Hormone Replacement Therapy Truth: Study Found 37% Decrease in Colorectal Cancer

National Review ^ | 8/13/02 | Jacob Veltman

[Dr. Scarpetta]

HRT Truth
It’s not all bad.

Hormone Replacement Therapy has been all over the news since a recent trial revealed that HRT comes with some significant health risks. The trial, funded by the Women's Health Initiative, was terminated prematurely after its safety-monitoring board found HRT responsible for a 26-percent increase in breast-cancer incidence.

Even women who have taken estrogen and progestin for decades have consequently decided to forego treatment for postmenopausal symptoms altogether, after learning of HRT's supposed carcinogenic properties. Similarly, the drug industry is now forced to consider the possibility of liability for any serious medical condition incurred while on HRT.

However, while WHI's study is as thorough an examination of the risks of HRT as we are likely to see, the logic behind its conclusions leaves a bit to be desired. The most oft-repeated finding of the study is that HRT resulted in a 26-percent increase in breast-cancer incidence. While this is alarming, the relevance of that statistic is mitigated by less-publicized details.

Although the study found a 26-percent increase in breast-cancer incidence, it also found a 37-percent decrease in colorectal cancer and a 17-percent decrease in endometrial cancer. There was therefore actually a two-percent decrease in total mortality rates of HRT patients and only a three-percent increase in total cancer incidence, which is essentially negligible.

In fact, a majority of recent studies have found induced abortion to cause a similar increase in breast-cancer incidence (20-31 percent). However, many of the same critics now labeling HRT as a carcinogenic nightmare perpetrated by the drug industry found it equally convenient to disregard the dangers of induced abortion.

Moreover, although the WHI did study approximately 16,000 women, it did so only for an average of 5.2 years per person. This is lengthy by medical-study standards, but wholly insufficient to judge the effects of a treatment taken for several decades by many women.

HRT has been proven to reduce the debilitating effects of osteoporosis, and one can only speculate as to what therapeutic benefits this provides to women who remain much more robust in their old age than previously was possible. Even in just the short timeframe of the study, HRT was found to reduce hip fractures by 44 percent. It may well be that HRT's value increases steadily over time.

The most deficient aspect of the findings by the WHI though, is that although the study was meticulous in examining the various potential complications or HRT, it makes no attempt to quantify, or even acknowledge, the relief HRT grants to postmenopausal women.

Although HRT has been labeled as a cure (often mistakenly) for everything from heart disease to Parkinson's Disease, most women take it primarily because of the relief it grants from the symptoms of menopause.

HRT has been as effective as promised in relieving women of hot flashes, cramps, and many other encumbrances. The WHI however, has chosen to scrutinize the risks of HRT while totally ignoring its most basic advantages.

Given such an environment, very few of today's most common medications would pass the test. Aspirin, Prozac, and Viagra certainly wouldn't.

As one long-time HRT user who was diagnosed with breast cancer at age 70 said, "I would still prefer the high quality years I have had and, to an extent, am still having even breast-less — to the long, drawn-out miseries of the symptoms that once plagued me."

WHI's study is certainly worth considering when determining the relative merits of HRT, but it should by no means disqualify HRT from remaining the treatment of choice for the relief of the symptoms of menopause.

[Dr. Scarpetta]

Although the study found a 26-percent increase in breast-cancer incidence, it also found a 37-percent decrease in colorectal cancer and a 17-percent decrease in endometrial cancer.

[Amore]

I think there's a lot of women who aren't giving up their hormones without a lot more evidence, myself included!

[nimc]

Thank-you. I just sent the URL to my wife who has an appointment with her GYN tomorrow to review her HRT.

We are so influenced by the fear of being sued that I fear we will be denied true breakthroughs that have improved our lives in the past. A 1.2 % increase risk is enough for insurance and pharisaical companies cringe and lawyers drool.

[Dr. Scarpetta]

In fact, a majority of recent studies have found induced abortion to cause a similar increase in breast-cancer incidence (20-31 percent).

However, many of the same critics now labeling HRT as a carcinogenic nightmare perpetrated by the drug industry found it equally convenient to disregard the dangers of induced abortion.

HRT Ping

[Dr. Scarpetta]

Since the study came out, I went on a lower dose of HRT, which seems to be working just as well to stop the hot flashes and insomnia!

[Dr. Scarpetta]

Given such an environment, very few of today's most common medications would pass the test. Aspirin, Prozac, and Viagra certainly wouldn't.

HRT Ping

[Dr. Scarpetta]

There was therefore actually a two-percent decrease in total mortality rates of HRT patients and only a three-percent increase in total cancer incidence, which is essentially negligible.

HRT Ping

[widowithfoursons]

I simply went insane for a couple of years (being insane, I thought I was OK). I have never taken HRT, but then I was nuts and couldn't make a rational decision.

[Dr. Scarpetta]

I simply went insane for a couple of years (being insane, I thought I was OK). I have never taken HRT, but then I was nuts and couldn't make a rational decision.

Are you feeling well now?

[SwatTeam]

Thanks for the ping. This article just reinforces my belief that it is better to wait until the initial hysteria subsides over a medical report before making any important decisions. The medical community is now having second thoughts about their stance on fat consumption and cholesterol. So I will continue to take my hormones and be in a good mood and I will eat butter on my biscuit in the belief that it really isn't all the bad.

[Mrs. P]

Thanks for the ping. This is pretty much what I thought, there was a lot of hysteria about the bad things about HRT and none of the benefits. I'm still taking mine!

[Dr. Scarpetta]

According to my pharmacist, women are staying on hormones. My GYN is opposed to hormones and wanted me to go off cold turkey, instead of taking a lower dose. I made the decision to take a lower dose, and I think it was the best thing to do right now.

[widowithfoursons]

Am I feeling well now? I think so, but if I'm still nuts I couldn't be sure, right?

[Cincinatus' Wife]

When in doubt, throw them out.

[Iowa Granny]

After 10 years, I stopped cold turkey when the report came out. I have spent a miserable month.

Can you recommend additional reading? I am very tempted to begin again.

[OrangeDaisy]

Just use common sense. I have a history of breast cancer (my mother, my maternal grandmother, and my maternal grandmother's sister). I'm going to try very hard NOT use HRT, and if I have to have it, I hope I can take it a few months (years?) until the "change of life" symptoms subside. I think using HRT post-menopouse with this kind of family history is a no-no. I hope they find a subsitute before I need it in the next 8 - 10 years. If you don't have a family history, it may not be necessary to be so cautious.

[snippy_about_it]

I've been on and off the past year and a half trying to make an informed decision. I've been on low doses since forced menopause for the last 18 years. I was fine then it started interferring with fibrocystitis and I felt much better once I quit, except for the hot flashes. They drive me nutty which is why I have given up, gone back on, gone off, gone back on and finally off again. It kept my cholesterol down but I felt so miserable on the ERT I just decided I would rather put up with the hot flashes if I can just hang in there.

[RJCogburn]

It is worth noting that this study involved oral estrogens. There are now transdermal estrogens (and progesterone) that are absorbed through the skin into the blood stream, thereby avoiding the oral of route of from the intestine directly through the liver first.

Does this matter? It might, but the similar long term studies to know have not been done.

[IVote2]

Very interesting, thanks for the ping!

[Mrs. P]

I highly recommend reading Strong Women Strong Bones by Dr. Miriam Nelson. I am reading it right now - one interesting statistic if you are worried about breast cancer - she quotes statistics that say 43,000 women die each year of breast cancer, and 65,000 die of osteoporosis-related hip fractures in this country. (She also gives information contrary to this study about HRT helping prevent heart disease, but this book was written before the latest research had begun to show that HRT didn't decrease heart disease.) Estrogen has been shown to help decrease bone loss.

I'm taking my pills. I am also lifting weights, following the exercises in the first Strong Women book, the Stay Young one, and I'm eating better and taking a calcium citrate supplement with vitamin D. I'm not writing this to brag, I'm scared of getting osteoporosis, I've seen more old ladies die from hip fractures than women die of breast cancer, and I used to work for an oncologist! I'm reading everything I can find on the subject, and this is the best I have found.

My mother had an osteoporotic fracture of her vertebrae a few years ago, and I'm not going to follow in her footsteps. As a matter of fact, she is following in mine. She's been doing the weight training off and on now for a couple of years and feels great. She takes estrogen, too.