To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: NAMS: Doctor Offers Closest Recommendation Yet for Estrogen Use in Breast Cancer Survivors URL: http://www.pslgroup.com/dg/208252.htm Doctor's Guide October 8, 2001
By Cameron Johnston Special to DG News
NEW ORLEANS, LA -- October 8, 2001 -- The question of whether menopausal or peri-menopausal women who have had breast cancer should take estrogen has challenged physicians, and frustrated their patients for years now.
At the annual meeting of the North American Menopause Society, Dr. Bruce Ettinger, presented a retrospective look at a number of studies that have addressed the issue. The results he offered might not be considered alarming, but nor did they indicate with any degree of certainty whether estrogen use in these women is safe.
The upshot is that for these women to use hormone replacement therapy (HRT) might present a gamble in some respects, but many studies have shown no risk, or an inconclusive risk. Therefore, the woman herself has to decide how much risk she is willing to tolerate.
Dr. Ettinger is head of research with the Kaiser Permanente Medical Care Program, in Oakland, California.
No randomly controlled trials have yet been completed showing benefit or harm from using estrogen in post-menopausal breast cancer survivors, he said.
However, an analysis of 11 studies (Col et al, J Clin Oncol 2001;19:2357) found that only four out of the 11 studies had control groups, and out of those four studies, only one found a higher recurrence rate of breast cancer among the women who had taken estrogen.
In his presentation, Dr. Ettinger did not specify the doses, or regimens of estrogen the women were receiving.
On average the women involved in these studies had been disease-free for five years, and had used estrogen for a period of two years. The results from this, he said were "comforting" and those results indicated a substantial reduction in the increased risk of recurrence.
However, in the seven studies where there were no controls (a comparison was derived by comparing the women in these seven studies with the control groups analyzed in the four studies mentioned above), there was a four percent annual rate of recurrence, and while three showed a higher recurrence rate which was not "dramatic" Dr. Ettinger said.
Three studies showed no significant change.
The most recent article to address this issue (O'Meara et al, JNCI 93;754:2001) compared 174 women who had had breast cancer over a 17-year period and had used HRT after their diagnosis, against a group breast cancer survivors (ratio of subjects 4:1) who had never used estrogen.
It was found that there was a 50 percent drop in recurrence with any estrogen use, and a 43 percent drop in recurrence with oral estrogen use, but there was a 33 percent increase in the risk of a new contralateral cancer among those women who had used estrogen. Interestingly, there were no differences in whether the women used vaginal only estrogen.
"So I don't think there is a protective effect from estrogen. I think this is related to the other biases that are at play here," Dr. Ettinger said.
"What should we advise these women?" Dr. Ettinger asked. The answer he suggested is that they should stick with their tamoxifen for five years "there is good solid evidence for that [approach]" and then they should stop taking it. "It makes no sense to take tamoxifen longer than that, and there might even be some disadvantage in taking it longer than five years."
"But the next question is what about estrogen, because I feel that the big issue five years or 10 years from now will be what about contralateral cancer?"
"I believe if [the patient with a history of breast cancer] wants to use estrogen for quality of life, and if she has been disease free for five years or more, then we can tell her that she can use estrogen for a year or two, without increasing her risk. That is basically the information we have today.
"There is no data to support the use of estrogen earlier on, and unfortunately that is when women are asking for it - that is when the issue comes up. But the longer a woman is disease free, the safer it appears to be using estrogen," he said. --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.