[Pharmwaste] Breast Cancer Drop Tied To Less Hormone Use

[DeBiasi,Deborah]

http://www.washingtonpost.com/wp-dyn/content/article/2007/04/18/AR200704
1801843.html?referrer=email



Breast Cancer Drop Tied To Less Hormone Use

By Rob Stein
Washington Post Staff Writer
Thursday, April 19, 2007; A01



New federal statistics provide powerful evidence that the sharp drop in
hormone use by menopausal women that began in 2002 caused a dramatic
decline in breast cancer cases, according to an analysis being published
today.

The statistics show that the number of breast cancer cases being
diagnosed began falling abruptly after concerns emerged about the safety
of hormone treatment and that the decrease persisted into the following
year, strengthening the case that the trends are related, researchers
said.

"At first I didn't believe it -- it was so astounding," said Donald A.
Berry of the University of Texas, who led the analysis published in the
New England Journal of Medicine. "But it really looks like it's a story
that holds together."

The researchers estimated from the findings that about 16,000 fewer
cases of breast cancer are being diagnosed each year because of the
decrease in hormone use, a stunning reversal of a decades-long increase
in cases.

"This is colossal," said Rowan Chlebowski of Harbor-UCLA Medical Center,
who helped conduct the analysis. "It translates into thousands of fewer
breast cancers that have been diagnosed in women in the United States
and could be in the future."

The findings also help explain one of the biggest mysteries about breast
cancer -- why the number of cases rose steadily for decades. Increasing
hormone use probably played a key role, along with better detection by
mammography and other factors, several experts said.

"I think this solves at least part of the mystery," Berry said.

Others said the findings underscore the danger of drug therapies
becoming widely used before they have been thoroughly tested.

"An awful lot of breast cancer was caused by doctors' prescriptions,"
said Larry Norton of Memorial Sloan-Kettering Cancer Center in New York.
"That's a very serious and sobering thought."

Norton and others said the findings should encourage more women to stop
hormone use altogether or to continue at the lowest dose and for the
shortest time necessary.

The findings come as another study involving nearly 1 million British
women found that hormones also increase the risk of ovarian cancer.

"These data add to the message that we really should be discouraging
women from initiating menopausal hormones," said Marcia L. Stefanick of
Stanford University. "We need to stop underplaying those risks. They are
very real."

Some researchers, however, questioned the findings, saying the drop in
breast cancer occurred too soon to have been caused by the decline in
hormone use.

"Even if there was a cause and effect, you wouldn't expect it to show up
for five or 10 years," said Hugh Taylor of Yale University. "It just
doesn't fit with what we know about the basic biology of breast cancer."

Wyeth Pharmaceuticals, which makes the most widely prescribed hormones,
also questioned the link, saying hormone use continued to fall while the
breast cancer rate remained stable after the initial drop. The
researchers, they said, had failed to rule out other causes, such as a
decline in mammogram use.

"We do respectfully disagree with the conclusion here," said Joseph
Camardo, Wyeth's senior vice president of global medical affairs.

Millions of women took hormones for years to alleviate hot flashes and
other symptoms of menopause. Some also viewed hormones as a virtual
fountain of youth -- boosting energy, preventing wrinkles and providing
health benefits, including reducing the risk of heart disease.

In 2002, however, the large federal Women's Health Initiative study
stunned doctors and patients when it showed that the hormones not only
failed to protect women's hearts, they appeared to increase the risk of
heart attacks and strokes, as well as breast cancer and other health
problems. The news prompted millions of women to abandon the drugs.

Researchers first reported last year that the breast cancer rate had
dropped in 2003 after rising steadily since the 1980s, and that the drop
appeared to coincide with the news about hormones. Experts have been
waiting for the latest federal data, from 2004, to see if the trend
persisted.

The new analysis showed that the breast cancer rate began falling almost
immediately after the Women's Health Initiative findings were released
in July 2002, dropping 6.7 percent between 2002 and 2003. The 2004 data
showed that the rate remained at the lower level, having fallen 8.6
percent between 2001 and 2004.

The researchers said that indicates the drop was primarily caused by the
decrease in hormone use and not other factors, such as fewer women
having mammograms, greater use of hormone-blocking drugs such as
tamoxifen or an unknown change in the environment, and that it will be
long-lasting.

"The fact that the incidence rate did not go back up suggests that the
effects will be long-lived," said Peter Ravdin of the University of
Texas, who helped conduct the analysis.

The link is strengthened by the fact that the decline occurred primarily
in women ages 50 to 69, the age group most likely to use hormones, and
predominantly in a form of breast cancer sensitive to estrogen. New
cases of this type fell 14.7 percent, the researchers said.

The researchers and others emphasized that further research will be
needed to determine whether the reduction in diagnoses will translate
into fewer deaths.

Researchers suspect hormone use may spur the growth of tumors that may
never become life-threatening. Without hormone use, the tumors may
remain small enough to never be detected by mammograms. They may even
shrink.

"Think of a cancer that you are feeding with hormones and now you stop
the fuel. What's going to happen to it?" Berry said. "Most likely it
stops growing and stays under the radar, or maybe even regresses. It
could even disappear."


Deborah L. DeBiasi
Email:   dldebiasi at deq.virginia.gov
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