NEW YORK (Reuters Health) - The image of hormone replacement therapy, battered by last week's revelation that the risks can outweigh the benefits in the long term, received another blow from researchers on Tuesday.

 

They report that women who take estrogen-only hormone replacement therapy (HRT) for a long period of time have a higher-than-average risk of developing ovarian cancer.

However, Dr. James V. Lacey, Jr. and his colleagues at the National Cancer Institute in Rockville, Maryland found that women who take short rounds of estrogen that is combined with progestin seem to have no higher risk of ovarian cancer than women who have never taken HRT.

Typically, only women who have had their uterus removed take estrogen alone because the hormone is known to increase the risk of cancer of the uterine lining. Women who have a uterus take estrogen in combination with progestin, which cuts the cancer risk.

In an interview with Reuters Health, Lacey stressed that these results only suggest a link between ovarian cancer and estrogen replacement therapy and do not prove that ovarian cancer is a direct result of the estrogen.

Previous research into long-term use of estrogen did not connect it with an increased risk of ovarian cancer, the authors note, which demonstrates how easily the state of knowledge can change.

Given the recent report that estrogen/progestin combinations can increase the risk of heart disease and breast cancer when taken for more than 4 years, the choice of whether or not to take HRT can be quite complicated, Lacey added. That study found that estrogen/progestin decreased the risk of colon cancer and hip fractures, but the risks of other problems outweighed the benefits.

A second study due in 2005 will determine if estrogen alone increases the risk of heart disease and breast cancer.

"Because hormone therapy may influence so many conditions that affect women after menopause--cardiovascular disease, osteoporosis, breast cancer, uterine cancer, gallbladder disease, blood clots, and now potentially ovarian cancer--we should no longer think of a woman basing her decision to use hormones on the potential risk of just one condition," he said.

While millions of women choose HRT to reduce menopausal symptoms, many used it as a preventative therapy to reduce their risk of heart disease or the bone-thinning condition osteoporosis.

The findings, reported in the July 17th issue of The Journal of the American Medical Association, are based on a follow-up of 44,241 women who began taking HRT when they were an average of 57 years old. Some of the women had a hysterectomy but still had one or both of their ovaries.

During the study period, 329 women developed ovarian cancer. Women who took estrogen for longer periods of time had a higher risk of the disease, and the researchers noted a 7% increase in risk associated with every extra year of estrogen use.

Those who took estrogen for at least 10 years were twice as likely to develop ovarian cancer and those who used the drugs for 20 or more years were three times as likely to develop ovarian cancer as those who did not take the hormone, the report indicates.

An important caveat, Lacey and his team note, is that this study included women who began taking HRT in the 1970s, when the therapies contained higher doses of estrogen than what is in use today. "Whether long-term use of lower-dose estrogen replacement therapy increases the risk of ovarian cancer is not known," they write.

Women who took estrogen/progestin alone, or after using estrogen alone, appeared to be no more likely to develop ovarian cancer than women who did not take hormones, the study reports. However, the jury is still out on whether estrogen/progestin combinations can have an impact on ovarian cancer risk, the authors note.

"This recent emergence of an increased risk (of ovarian cancer) in long-term (estrogen) users should remind investigators that it is premature to conclude that estrogen/progestin replacement therapy has no association with ovarian cancer until other large studies specifically assess ovarian cancer risk among persons with short-term or long-term estrogen/progestin replacement therapy use," they write.

In an interview with Reuters Health, Dr. Kenneth L. Noller of Tufts University and the New England Medical Center in Boston, Massachusetts, who wrote an accompanying editorial, said that there is no obvious biological explanation for why estrogen might cause ovarian cancer.

"In general, this is one of those times when we have an observation without a good biological basis," he said. "There seems to be a clear-cut increase in ovarian cancer, but we really don't know why."

The finding is especially puzzling given that long-term use of oral contraceptives, which contain hormones similar to HRT, can reduce the risk of ovarian cancer, he noted.

He emphasized that the increased cancer risks reside with women who take HRT for long periods of time. As such, women who have "terrible menopausal symptoms should not be afraid to take HRT for a short period of time," he said.

However, for women with less severe symptoms, the answer is less clear. "With all of the new information about HRT, it seems to me that we must take a new approach to its use," Noller said.

SOURCE: The Journal of the American Medical Association 2002;288:334-341, 368-369.

Thanks for posting the info Mary.  A friend of mine was recently diagnosed with stage 4 ovarian cancer.  She is about 50 years old and had been taking BCPs for many years.  So much for the notion that BCPs protect you from ovarian cancer.

Thanks for the great post Mary. It's exactly what I was looking for. I had a complete hysterectomy 4.5 years ago and having been using Climara patches. I've slowly decreased the dose from 1.0 to .05. Do I go off completely now? If anyone has any further personal experience, would like to hear from you!

I am SO sorry to hear about your friend!  That really scares me.  I also was on BCP's for years and really bought into the stories that said it protected you from ovarian cancer.  

So many cases of this are caught at late stages.  Why, why, why don't gyno's do the blood test for ovarian cancer as part of the annual exam?  Have we learned nothing from Gilda Radner?  Have any of you insisted on it?  I would be very curious as to how the doctor reacted.  I'm going to at least ask how much it costs.  I may start paying out of pocket to have it done.  

You have just answered a question I was going to ask here, KittyMom.In the UK we have smear (pap) tests every 3 years, and mammogrmas only after the age of 50.In the States it seems better, annual checks etc, and I wondered if a check for ovarian cancer was included. I see not by your post.This worries me a lot, I know a young woman in her early 30s with 3 pre-school children who died from this disease.It is scary as there are no symptoms, when they find it it is well advanced usually.I may ask my Dr. how much it would cost to have to test done privately, good idea.

I think the test of ovarian cancer has many false positives--I think that is why it isn't used.  I don't remember if it also has alot of false negatives.

Zelma

SUPPORT H. CON. RES. 385! RESOLUTION CALLS FOR HHS TO SPEED UP ITS RESEARCH INTO ACCURATE OVARIAN CANCER SCREENING TOOL

Calling on the Secretary of Health and Human Services to support and accelerate research on the development of an accurate ovarian cancer screening tool, Reps. Steve Israel (D-NY) and Rosa DeLauro (D-CT), who is an ovarian cancer survivor, introduced H. Con. Res. 385. The resolution encourages federal researchers to step-up their work into a new test that uses protein patterns to detect ovarian cancer, and urges insurance coverage for the test, if it is found to be an effective screening tool. Take action now - urge your representatives to co-sponsor this important resolution.

YES, I WANT TO HELP! WHAT CAN I DO?

Contact your representative. If you don't know who your representative is, visit www.congress.gov or contact the Alliance at 202-331-1332.

Call your representative's office and ask to speak to the staffer who handles the member's healthcare issues.

Once you get someone on the phone:

Introduce yourself as a constituent and/or a survivor and tell them you are calling to inquire if the member has signed onto the H. Con. Res. 385, a resolution that will ensure that the National Institutes of Health completes a full field test of the new ovarian cancer early detection process.

Tell them a "Dear Colleague" letter was sent to the member from Reps. Rosa DeLauro and Steve Israel on April 30, asking him/her to support funding for this invaluable research program.

If the staffer doesn't know about the letter, you should offer to fax it to them. If you fax/e-mail it to them, tell them that you would like to follow up with them to see what they have decided to do. If you tell them that you will follow-up, please do so.

Copy and paste the sample email below in the body of an email and send it to your representative:

Dear Representative,

Ovarian cancer, the deadliest of all gynecologic cancers, has affected my life and the lives of my family and friends. I am writing to urge you to co-sponsor H. Con. Res. 385. This resolution requires a stronger federal effort to find a screening tool that can detect this devastating disease in its earliest, most treatable stages. The most devastating fact about ovarian cancer is that most women are diagnosed at an advanced stage, when the cancer is far more difficult to cure. Yet, if ovarian cancer is detected early, more than 90 percent of women survive.

Ovarian cancer research is advancing, but not quickly enough! In order to save lives, we need the help of Congress NOW to steer federal research efforts towards finding an effective screening tool to detect ovarian cancer. Please co-sponsor H. Con. Res. 385; your support will help save the lives of thousands of women.

Sincerely,

Name _______________________________Address ______________________________City _____________ State_____ Zip _______E-mail _______________________________

See if your representative has signed on.

H.CON.RES.385 Sponsor: Rep Israel, Steve(introduced 4/23/2002) Latest Major Action: 7/11/2002 House committee/subcommittee actions. Status: Ordered to be Reported by Voice Vote.

Title: Expressing the sense of the Congress that the Secretary of Health and Human Services should conduct or support research on certain tests to screen for ovarian cancer, and Federal health care programs and group and individual health plans should cover the tests if demonstrated to be effective, and for other purposes. --------------------------------------------------------------------------------COSPONSORS(143), ALPHABETICAL:     (Sort: by date)

Rep Ackerman, Gary L. - 5/14/2002 Rep Allen, Thomas H. - 6/4/2002Rep Baca, Joe - 5/16/2002 Rep Bachus, Spencer - 7/15/2002Rep Baird, Brian - 6/4/2002 Rep Baldacci, John Elias - 5/23/2002Rep Baldwin, Tammy - 5/16/2002 Rep Barrett, Thomas M. - 7/10/2002Rep Becerra, Xavier - 5/16/2002 Rep Berkley, Shelley - 6/4/2002Rep Berman, Howard L. - 5/15/2002 Rep Bishop, Sanford D. Jr. - 6/18/2002Rep Blagojevich, Rod R. - 5/21/2002 Rep Bonior, David E. - 5/16/2002Rep Bono, Mary - 5/16/2002 Rep Boyd, Allen - 5/16/2002Rep Brady, Robert - 5/22/2002 Rep Brown, Corrine - 5/2/2002Rep Brown, Sherrod - 5/16/2002 Rep Burton, Dan - 5/20/2002Rep Capps, Lois - 5/7/2002 Rep Capuano, Michael E. - 5/2/2002Rep Carson, Brad - 5/22/2002 Rep Carson, Julia - 5/16/2002Rep Clayton, Eva M. - 5/16/2002 Rep Clyburn, James E. - 5/16/2002Rep Conyers, John, Jr. - 6/4/2002 Rep Crowley, Joseph - 5/14/2002Rep Davis, Danny K. - 5/20/2002 Rep Davis, Susan A. - 5/16/2002Rep DeLauro, Rosa L. - 4/23/2002 Rep Deutsch, Peter - 5/16/2002Rep Dingell, John D. - 5/7/2002 Rep Doyle, Michael F. - 5/20/2002Rep Edwards, Chet - 6/4/2002 Rep Emerson, Jo Ann - 5/16/2002Rep Engel, Eliot L. - 5/16/2002 Rep Eshoo, Anna G. - 5/16/2002Rep Evans, Lane - 7/16/2002 Rep Farr, Sam - 5/21/2002Rep Fattah, Chaka - 6/27/2002 Rep Filner, Bob - 5/15/2002Rep Ford, Harold, Jr. - 6/20/2002 Rep Frank, Barney - 6/4/2002Rep Frost, Martin - 7/8/2002 Rep Gilman, Benjamin A. - 5/16/2002Rep Grucci, Felix J., Jr. - 5/20/2002 Rep Gutierrez, Luis V. - 5/14/2002Rep Hastings, Alcee L. - 5/20/2002 Rep Hinchey, Maurice D. - 5/9/2002Rep Hinojosa, Ruben - 5/21/2002 Rep Hoeffel, Joseph M. - 5/22/2002Rep Holden, Tim - 5/16/2002 Rep Honda, Michael M. - 5/22/2002Rep Hoyer, Steny H. - 6/4/2002 Rep Inslee, Jay - 6/4/2002Rep Jackson, Jesse L., Jr. - 6/4/2002 Rep Jackson-Lee, Sheila - 5/16/2002Rep Jefferson, William J. - 5/7/2002 Rep Johnson, Eddie Bernice - 5/16/2002Rep Jones, Stephanie Tubbs - 5/6/2002 Rep Kaptur, Marcy - 5/16/2002Rep Kildee, Dale E. - 5/8/2002 Rep Kilpatrick, Carolyn C. - 5/22/2002Rep King, Peter T. - 5/16/2002 Rep Lampson, Nick - 5/20/2002Rep Langevin, James R. - 5/21/2002 Rep Lantos, Tom - 5/22/2002Rep Larsen, Rick - 5/21/2002 Rep Larson, John B. - 6/4/2002Rep Lee, Barbara - 5/6/2002 Rep Lipinski, William O. - 5/15/2002Rep Lofgren, Zoe - 5/6/2002 Rep Lowey, Nita M. - 5/16/2002Rep Lucas, Ken - 5/15/2002 Rep Lynch, Stephen F. - 5/9/2002Rep Maloney, Carolyn B. - 5/7/2002 Rep Maloney, James H. - 5/22/2002Rep Markey, Edward J. - 5/16/2002 Rep Mascara, Frank - 5/15/2002Rep Matheson, Jim - 5/16/2002 Rep Matsui, Robert T. - 5/21/2002Rep McCarthy, Carolyn - 5/6/2002 Rep McCarthy, Karen - 5/16/2002Rep McCollum, Betty - 5/22/2002 Rep McDermott, Jim - 6/4/2002Rep McGovern, James P. - 6/4/2002 Rep McKinney, Cynthia A. - 5/10/2002Rep McNulty, Michael R. - 5/2/2002 Rep Meehan, Martin T. - 5/15/2002Rep Meeks, Gregory W. - 5/21/2002 Rep Menendez, Robert - 5/15/2002Rep Millender-McDonald, Juanita - 5/16/2002 Rep Mink, Patsy T. - 5/7/2002Rep Moore, Dennis - 5/14/2002 Rep Morella, Constance A. - 5/8/2002Rep Murtha, John P. - 6/4/2002 Rep Nadler, Jerrold - 5/23/2002Rep Napolitano, Grace F. - 6/4/2002 Rep Norton, Eleanor Holmes - 5/2/2002Rep Oberstar, James L. - 5/16/2002 Rep Olver, John W. - 6/4/2002Rep Owens, Major R. - 5/9/2002 Rep Pallone, Frank, Jr. - 5/16/2002Rep Pascrell, Bill, Jr. - 5/23/2002 Rep Pelosi, Nancy - 5/16/2002Rep Phelps, David D. - 5/10/2002 Rep Pryce, Deborah - 6/27/2002Rep Quinn, Jack - 5/16/2002 Rep Rangel, Charles B. - 6/26/2002Rep Rivers, Lynn N. - 6/4/2002 Rep Rodriguez, Ciro - 5/16/2002Rep Ross, Mike - 5/22/2002 Rep Rothman, Steve R. - 7/11/2002Rep Roukema, Marge - 5/7/2002 Rep Roybal-Allard, Lucille - 6/4/2002Rep Rush, Bobby L. - 5/16/2002 Rep Sanders, Bernard - 5/7/2002Rep Sandlin, Max - 5/14/2002 Rep Schakowsky, Janice D. - 5/6/2002Rep Scott, Robert C. - 5/21/2002 Rep Serrano, Jose E. - 6/5/2002Rep Shows, Ronnie - 5/21/2002 Rep Slaughter, Louise McIntosh - 5/9/2002Rep Smith, Christopher H. - 5/8/2002 Rep Solis, Hilda L. - 5/22/2002Rep Strickland, Ted - 5/21/2002 Rep Tanner, John S. - 5/16/2002Rep Tauscher, Ellen O. - 6/4/2002 Rep Thompson, Mike - 5/21/2002Rep Thurman, Karen L. - 5/8/2002 Rep Tierney, John F. - 7/10/2002Rep Towns, Edolphus - 5/7/2002 Rep Velazquez, Nydia M. - 5/14/2002Rep Visclosky, Peter J. - 6/4/2002 Rep Waters, Maxine - 6/4/2002Rep Waxman, Henry A. - 5/6/2002 Rep Weiner, Anthony D. - 5/16/2002Rep Wexler, Robert - 5/22/2002 Rep Wilson, Joe - 5/20/2002Rep Woolsey, Lynn C. - 5/10/2002 Rep Wu, David - 5/22/2002Rep Wynn, Albert Russell - 5/9/2002

Estrogen Replacement Therapy Linked to Increased Risk of Ovarian Cancer August 15, 2002, Acurian  Source: Acurian Inc.by: Carrie Wingate, Ph.D.  In a long-term study involving more than 44,000 women who were followed for approximately 20 years, researchers from the National Cancer Institute (NCI) have found that women who used estrogen replacement therapy after menopause were at increased risk for ovarian cancer.

The report was published in the July 17, 2002, issue of the Journal of the American Medical Association, the same issue that reported results from another study showing that women on estrogen-progestin therapy showed increases in breast cancer, coronary heart disease, stroke, and blood clots in the lungs and legs. The latter study was stopped 3 years ahead of schedule because of potential risks.

In the NCI study, researchers followed 44,241 women for approximately 20 years. Compared to postmenopausal women who were not taking hormone replacement therapy, women who received estrogen-only therapy had a 60 percent greater risk of developing ovarian cancer. The risk increased with length of estrogen use, meaning that the longer estrogen replacement therapy was used, the greater the risk. Participants, who were followed from 1979 to 1998, were all former participants in the Breast Cancer Detection Demonstration Project, a mammography screening program conducted between 1973 and 1980.

Estrogen is a natural hormone produced primarily by the ovaries. After menopause, the ovaries produce lower levels of the hormones estrogen and progesterone. By the time natural menopause is complete -- usually between ages 45 and 55 -- hormone output decreases significantly. As early as the 1940s, women began taking estrogens in high doses to counteract some of the short-term discomforts of menopause, such as hot flashes, vaginal drying and thinning, urinary tract infections, and urinary incontinence.

It became clear in the 1970s, however, that women who took estrogen alone had a six to eight times higher risk of developing endometrial cancer (cancer of the lining of the uterus). To lower this risk, doctors began prescribing progestin along with much lower doses of estrogen. Progestin is a synthetic form of the natural hormone progesterone. The addition of progestin to estrogen therapy reduces the increased risk of endometrial cancer associated with using estrogen alone. As a result, it has become increasingly common to prescribe combined estrogen-progestin therapy for women who have not had a hysterectomy.

The main finding of our study was that postmenopausal women who used estrogen replacement therapy for 10 or more years were at significantly higher risk of developing ovarian cancer than women who never used hormone replacement therapy, said James V. Lacey, Jr., Ph.D., lead author of the study from NCI's Division of Cancer Epidemiology and Genetics. The relative risk for 10 to 19 years of use was 1.8, which translates to an 80 percent higher risk than non-users, and increased to 3.2 (a 220 percent higher risk than non-users) for women who took estrogen for 20 or more years.

Past studies have suggested that postmenopausal hormone treatments might be effective in preventing or reducing some of the negative long-term effects of aging, such as heart disease and osteoporosis. The results from another large multi-center clinical trial, however, published in the same issue JAMA, showed increases in breast cancer, coronary heart disease, stroke, and blood clots in the lungs and legs for women on estrogen-progestin therapy for an average of 5.2 years. The trial, part of the Women's Health Initiative (WHI), also found fewer cases of hip fractures and colon cancer among women taking the combined therapy.

Nonetheless, because overall the harm was greater than the benefit, the trial was stopped in July 2002. The group of women in the WHI study who had been randomly assigned to receive estrogen alone, all of whom have had their uterus removed, is continuing.

In the NCI study, Lacey and his colleagues also looked at whether women using estrogen-progestin therapy were more likely to develop ovarian cancer. No increased risk was found. Lacey commented, however, that even though our data showed that women who took estrogen combined with progestin were not at increased risk for ovarian cancer, only a few women in our study who developed ovarian cancer had used estrogen-progestin therapy for more than 4 years. So, at this point, there simply aren't enough data to say whether taking the combined therapy has any effect on ovarian cancer.

Lacey emphasized the complexity of weighing the various risks and benefits of hormone use for individual women. Because hormone therapy may influence so many conditions that affect women after menopause -- cardiovascular disease, osteoporosis, breast cancer, uterine cancer, gallbladder disease, blood clots, and now potentially ovarian cancer -- we should no longer think of a woman basing her decision to use hormones on the potential risk of just one condition. Women should continue to talk to their health care providers about whether hormones might be right for them.

Previous studies looking at the effect of postmenopausal hormones on ovarian cancer risk have been inconsistent. Some reported increased risk with estrogen use while others reported either no effect or a protective one. Most of these earlier studies were relatively small and limited by incomplete information about ovarian cancer risk factors.

Two more recent studies found a link between hormone use and ovarian cancer. A large prospective study published in 2001 showed that using postmenopausal estrogen for 10 or more years was associated with increased risk of ovarian cancer mortality. In addition, a Swedish study found that both estrogen use alone and estrogen-progestin used sequentially (progestin used on average 10 days/month) may be associated with an increased risk for ovarian cancer. In contrast, estrogen-progestin used continuously (progestin used on average 28 days/month) seemed to confer no increased ovarian cancer risk.

Lacey said that there are still many unknowns concerning hormone use and ovarian cancer. These include the following:

Duration versus dose of estrogen therapy It is not clear from this study whether the increased risk with estrogen use is due to higher doses of estrogen, longer duration of estrogen use, or both dose and duration. It is also not clear whether long-term use of lower-dose estrogen is associated with ovarian cancer.

Duration of estrogen-progestin therapy Most women in this study were on the combined therapy for less than four years, so more data will be needed to determine whether estrogen-progestin use increases risk in this group. The effect of long-term use of estrogen-progestin therapy is not known.

The type of estrogen-progestin regimen The continuous regimen involves taking both hormones simultaneously throughout the month. The sequential regimen, on the other hand, involves taking estrogen every day, and progestin for 10 to 14 days each month.

Use of more than one type of hormone replacement therapy For instance, after taking estrogen alone, some women changed to a combined regimen after reports of increased endometrial cancer risk with estrogen alone. More data are needed to analyze the effect of switching from one regimen to another.

The form of estrogen administration Most studies have analyzed the use of estrogens in pill form, but in recent years it is also available as patches, shots, and creams.

Every year, about 23,000 women in the United States are diagnosed with ovarian cancer, and 14,000 women die from the disease. A woman's lifetime risk of developing ovarian cancer is 1.7 percent. This means that in a group of 100 women followed from birth to age 85, fewer than two would get ovarian cancer. In comparison, about 13 women of that 100 would get breast cancer (lifetime risk is 13.3 percent), fewer than three women would develop uterine cancer (lifetime risk is 2.7 percent), and between 16 and 32 women would develop osteoporosis.

In the United States, an estimated 40 million women will experience menopause during the next 20 years, and women today are living approximately one-third of their life after menopause.

Anywhere from 20 percent to 45 percent of women in the United States take some form of hormone therapy between the ages of 50 and 75. According to industry estimates, about 8 million women use estrogen alone and about 6 million women use estrogen-progestin therapy. About 20 percent of hormone users continue for more than 5 years.

Copyright © 2002 Acurian Inc. All Rights Reserved.

http://health.yahoo.com/search/healthnews?...mp;p=id%3A26911

A terrrific post that just helped me make my decision about continuing on estrogen only HRT. I've been using the patch for almost 5 years and have slowly decreased the dosage. My mom died of ovarian cancer and I had a ful hysterectomy. I'm cutting my patch in half today  (to the lowest dose)and ordering Revival. Thanks.