Topic: HRT takers live longer than non HRT takers

Is this refering to women taking hormone replacement therapy prior to diagnosis? After treatment?  Or is this referring to Tamox and AI's?  I'm confused.

This study is referring to estrogen and progesterone (HRT), not the hormone "blockers," Tamox. and Arimidex.

The study refers to women who took HRT and continued on HRT after diagnosis. The researchers believe the hormones "pre-treat" cancer cells, making them more normal so they are not deadly years later.

This study is similar in its findings to many other studies but goes against what we have been told in recent years.

Apparently, thirty years ago they used estrogen and testosterone to treat breast cancer. That was B.C. Before the chemo business got started.

Nico,

Statistics were not kept as well 30 years ago as they are now but the SEER division of the NIH has kept them from certain states. The American Cancer Society also keeps its own stats. If you phone them they will direct you to a line graph on their respective websites.

Anom

I think that an important thing to remember is the context ... HRT has been implicated in increased risks for breast cancer and ovarian cancer in women.  In fact, the decrease in the new dx's of breast cancer in recent years has been attributed to the decline in the number of women taking HRT.  This study doesn't appear to address the very real risks of HRT -- it only addresses what happens to women AFTER they get breast cancer and they took HRT. 

I interpret it as saying that if you had taken HRT and got bc, then you might survive longer than if you got bc and hadn't taken HRT.  I do NOT interpret it as a blanket statement that women who take HRT live longer than women who don't.

JMHO.

Layne

More recent information than the 2001 study cited above:

Posted on the National Cancer Institute Website 4/18/2007:

http://www.cancer.gov/newscenter/pressreleases/BreastIncidenceDrop

Decrease in Breast Cancer Rates Related to Reduction in Use of Hormone Replacement Therapy

The sharp decline in the rate of new breast cancer cases in 2003 may be related to a national decline in the use of hormone replacement therapy (HRT), according to a new report in the April 19, 2007, issue of the New England Journal of Medicine. The report used data from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute (NCI), part of the National Institutes of Health.

Age-adjusted breast cancer incidence rates in women in the United States fell 6.7 percent in 2003. During this same period, prescriptions for HRT declined rapidly, following highly-publicized reports from the Women's Health Initiative (WHI) study that showed an increased risk of breast cancer, heart disease, stroke, blood clots, and urinary incontinence among postmenopausal women who were using hormone replacement therapy that included both estrogen and progestin. The two most commonly prescribed forms of HRT in the United States, Premarin® and PremproTM, had their steepest declines starting in 2002-2003 -- from 61 million prescriptions written in 2001 to 21 million in 2004.

Led by senior investigator Donald Berry, PhD., of the University of Texas M.D. Anderson Cancer Center, Houston, Texas, the research team showed that the decrease in breast cancer incidence began in mid-2002 and leveled off after 2003. Comparing rates from 2001 and 2004 showed a decrease in annual age-adjusted incidence of 8.6 percent. The decrease occurred only in women over the age of 50 and was more evident in women with cancers that were estrogen receptor (ER) positive -- tumors that need estrogen in order to grow and multiply. The speed at which breast cancer rates declined after the WHI announcements may indicate that extremely small ER-positive breast cancers may have stopped progressing, or even regressed, after HRT was stopped.

"Breast cancer is the most frequently diagnosed cancer among women in the United States, and we have made great strides in its treatment," said NCI Director John E. Niederhuber, M.D. "Still, we don't know all the causes of breast cancer, and breast cancer rates had been increasing for two decades up to 2002. Finding the simple ways, such as limiting HRT use to decrease breast cancer risk, is a step forward."

Preliminary findings of this report were presented at the 29th annual San Antonio Breast Cancer Symposium in 2006. Data from 2004, which was of great interest to those present for the meeting, were not available at that time. This report now includes the data from 2004, which show a leveling-off of breast cancer incidence from 2003 to 2004. This observation, combined with a stabilization of HRT use in 2004, further strengthens the association between breast cancer incidence and use of HRT.

Understanding the effect of cessation of HRT may be complex. Effects may vary depending on the type of HRT used and other factors specific to how the hormones affect the body. From the data in this report, it seems that the decline in breast cancer incidence that is related to a nationwide decline in use of HRT may have has run its course, and breast cancer incidence rates may stabilize or even begin to rise again. Researchers do not yet know if this reduction in HRT use will have a long-term effect on rates, or whether reduction in hormone levels simply slowed the growth of clinically detectable tumors, in which case as HRT use stabilizes, breast cancer incidence will begin to rise again.

Several other possibilities were considered to explain the sudden decrease in new breast cancer cases, including changes in reproductive factors, rates of mammography screening, environmental exposures, and changes in diet. HRT was the only risk factor that changed substantially from 2002 to 2003 and provides a possible explanation for this trend. "Recent reports have suggested a small decline in mammography use after 2000," said Kathy Cronin, Ph.D., of the Surveillance Research Program at NCI. "Screening may play a role as well, and the contribution of mammography to the observed decline in incidence is currently being investigated."

Because this analysis is based on population statistics, the study does not prove a link between HRT and breast cancer incidence. Only a randomized clinical trial could prove causation. When the link between breast cancer and HRT was first confirmed in the WHI, which was a randomized clinical trial, women in the study were asked to discontinue their study medications (either placebo or hormones), and were encouraged to continue undergoing annual mammography. These women are still being followed, and the WHI researchers are expected to release a follow-up report later this year about the group who received HRT (estrogen and progestin). This report will provide a much higher level of evidence about the influence of HRT (and cessation of HRT) on the incidence of breast cancer.

"The decision about use of HRT is complex," says study researcher Christine Berg, M.D., from the National Cancer Institute. "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 with their doctor to discuss what decision is right for them, particularly if they are at high risk for breast cancer."

# # #

*Ravdin M, Cronin KA, Howlader N, Berg CD, Chlebowski RT, Feuer EJ, Edwards BK, Berry DA. The Decrease in Breast Cancer Incidence in 2003 in the United States. NEJM. Vol. 356, No.16. April 19, 2007.

For information on NCI's Surveillance, Epidemiology, and End Results (SEER) Program, please go to http://seer.cancer.gov/

For more information about cancer, visit http://www.cancer.gov/, or call NCI's Cancer Information Service at 1-800-4 CANCER.

Not my opinion.   Fact.

Edited to add link.

Nico, the NCI website does in fact have the SEER mortality rate data from 1975 onward -- you go to their statistics page and select your parameters.  Here is the portal page:

http://seer.cancer.gov/faststats/

The age-adjusted rate for mortality of cancer in the female breast in 1978 was 31.7345. 

The age-adjusted rate for mortality from cancer in the female breast in 2005 was 24.0041.

Mortality source: US Mortality Files, National Center for Health Statistics, CDC.

Rates are per 100,000 and are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1130). The modeled rates are the point estimates for the regression lines calculated by the Joinpoint Regression Program (Version 3.3, April 2008, National Cancer Institute).  (I didn't include the modeled rates but you can see them when you pull up the tables.)

Hi Layne -- I guess I think it's probably true that even ER+ cancers can grow faster than the proverbial "7-10 years" -- but I also don't think a big drop in BC diagnoses could really be due to a big drop in HRT prescriptions 6 to 18 months earlier!

Best,

Ann

Ann,

Here are some more results from analysis of the discontinuation of the WHI study.  I can't get the full texts on some of them because I'm not a subscriber.

Here is one that addresses your question about the drop: 

Breast Cancer Risk Lingers After Stopping HRT

As Reported by The Washington Post. 2008 Mar 5

Women who have used hormone replacement therapy (HRT) continue to experience an increased risk of cancer after discontinuing treatment. Researchers also found an unexpected increase in lung cancer in these women. Some of the other risks associated with HRT, such as heart disease and strokes, disappeared after stopping the therapy. However, benefits of the therapy, such as a reduction in the risk of colon cancer and bone fractures, also diminished with the discontinuation of treatment. It was previously reported that a substantial drop in breast cancer rates after 2002 was due to a reduction in the use of HRT, but those data disagree with these new findings. Researchers believe that drop could have been caused by a decrease in the number of women starting HRT rather than women's decision to stop the treatment. In the new report, researchers found that women who had taken HRT and stopped it had an increase of 24% in their overall cancer risk compared with those who had taken a placebo. The largest increase in risk was noted in breast cancer, which had an increase in risk of 27% in women who had taken HRT. The study, which was published in the March 5 issue of The Journal of the American Medical Association, studied 15,730 women aged 50 to 79 who had taken HRT for an average of 5.6 years. Of these women, 281 developed cancer, as opposed to 218 in a placebo group. Breast cancer occurred in 79 women in the HRT group compared with 60 in the control group. Further research is needed to fully understand the role that hormones play in cancers such as lung cancer.

Here's the JAMA abstract link:

http://jama.ama-assn.org/cgi/content/abstract/299/9/1036

(sorry it's bold -- I can't seem to unbold it)

Here is the link from OncologyStat where I got the original article.

Here is a summary of the JAMA article written by the OncologyStat staff.

And rather than make this an epic post, here is another link to an OncologyStat capture of a Reuters article of January 15, 2008 - HRT Increases Cancer Risk Quickly.

There are others on the OncologyStat website:  www.oncologystat.com .  I find it a very useful source.

Layne

Thanks, Layne!

Ya know, I really don't care about these damned studies. 

I took progesterone.  Then I took the combo, estrogen and progesterone (Fmhrt).  I believe it was 2002 when I stopped taking it after we learned that taking HRTs caused bigger problems.  Anyway, in Dec. 2004 I found my large tumor.  It was 4.5 cm and I had five postive nodes.  And I've often wondered why or how they can say that our tumors have been growing for X number of years.  I had a great clinical exam in March and apparently it was not felt.

<stomping off>