January 8, 2002
Hormone replacement therapy and cancer: Balancing safety and quality
of life
Sandra Shuman feels that HRT contributed to her breast cancer.
Rock or hard place? Before last summer, this seemed to be the choice for women entering menopause and considering hormone replacement therapy (HRT). If they took HRT — an oral combination of estrogen and progestin to ease symptoms of menopause — they might increase their risk for breast cancer. If they did not take the medications, doctors said, they would be more prone to heart disease and osteoporosis. The comfortable place these women sought was freedom from the symptoms that HRT is intended to relieve: hot flashes, night sweats, insomnia, and vaginal dryness.
For the average woman, this decision became even more difficult last July, when the results of a major study of HRT were published, setting off a torrent of publicity. Conducted under the Women's Health Initiative (WHI) and supported by the National Institutes of Health, it was the first randomized, controlled study to confirm what previous studies had suggested: that the standard HRT drug does raise the risk of breast cancer. The study also established that HRT can protect women from osteoporosis. But the greatest surprise was that it failed to confirm the supposed benefit of reducing heart disease, and even found an increased risk of heart attacks and strokes.
For patients in the Women's Cancers Program at Dana-Farber, the HRT decision is more complicated than for the average woman — and the stakes are higher. These women are at risk for developing cancer or have already been diagnosed with cancer, and they come to Dana-Farber with a battery of unique questions.
Next page: Women at risk
