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Study: Hormone Replacement Therapy May Cause Aggressive Cancer

Aired June 24, 2003 - 20:36   ET


PAULA ZAHN, CNN ANCHOR: Just when you thought it was pretty murky out there when it comes to women's health, yet another story to add confusion in that world. According to a new study, certain hormone pills may actually cause an aggressive form of breast cancer. Even more troubling, the estrogen, progestin pills make it harder to find tumors until they have reached a later, less curable stage. Our medical correspondent Dr. Sanjay Gupta joins us from CNN Center in Atlanta. You know how upset I get about these studies that are highly contradictory. Give us the bottom line on this one this evening, Sanjay.
SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Well, Paula, good evening. It's a been a study -- a story that you and I have talked about for quite some time. Now another study adding some fodder to some of the studies from previous, although a little confusing and a lot of consternation as well.

Briefly, and succinctly, what this study is saying, it's looking specifically at the issue of breast cancer as an adjunct to the women's health initiative. This is the largest study ever done looking at hormone replacement therapy, its benefits and its risks. What they specifically looked at here was breast cancer. They had already shown that there is an increased risk of actually developing breast cancer as a result of taking hormone replacement therapy. In this study, over 16,000 women were studied. They found that taking hormone replacement therapy led do a 25 percent increased risk in developing breast cancer.

But they're also finding, Paula -- this is the new part -- is that the women who were getting the breast cancer were found to have larger tumors, 1.7 centimeter in size versus 1.5 centimeters in size, and they're also having found tumors that had already spread more often than not.

So those are sort of the headlines out of this particular study. This is not good news for women who use hormone replacement therapy, who are concerned about either developing breast cancer or who have breast cancer, because it's probably a more invasive kind -- Paula.

ZAHN: Now, is it true this study also links this pill, this combination pill to other problems as well, above and beyond what you're talking about here?

GUPTA: Yes, you know, Paula, just really briefly, taking a step back, for a long time hormone replacement therapy was felt to be this panacea, or cure-all for everything. The concept was simple: A lot of women were developing problems when they went through menopause and when hormones went down. So if you replace the hormones, maybe you'll get rid of the problem. That was the logical thinking many years ago. That's not proving to be true.

Take a look at the list of all the things that hormone replacement therapy is actually increasing the risks of. It was believed to actually decrease the risk of some of these things. You actually have some of the benefits, as you can see here, colorectal cancer, hip fractures, and total fractures. But there are increased risks as well. Paula, we talk so much about breast cancer, heart disease, stroke and Alzheimer's, most recently. Almost a double fold increase in Alzheimer's in the women who take chronic hormone replacement therapy.

ZAHN: I know it wouldn't be smart of me to ask you to give a blanket advice to women out there. But just help us for a moment with this. Last year this time, women hear that hormone replacement therapy, that breast cancer survival rates were better among hormone users. And then along comes this study just last month, saying the use of this pill may be linked to dementia. Now this report suggesting that it leads to a stealthier, riskier kind of cancer. Are you basically telling us tonight that women should stop taking this combination pill?

GUPTA: Well, I think it's an excellent question. Let me answer it as well -- and I don't want to be evasive here. And I'm saying -- and I think most doctors would agree -- that probably hormone replacement therapy isn't at all what it was panned out to be at first. It probably is not going to provide any of the benefits that women thought it was going to provide, except for a couple of the ones that we mentioned there.

Here's what I would say. If the symptoms of menopause, the significant symptoms of menopause, such as hot flashes, sleep disturbances are so problematic and nothing else seems to be of benefit, hormones are the only thing that offer any benefit, then go ahead and take them, but lower the dosage as low as you can, shorten the duration as short as you can possibly shorten it, and recognize that this is a risk. But we all take risks, and we get certain benefits. You know, people want to smoke a cigarette, they know that it's not good for you, but they still do it. Eating a cheeseburger, probably not good for you, but you still do it.

For women, I'm not saying hormone replacement therapy is like smoking a cigarette, but I'm saying it has its risks. If you think the benefit of getting rid of those symptoms of hot flashes is worth it, then go ahead and do it, but try and recognize that there is a risk. Shorten the duration, lower the dose.

ZAHN: OK. Finally, (UNINTELLIGIBLE), how about the use of natural hormones? Some doctors say they would encourage the patients to use them. They don't because a lot of drug companies can't make a whole lot of money off of that, and there's not a whole lot of information out there about it.

GUPTA: There isn't a whole lot of information. The prescription drugs go through a specific process. They go through three trials where they're shown to be safe, they are shown to be effective and they are shown to be more effective than anything else that's out there. Over-the-counter medications, herbal medications don't go through that process, and that's why there's not the data there.

If it works for you, if something like black hahash (ph), which you and I have talked about, Paula, a lot of women do get benefit from that, in terms of treatment of their hot flashes. If that works for you, go ahead and try that, and then maybe that will get you off hormone replacement therapy.

But you're right, Paula. There's not the data there. In part that could be because there's no profits or little profits to be made from some of these medications, and part because they don't have to go through the rigorous FDA trial process so they don't have some of these same obstacles they have to overcome.

ZAHN: Well, Dr. Sanjay Gupta, we can always count on you to try to clear up all this confusion. Good job, my man.

GUPTA: I look forward to speaking with you. Thanks, Paula.

ZAHN: Thank you.

GUPTA: Good to see you. Bye-bye.



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