Dear Jacqui,
I recently read that a panel of scientists recommended to the government that estrogen in hormone replacement therapy and in oral contraceptives should be listed as "known" cause of cancer. My wife has been taking estrogen for over ten years? I am very worried that she put herself at great risk. Why didn't her doctor ever mention the danger? What are the facts and what should she do?
Mike R.

Dear Mike,
You are correct. The quoted scientists indeed recommended that the cancer warning should be included in the "Tenth Report on Carcinogens" to be issued later this year. This is news. What we have known for several years, however, is the fact that estrogen increases the risk of breast cancer. Since l997 I have reported regularly on the results of ongoing studies. So what have we learned about the benefits and risks of HRT (Hormone Replacement Therapy)?

We know that Estrogen protects against Osteoporosis but so do several new drugs that are risk free. We know that HRT alleviates several symptoms of menopause such as night sweats, mood swings, sleeplessness, etc. But various reports suggest that herbal remedies such as Black Cohosh, Primrose, St.John's Wart, and natural estrogens are effective for alleviating these same symptoms.

The problem is which brand can you trust and how can you assess the risk of potential interference with other medications? Many physicians know little about herbal alternatives.What about the common belief that HRT protects mature women's heart, heart disease being the number one cause of death of American women? The assertions may be unfounded.

Two major l998 studies concluded that women on HRT had just as many heart attacks as those not on the hormone treatment. Both these studies made a strong argument that women with heart disease should definitely choose proven heart protection therapies rather than rely on HRT.

The fact is, every single study done over the last ten years confirmed that HRT increases the risk of breast cancer by at least l0% to l5% for shorter term use and over 30% for longer term use (6 to 8 years or more). The National Institute of Health also cites increased risk of uterine and endometrial cancer linked to estrogen.

To choose or forego HRT is a difficult decision that should be discussed between a woman and her doctor and then monitored carefully. It must include a thorough analysis of a woman's health history and that of her family. It must give equal weight to a woman's feelings and instincts as well as her doctor's recommendation, especially if there are no clear cut indications. In either case, I recommend yearly mammograms and pap smears and yearly reevaluation. Early detection is still the best protection.

Jacqui

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