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Expert Warn- Odds Still Stacked Against Hormone Replacement Therapy

Debates and vigorous arguments never seem to leave the Hormone Replacement Therapy (HRT) issue, especially in the wake of a respected// report reversing its ‘notoriety’.

Yet say some experts, don’t be in a hurry to start HRT all over again. According to them, hormone replacement therapy may have led to the deaths of more than 1,000 women in the UK from ovarian cancer since 1991.

In an article said to be the first such decisive one on the calculations of deaths related to HRT, the research led by Professor Valerie Beral and team from Oxford University feel that the results should sound the warning loud and clear; HRT is to be taken with caution.

Published in the online version of The Lancet, the research was based on 1.3 million women in the UK aged around 50 years. The study :The Million Women Study, claims to be the largest of its kind with one in four women in the UK of the target age participating.

Between 1996 and 2001, the subjects completed a questionnaire about their lifestyle, their social and demographic background and their use of HRT. Three years later they were sent a second one, which 64 percent filled in. Every participant was followed up for death, emigration or cancer registration.

Accordingly, the study shows that one woman in 2,500 will get ovarian cancer while a long-term user of HRT and one in every 3,300 will die from it. The risks of breast cancer are the highest, accounting for a probable 20,000 cases over a decade.

The article also says the ovarian cancer risks should not be taken in isolation.

Says Beral: "In total, ovarian, endometrial and breast cancer account for 39 percent of all cancers registered in women in the UK. The total incidence of these three cancers in the study population is 63 percent higher in current users of HRT than in newer users.”

HRT leads to "a material increase" in these common cancers, the authors conclude. When women stop tak ing it, however, their risk returns to normal.

Yet on the issue whether HRT should be taken off the market, Beral was quoted: "The regulatory bodies have said for five years if you want to take HRT, take it for as short a time as possible and in as low a dose as possible. "The trouble is that there are some people who say they couldn't survive without it.

"My personal view is that it would be quite hard to do that [ban HRT] but I think this is just more evidence that it is not a good idea to take HRT for very long because the risks do go up with duration, as with breast cancer."

Professor Beral’s findings are echoed by another respected study group, which reiterates its previous conclusions that the decline in prescription of HRT after 2002 was linked to a significant decrease in breast cancer incidences.

Published yesterday in The New England Journal Of Medicine, lead author of the article, Dr. Peter Ravdin of the Texas University M.D Anderson Cancer Center, compared cancer registry data from 2001 with data from the same sources in 2004. The authors report an 8.7 percent decrease in the annual age-adjusted incidence of breast cancer. Significantly, a 14.7 percent drop accounted for most of the decline in the number of estrogen-receptor-positive tumors, which may have occurred when women with sub clinical estrogen-receptor positive tumors abruptly stopped taking hormones, the authors suggest. In contrast, estrogen receptor-negative tumors decreased by only 1.7 percent and this change is not statistically significant.

According to the authors, these findings add weight to the recommendations about limited use of HRT to treat the symptoms of menopause.

Co-author Christine D. Berg, of the National Cancer Institute says:"The decision about use of HRT is complex. “While HRT provides relief from the symptoms of menopause, it may also increase one's risk of breast cancer. It is important that women meet wi th their doctor to discuss what decision is right for them, particularly if they are at high risk for breast cancer.”

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