STUDY: Latest study adds to confusion over hormone therapy

JOURNAL: Journal of the American Medical Association

AUTHORS: James Lacey

ABSTRACT: In another piece of the increasingly complex hormone-replacement health puzzle, women given estrogen-only therapy after menopause ran a significantly higher risk of ovarian cancer, researchers reported.

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COMMENTARY: The report followed two other recently released studies that found estrogen in combination with progestin — a slightly less common replacement therapy than estrogen-only — does not generally protect against heart disease after all and may increase the risk of breast cancer, stroke and blood clots.

Hormone replacement therapy (HRT) of both types is used by an estimated 13.5 million women in the United States alone, nearly 8 million estrogen-only and up to 6 million in combination with progestin.

The therapy is prescribed to treat immediate symptoms such as hot flashes and vaginal dryness, and to protect against bone-thinning osteoporosis.

James Lacey of the National Cancer Institute, lead author of the estrogen study published in this week’s Journal of the American Medical Association, said there was not enough evidence to say if there was also an ovarian cancer risk from estrogen-progestin use.

He offered this advice to women: “Because hormone therapy may influence so many conditions ... 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.

Lacey’s research involved 44,241 post-menopausal women whose health histories were tracked for about 20 years as part of a major breast cancer study. Among those women, 329 developed ovarian cancer. The researchers found that compared to similar women not on hormones, those taking estrogen therapy had a 60 percent greater risk of developing ovarian cancer.

The risk increased proportionately with longer duration of hormone use; those who used estrogen therapy for 20 or more years were approximately three times more likely to develop ovarian cancer.

The main finding of the study was that post-menopausal 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.

Estrogen replacement therapy certainly is not the panacea it once appeared. Physicians counseling women about HRT must consider the unique needs of each patients and attempt to weigh the benefits and risks on an individual basis.