Avoid menopause treatment: group

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This article was published 24/09/2010 (5665 days ago), so information in it may no longer be current.

The debate over the safety of hormone replacement therapy was reignited Thursday when the Canadian Cancer Society warned women to avoid HRT because of its links to breast cancer.

The CCS released a study that analyzed national health databases and found the incidence of breast cancer among women age 50 to 69 dropped by nearly 10 per cent between 2002 and 2004 — the same time period the number of women taking HRT declined by 50 per cent.

The dramatic drop in HRT use coincided with a controversial 2002 U.S. study, called the Women’s Health Initiative, that concluded the risks do not outweigh the benefits and HRT increases the risk of breast cancer, heart attack and stroke.

The study terrified women and divided the medical community, since many experts — including the Society of Obstetricians and Gynecologists of Canada (SOGC) — have said the increased risk is small and HRT is the most effective therapy for symptoms of menopause.

Dr. Prithwish De, the Canadian study’s lead investigator and an epidemiologist, said the new findings reinforce the link between HRT and breast cancer, and women should avoid the treatment altogether unless they have severe menopausal symptoms. He said he’s not sure exactly what the link is, but suspects HRT speeds up the growth of certain breast cancer tumours.

The warning sparked immediate ire among some of the nation’s leading medical experts who say HRT is the “gold standard” for women and is safe.

“I’m disturbed,” said Dr. Richard Boroditsky, head of Winnipeg’s Victoria General Hospital Mature Women’s Centre and advisory committee member of the SOGC. “I’m surprised the cancer society is continuing to come up with these statements.”

The cancer society first told women to avoid HRT in 2004 based on the findings of the U.S. study, saying the evidence against combined estrogen-progestin therapy is too strong to ignore.

Boroditsky said a slew of medical advisory bodies in Canada and the U.S. have deemed HRT safe and beneficial for women when used to treat symptoms of menopause early. He said the results of the U.S. study were misinterpreted, since the average age of participants was 63, and many of the women in the study were already at higher risk of cardiovascular and other diseases due to their age and overall poorer health.

Boroditsky said many researchers believe HRT doesn’t cause cancer, and estrogen helps the tumour cells grow so they are more easily detected by a mammogram. He said he’s worried the scare over HRT use will allow estrogen-positive tumours to go unnoticed until they are more aggressive.

“In other words, it’s not causing or initiating the cancer, it’s probably identifying early cancer,” Boroditsky said. “Hormone therapy helps the cells get bigger, more swollen, and they grow and therefore a mammogram is able to pick these up.”

De said his study did not examine whether the decline in breast cancer incidence was due to a drop in estrogen-positive tumours. He said the cancer society plans to further study the hormone sensitivity of the tumours.

“There are different interpretations of the same evidence, and in our review and based on our review, we’ve come to the conclusion that HRT should be avoided by women for any use other than for severe menopausal symptoms,” De said.

jen.skerritt@freepress.mb.ca