An editorial in the April 6 issue of the Journal of the American Medical Association cautions against estrogen-only hormone therapy in women who have had a hysterectomy because of longstanding evidence that it raises the risk of breast cancer.
The editorial is a response to a study in the same issue of the journal that found that estrogen-only therapy, currently used in women with menopausal symptoms who have had a hysterectomy, may decrease breast cancer risk if it is used for fewer than five years. The study found this benefit persisted even after the hormone therapy was discontinued.
But in the editorial, Graham Colditz, MD, PhD, the Niess-Gain Professor of Surgery, and Emily Jungheim, MD, of Washington University School of Medicine in St. Louis, say that while short-term use of estrogen-only therapy appears safe, the long-term consequences of that short use are unknown.
The study, by researchers at Fred Hutchinson Cancer Research Center, looked at data from the Women's Health Initiative, a large study of the risks and benefits of hormone therapy in preventing chronic disease.
The researchers found that the negative effects of hormone therapy (HT), primarily stroke, went away after the women stopped treatment. Likewise, the benefits, mainly a decreased risk of bone fracture, also disappeared. The exception, according to the authors, was that a possible decreased risk of breast cancer found in the estrogen-only group continued even after therapy ended.
But Colditz and Jungheim caution doctors to look at the larger body of evidence that contradicts this finding and shows that hormone therapy may raise the risk of breast cancer. While estrogen therapy is commonly used on a short-term basis to manage menopausal symptoms after hysterectomy, Colditz and Jungheim say questions remain about its safety, including whether there is a safe duration of use.
The Women's Health Initiative (WHI) began recruiting p
|Contact: Julia Evangelou Strait|
Washington University School of Medicine