Shirley Hogan sweated so much at night that her pajamas stuck to her. The Omahan took hormones to control the night sweats and hot flashes brought on by menopause, even though doctors told her that the medications increased her risk of breast cancer. "I told (them) I'll take the risk," she said after weighing the drawbacks against the benefits. It's a choice that many women struggle with. A new analysis of a large federal study confirms that the combined use of estrogen and progestin increases the risk for breast cancer, local doctors say. But they emphasized that the new findings shouldn't deter women from talking with their doctors about taking the hormones. For some women, taking low doses for a short duration can be a safe way to control menopause symptoms. "If you take (hormones) away from them, they have a pretty miserable life," said Dr. J. Christopher Gallagher, professor of medicine at Creighton University School of Medicine. The new findings, presented at a national symposium this month, have not yet been published in a peer-reviewed medical journal, so they should be considered preliminary, said Dr. Rowan Chlebowski, the lead researcher. The analysis is of data from the Women's Health Initiative. It was a federal study that tested estrogen and progestin pills that doctors long believed would prevent heart disease, bone loss and many other problems in women after menopause.
In the study, about 16,000 women were randomly assigned to take either a combination of estrogen and progestin or dummy pills. The main part of the study was stopped in 2002 when researchers saw higher risks of breast cancer in women who took the combined hormones. They had been on them for about five years. Researchers studied those women in the new analysis. After about two years of being off the hormones, the women's risk for breast cancer returned to normal, said Chlebowski of the Los Angeles Bio-Medical Research Institute. He said there is a slight increased risk of breast cancer for women taking the hormones for less than five years. The risks increase after that period, he said. For example, a 60-year-old woman who is not taking hormones and has no other risk factors has about a 1.7 percent chance of getting breast cancer within five years, said Dr. Ken Cowan, director of the Eppley Cancer Center at the University of Nebraska Medical Center. If she is on the combined hormones, her risk rises to about 3 or 4 percent, he said. Still, he said, a woman must be careful about doing anything that boosts her chances of getting the disease. Women with a family history of breast cancer must be particularly careful about using the hormones, he said. Their chances of getting the disease are higher to begin with.
Dr. Thomas Besse, an obstetrician and gynecologist with Alegent Health, said that in the past five or six years the combined use of estrogen and progestin among patients has dropped.
Dr. Suzanne Cornwall of UNMC Physicians in Bellevue agreed.
Both doctors said the decline coincided with 2002 news reports about the federal study.
Chlebowski said hormone use has declined nationally, as well. Breast cancer cases also dropped starting in 2003, probably because of decreased hormone use, he said.
Besse said some patients stopped taking the hormones on their own, and he would find out about it during a patient's next appointment. He would explain that the increased risk was low and that if they limited the use to less than five years, it would be reasonable to consider taking hormones.
Hogan, 74, said she has no family history of breast cancer. She stayed on the hormones for more than 15 years. She has not had breast cancer and makes sure to get a mammogram every year.
For Sharon D'Ercole, the risk wasn't worth it.
She started taking estrogen and progestin around 1994, when she was in her early 50s and just starting menopause. She stopped taking the hormones about eight years later after reading about the federal study.
Hot flashes and insomnia returned.
The hot flashes, sometimes as many as 10 per day, sometimes woke her at night.
Even in the winter, she would set the thermostat low and run two fans in her bedroom -- and still get hot. Her husband joked that they could hang meat in their bedroom.
D'Ercole, who is 64 and no longer has symptoms, said it was "hell." But she's glad she dropped the hormones.
"I just didn't want to take any chances," she said.
