More on HRT and breast cancer

woman with covered breast
Last month researchers at the University of Texas M.D. Anderson Cancer Center announced that the incidence of breast cancer in the United States had dropped by just over 7% in 2003. This drop came after the WHI brought out a report showing an increase in the risks for breast cancer and stroke for women taking combined estrogen/progesterone hormone replacement therapy. This has added more fuel to the debate on HRT.

Two articles (here and here) discussed the results of the study and the impact it may have on women already on HRT and those who may be thinking of starting it. Some specialists ask if the the decline in the incidence of breast cancer is actually due to women coming off HRT.

“This is exciting news about the incidence going down, but I think it’s very confusing as to whether or not it’s related to hormone use,”
said Dr. William Rayburn, an associate professor of obstetrics and gynecology at Texas A&M Health Science Center College of Medicine. “This has simply muddied the water more.”

Similarly, the International Menopause Society (IMS) called on experts and the public “to be very cautious when interpreting the new data on trends in breast cancer incidence in the United States” and said that hormone therapy “has a very minor potential for harm, but may carry substantial benefits.”

Out of about 2 million women starting menopause every year in the United States, about 1/4 may have moderate to severe symptoms. Women should consider the following:

  1. Do I have a family history or do I otherwise have a higher than average risk of developing heart disease, blood clots or breast cancer?
  2. Are my symptoms disrupting my life substantially?

There may not be a dramatic increase in the number of women coming off HRT because so many went off it after the WHI report on HRT risks. It is likely that most of the women on HRT today have very severe symptoms and as such are willing to accept a certain level of risk to obtain relief from their symptoms. For women who are contemplating conventional hormone replacement therapy

  • Take the lowest dose for the shortest time — two or three years if possible. Start with low doses and add increase if your symptoms don’t subside.
  • Don’t take hormones to try to prevent heart disease.
  • Never take estrogen without progestin if you still have a uterus because that raises the risk of uterine cancer.
  • Try to gradually reduce your dose and eventually wean yourself off.

Black women more likely to die from breast cancer

black women, breast cancer
African American women are more likely to die from breast cancer than white women.
Although black women are less likely than their white counterparts to develop breast cancer, they are more likely to die from it. African
American women are also more likely to see their doctor when the disease is at an advanced stage. Unfortunately their cancers
are usually more aggressive and are less likely to have estrogen receptors. When estrogen binds to tumors that have estrogen receptors it promotes the growth of the tumor. A group of drugs known as Selective Estrogen Receptor Modulators (SERMs) block the action of estrogen on the cancer and so are used in treatment of breast cancer. In the absence of estrogen receptors on the tumor, this treatment option is not available.
On the other hand there are several other factors apart from the type of tumor that account for the difference in mortality:

  • African American women are less likely to have mammograms
  • Certain socioeconomic factors predispose to more deaths in black women
  • Differences in diet
  • They are more likely to be overweight or obese
  • They tend to have more children
  • They tend to have a greater delay in receiving appropriate treatment after diagnosis
  • There may be some genetic differences that account for the disparity

These findings emphasize the need for women, especially African Americans to have mammograms at regular intervals to screen for breast cancer. The earlier cancer is diagnosed, the easier it is to cure.

Fewer American women having mammograms

Fewer American women are having mammograms to screen for breast cancer. This is according to a study carried out by the National Cancer Institute and the Center For Disease Control. The opposite had been the case for 20 years before the period of the study with increasing numbers of women having mammograms each year.

Why are less women having mammograms?

There may be several reasons for this decline:

  1. Some women may feel that it’s not worth the time, money and inconvenience to have a mammogram especially as the results are sometimes conflicting and difficult to interpret.
  2. Lack of health insurance
  3. Doubts about how effective mammograms are at reducing the number of deaths from breast cancer
  4. The feeling that breast cancer causes fewer deaths and perhaps is more treatable than it used to be
  5. With many women coming off combined progesterone/estrogen hormone replacement therapy after results from the WHI (Women’s Health Initiative) showed that it increases risks of developing breast cancer, these women may not see their doctors as often as they used to. As a result, many would not have their usual yearly mammogram.
  6. Less aggressive promotion of mammograms by major organizations.
  7. Some breast cancer screening centers have closed and there are fewer radiologists trained to read mammograms. If women don’t have a screening center reasonably close to them they may not go for a mammogram.

In spite of the debate over the effectiveness of mammograms and whether there aren’t better screening methods for breast cancer, they have been very useful up till now. For the meantime, having a regular mammogram is still a very good idea.

Mammogram tips

Many women have a yearly mammogram to help detect early breast cancer. Unfortunately, some women find the procedure so uncomfortable that they delay or skip it altogether. Here are a few tips to help you get through your yearly mammogram.

  1. Avoid caffeine the week before your mammogram. This means cutting out coffee and caffeinated drinks, chocolate and pain relievers that contain caffeine (read your labels!). Caffeine can make the breast tissue sore making the procedure more uncomfortable.
  2. Schedule the mammogram for the first half of your cycle. Many women find that their breasts are more painful in the second half of their cycle due to water retention and bloating.
  3. Don’t use deodorants, perfume, body oils, talcum powder e.t.c. on the day of your mammogram. They can leave a film behind which can make it more difficult to interpret the mammogram and increases the chances of having to have a repeat mammogram.
  4. Wear a 2 piece outfit so you can easily take off the top part and leave on the bottoms to have your mammogram.

All said, don’t let a little bit of discomfort prevent you from having this procedure which has been a lifesaver for many women.

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