home
***
CD-ROM
|
disk
|
FTP
|
other
***
search
/
TIME: Almanac 1990
/
1990 Time Magazine Compact Almanac, The (1991)(Time).iso
/
time
/
081489
/
08148900.003
< prev
next >
Wrap
Text File
|
1990-09-17
|
4KB
|
73 lines
MEDICINE, Page 56Hard Looks at HormonesDrugs to ease the toll of menopause are linked to breast cancer
Besides being emotionally stressful for some, menopause can
bring physical discomfort and may lead the way to serious health
risks in older women. When their reproductive years end and the
production of sex hormones drops, women face not only the prospect
of hot flashes and insomnia but also a greater chance of worse
conditions, such as heart disease and a weakening of the bones
called osteoporosis. Over the years, pharmaceutical companies have
developed pills designed to replace the hormones the women have
lost, and these drugs have come into wide use. Now, however, new
questions are being raised about their safety. Although the
evidence is far from conclusive, a major study published last week
in the New England Journal of Medicine suggests that at least some
of the post-menopause medication may increase the risk of breast
cancer.
The study, conducted in Sweden, involved 23,244 women who were
taking various types of estrogen, one of the main female sex
hormones, after menopause; a third of them were also on progestin,
an artificial form of the hormone progesterone. The researchers
compared these women with others who had not taken hormones. The
results: after nine years the women who took a kind of estrogen
called estradiol had about twice the breast-cancer rate of those
who were not on replacement therapy. The women on estrogen and
progestin had a higher rate -- about four times as many cases of
breast cancer after they used the combination for six or more
years. Medical experts point out that parts of this report
contradict some earlier evidence and that data on many more women
must be collected before the Swedish results are either confirmed
or refuted. Nonetheless, the study injects new doubts into the
already difficult choices that women must make concerning which
hormones, if any, to take.
Estrogen came into favor many years ago because it helped
prevent osteoporosis and appeared to guard against heart disease.
But it was discovered that estrogen increased the risk of uterine
cancer. To lower the odds of contracting uterine cancer, many
doctors added progestin to the treatment, and it was hoped that the
drug would also help reduce any risk of breast cancer associated
with estrogen alone. The drawback to progestin seemed to be that
it reduces some of the benefits of estrogen, in particular the
apparent protection against heart disease. Now the possibility of
a breast-cancer risk has further muddled an already confused
situation.
So what is a woman to do? In an editorial published along with
the Swedish study in the New England Journal, Dr. Elizabeth
Barrett-Connor of the University of California, San Diego, argues
that the "benefits of estrogen seem strongly established. In my
opinion, the data are not conclusive enough to warrant any
immediate change in the way we approach hormone replacement." Dr.
I. Craig Henderson of the Dana-Farber Cancer Institute in Boston
notes that estradiol, the estrogen implicated in the Swedish
report, is not the same as the estrogens most commonly used in the
U.S. "While women should not conclude yet that they are totally
without risk," he says, "it is highly likely that the estrogen
American women use may be safer for a longer period of time than
the estrogen used in Sweden."
There is more uncertainty, however, about adding progestin to
estrogen, since the study raised the possibility that this
combination produces a greater risk of breast cancer than does
estrogen alone. Dr. Charles Hammond, chairman of the department of
obstetrics and gynecology at Duke University Medical Center, is not
convinced that he should change his prescribing habits. "We
shouldn't frighten women into not taking progestin," he says. "We
could find an increase in uterine cancer." But that disease is less
common and less lethal than breast cancer. Some experts, including
Malcolm Pike, a professor of preventive medicine at the University
of Southern California, suggest that the benefits of progestin may
not be worth the potential dangers.