopause

> substantially increase their risk of dying of ovarian cancer compared with

> women who do not take the hormone, according to a study released

yesterday.

>

> During the 14-year study of more than 211,000 post-menopausal women, those

> who had been taking the hormone for a decade or more at the start of the

> project had more than twice the death rate from ovarian cancer seen in

> women who had not taken estrogen. Women who had taken estrogen for less

> than 10 years had a slightly higher risk than nonusers, but the difference

> was not statistically significant.

>

> Previous studies of estrogen use and ovarian cancer have yielded

> inconsistent findings, although some have suggested cancer risk might be

> increased in long-term users. The new study is the largest so far and the

> only one to question women about risk and then follow them for an extended

> period, monitoring cancer deaths.

>

> Although cancer of the ovary is rare, it is particularly serious because

in

> most cases, the tumor has spread by the time it is detected. A woman at

> average risk has about a 1 in 59 chance of developing ovarian cancer

> sometime during her life, compared with a 1 in 9 lifetime chance of breast

> cancer. Cancer of the ovary kills about 14,000 women in the United States

> annually.

>

> Experts said the new findings are likely to further complicate women's

> already difficult decisions about whether to take hormones after

menopause.

> An estimated 8.6 million post-menopausal women in the United States take

> combination hormone therapy with estrogen and progestin, and an additional

> 12 million (who have had hysterectomies) take estrogen alone.

>

> " The study's very compelling because of its size, " said Lacey, an

> epidemiologist at the National Cancer Institute. " It raises concern . . .

> that, although very rare, ovarian cancer might be something that you would

> need to consider " in deciding whether to take hormones after menopause.

>

> Besides relieving short-term menopausal symptoms such as hot flashes and

> sleep disturbances, estrogen helps prevent the bone-thinning common in

> older women and has been found in several studies to reduce the death rate

> from heart disease, as well as lowering overall mortality.

>

> However, a woman's decision about taking estrogen has become increasingly

> difficult in recent years as evidence emerged that it was not risk-free.

> Taking estrogen without progestin increases a woman's risk of cancer of

the

> endometrium -- the lining of the uterus -- while studies published last

> year suggest that taking combination hormone therapy significantly

> increases the risk of breast cancer, especially after several years of

> treatment. Estrogen also increases the risk of blood clots and gallstones.

>

> Women who have been on hormones for many years and those considering

> long-term treatment may wish to discuss the findings on ovarian cancer

with

> their doctors to determine whether the benefits for them outweigh the

> risks, said Carmen , an American Cancer Society epidemiologist

and

> principal author of the new study, which appears in today's issue of the

> Journal of the American Medical Association.

>

> " Certainly there is not any problem with using hormone therapy for a short

> period of time, " said. Decisions about long-term treatment

> " really will depend on the health profile of the woman. Not all women will

> have the same benefits from estrogen or combination therapy. "

>

> The findings come from the Cancer Prevention Study, an American Cancer

> Society project that recruited 1.2 million people in 1982. Participants

> filled out a detailed questionnaire on lifestyle and possible cancer risk

> factors. From 1982 to 1996, researchers periodically obtained information

> from death certificates and tabulated cancer deaths among the

participants.

>

> A total of 944 women in the study died of ovarian cancer during the

> follow-up period, including 255 who had reported taking hormones after

> menopause and 689 who had not. The researchers did not obtain information

> on the types of hormones taken, but at the time the study began, it was

> still common for doctors to prescribe estrogen alone rather than estrogen

> plus progestin.

>

> Women who had been on estrogen for 10 or more years at the start of the

> project had 2.2 times the death rate from ovarian cancer found in those

who

> had never taken the hormone. Among former users who reported taking the

> hormone for 10 or more years, the death rate was 1.6 times that seen in

> nonusers. Once a woman stopped taking estrogen, her risk of ovarian cancer

> appeared to decrease gradually with time.

>

> Estrogen stimulates cell growth and division in the ovaries, but the

> precise mechanism by which its use after menopause may increase cancer

risk

> is not known. In contrast with post-menopausal estrogen, a history of

> taking birth control pills earlier in life has been clearly shown to

reduce

> the risk of ovarian cancer. Women who have borne children are also at

lower

> risk, as are women who have had a tubal ligation.

>

> " A family history of ovarian cancer is a risk factor, but most women with

> ovarian cancer don't have a family history, " said Hunter, director

of

> the Harvard Center for Cancer Prevention. " The problem with this disease

> is, it's very hard to know what you do with this information, because we

> don't really have good screening modalities " to detect ovarian cancer at

an

> early stage.

>

> Women should keep in mind that ovarian cancer is rare, said Philip de

Vane,

> vice president of medical affairs for Wyeth-Ayerst Laboratories, the

> manufacturer of Premarin and other hormone products. " Whilst it [the

study]

> suggests that there is an increased risk " after 10 years of estrogen use,

> he said, " the overall likelihood for a woman developing ovarian cancer is

> very low. "

>

>

>