More Answers to Your Questions on Breast Cancer and Hormone Therapy

Dec. 18, 2006 — -- Thank you for the strong interest in participating in this Q&A with Dr. Clifford A. Hudis, the chief of breast cancer medicine service at Memorial Sloan-Kettering Cancer Center.

Your questions keep pouring in, and we can hardly keep up with them all!

Below are more answers from Hudis, in response to a selection of your questions from the "World News" message board.

To watch his interview on "World News" about the new study regarding falling breast cancer rates with respect to hormone replacement therapy, (HRT) click here.

Question: I have been taking estrogen since I was 30 and I am 51 now. I haven't had any problems with breast cancer and have mammograms every year. Should I be concerned about this and stop taking the HRT. My doctor has never been concerned about me taking the estrogen. -- grannyd54

Hudis: Every woman taking HRT will not get breast cancer. This is a risk. It is akin to wearing or not wearing seat belts while driving. Almost everyone will survive a lifetime of driving without wearing seat belts but the risk of dying in a car accident is increased. Similarly, you probably will not get breast cancer but your risk is increased. It is your tolerance for that increase in risk that should drive your decision. A final point is that most of the claimed benefits for HRT have not been confirmed in randomized trials so our bias is that you should not be on them if at all possible.

Question: I stopped taking HRT when the news came out about its increasing the risk of breast cancer. I have now noticed that having sex is uncomfortable and sometimes painful, resulting in either itching, soreness and/or abrasions. What can be done for that? -- usmbelle

Hudis: There are a variety of topical treatment options. You need to discuss this directly with your gynecologist.

Question: How could the rate of breast cancer immediately begin to drop by 1 percent per month in the Spring of 2003 (as reported by ABC News) when women just began to stop HRT per their doctors' advice? Does not it take years for breast cancer to develop as my wife pointed out to me and as happened to her? -- shneid

Hudis: Not necessarily. If there were small breast cancers fueled to grow larger by the hormones, they might immediately stop growing and shrink when the estrogen was removed. We see exactly this when we treat advanced breast cancers with hormone blocking drugs. The cancers shrink within days or weeks in many cases.

Question: My doctor wants me to use an estrogen vaginal cream. Does this carry the same risks as HRT? -- margiotta52

Hudis: We don't know. Some recent studies have documented absorption of these estrogens through the vaginal wall into the bloodstream but we don't yet know the significance. If this is the only effective option for an individual, then it should be used as sparingly as possible.

Answers from Dec. 15, 2006

Question: The news article referred to "long-term HRT." Please define "long-term" and tell me what other factors are involved in becoming a high risk for breast cancer if you are on HRT. Also, what are some alternatives to conventional HRT (Premarin, estratest, prempro, etc.) to relieve postmenopausal symptoms like night sweats, weight gain and hot flashes? -- mrspiz

Hudis: "Long-term" usually refers to more than a few months -- one or more years of therapy. Other risk factors include increasing age, weight, and family history.

As for alternatives to HRT, for each specific symptom there are tested options. Some work better than others and the right choice can only be made after consultation with your health care provider.

Question: I went through a natural menopause at the age of 40 and I am now 62. I stopped my HRT approximately four weeks ago. I am also a smoker. Is it too late for me? --carmarsm

Hudis: No, it is never too late. The presentation suggests that the risk of breast cancer falls quickly after you stop hormone replacement therapy. On the other hand, smoking is a huge risk for lung cancer and you should quit now!

Question: What about taking natural supplements like black cohash? Does that cause breast cancer? My mother died of breast cancer at age 45. -- mikesam50

Hudis: Alternative treatments are incompletely studied and we do not have the tremendous body of carefully conducted scientific studies needed to recommend their use.

Question: I am 58 years old and have been taking HRT for over 5 years. Without it I have frequent nocturnal hot flashes and cannot sleep. I have tried taking less, for example every other day, but the symptoms continue. With this new information what do I do? I have talked with my doctor but he assures me I should not worry. Thank you.

Hudis: If there is no effective alternative to HRT for an individual then the course of therapy should be as short and low-dose as possible. Since most hot flashes decrease significantly in number after a few months you may want to consider tolerating them for a while to see if, in the long run, you can stop HRT.

Question: I had a hysterectomy at 35 (no cancer was involved), am now 49 and have been taking Premarin 1.25 mg for 14 years for the hot flashes, night sweats and anxiety. If I stop taking Premarin now, will my chances of getting breast cancer still go down after being on HRT for 14 years? -- kminger

Hudis: Yes. The study suggests that the reduction in risk could be seen very quickly.

Question: Does consuming more soy, a source of natural estrogen, have any similar link to a higher cancer risk? -- calevey

Hudis: Alternative treatments are incompletely studied and we do not have the tremendous body of carefully conducted scientific studies needed to recommend their use. So-called natural estrogens could be better or worse than the ones your body produces. We simply don't know and can't endorse them as safe.

Question: On the government statistics on breast cancer, who actually did the study? What types of estrogen were actually recorded? Was it estrone + equilin (Premarin), estradiol, or ethinyl estradiol or bio-identical hormones? Does the report give the percentages of each of these? While the surface of this report shows a very important link between hormones and cancer, they have left us women without help again to just do nothing. -- MadonnaGK

Hudis: This study did not directly address hormone use. It described a fall in breast cancer risk mostly limited to postmenopausal patients with hormone responsive cancers (the kind known to be fueled by estrogen). After seeing the decline they looked for explanations. The most obvious explanation was the dramatic decrease in hormone therapy use seen after the randomized trials of replacement therapy failed to show benefit. The timing of the decrease in hormone therapy use and the fall in breast cancer is suggestive, but cannot prove (as the authors note) the cause. It remains possible (but unlikely) that there is another cause unrelated to hormone therapy use. Regarding doses and specifics, this effect is an average. It is possible that specific hormones at specific doses could have different effects. There is no available scientific evidence to address this specific question.