It is a fluke of the news cycle that if we don’t hear a product warning frequently, we can “forgive” that product and think it has somehow become safe. While no one would “forgive” cigarettes, lead in drinking water or mercury in tuna, the public has definitely softened on the danger of hormone replacement therapy (HRT) for menopause. So it is noteworthy that a recently released follow-up of subjects in the federal Women’s Health Initiative found that “breast cancer risk from menopause hormones may last decades.” Specifically, women prescribed HRT had a 29% greater incidence of breast cancer 19 years after using the drugs than those who never used the drugs, said the analysis.
It has been over 17 years since the Women’s Health Initiative found that HRT increased the risk of breast cancer by 26%, heart attacks by 29%, stroke by 41%, and doubled the risk of blood clots.
In a related study, HRT doubled the risk of dementia in women. Women on HRT were found to be more likely to lose their hearing, develop gallbladder disease, urinary incontinence, asthma, melanoma, and need joint replacement, said medical journals. They were at greater risk of ovarian, endometrial, and lung cancers and non-Hodgkin’s lymphoma.
Not only did HRT increase the risk of breast cancer, it made detecting the cancer more difficult. As early as 1995, an article in the journal Radiology said, “an increase in mammographic density” was demonstrated in most subjects undergoing continuous combined HRT. In fact, the effect of HRT on breast cancer was so dramatic, in one year after millions of women dumped HRT, 2003, the incidence of breast cancer fell seven percent. It fell 15% in women whose tumors were fed by estrogen.
The results should have been embarrassing to cancer researchers and public health officials because a major cause of cancer was hidden in plain sight. Worse –– the entire scenario had happened before.
After similar fears led to a drop off of menopausal hormones in 1975, the New England Journal of Medicine wrote: “From July 1975 to July 1977, there was a sharp downward trend in the incidence of endometrial cancer that paralleled a substantial reduction in prescriptions for replacement estrogens.”
What explains the tenacity of HRT?
Soon after the HRT meltdown, hormone makers and prescribers vehemently attacked studies that found risks. Subjects were too “old,” they said, and HRT was still a beneficial therapy — it just needed to be begun earlier.
But money was not the only reason for the aggressive HRT cheerleading. There was also sexism. When HRT surfaced more than 50 years ago, drug ads accused women of “outliving their ovaries” and having no value past fertility. One ad even suggested treating menopause with electroconvulsive therapy. Also, the understandable human desire to stay young looking is at play –– likewise seen with testosterone supplements.
Still, the public ignores menopausal hormone risks at its own peril. “The message is probably not clear” that even short-term HRT can have lasting effects, said Dr. Rowan Chlebowski of Harbor-UCLA Medical Center in Torrance, California, during at the San Antonio Breast Cancer Symposium in December.
In 2010, as HRT risks underwent “revisionism” in the media, I interviewed Dr. Chlebowski about the tenacity of HRT believers and prescribers.
Rosenberg: Why do doctors still promote HT despite its cancer, heart disease, stroke and blood clot risks? Are they influenced by drug companies?
Chlebowski: Certainly the estrogen drug used in the trials, Premarin, and the estrogen plus progestin drug Prempro are best selling products of Pfizer, previously Wyeth. These companies are also big supporters of the gynecology community. It is reasonable for companies to support groups who use their products, so it becomes a chicken and the egg question. The gynecology community tends to focus more on heart problems than the data about breast or lung cancer that is increasingly emerging from WHI.
Clearly, an unsafe product remains unsafe despite the public’s short memory or financial interests.
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