Hormone Replacement Therapy (HRT) and Cancer

Hormone replacement therapy (HRT) has dramatically reduced the unpleasant symptoms associated with menopause for many women. But new evidence suggests that it may increase the risk of cancer.

Most recent evidence from overseas centers now links the continual use of female hormones, called estrogens, with an increased risk of cancer of the uterus. The risk may be four to eight times greater.

But there is no need for women on HRT to panic at this sudden announcement.

By comparison, many of them take greater risks in their daily lives. For example, smoking 20 cigarettes a day increases the risk of death from lung cancer 17 times. So, in a sense, the risk must be looked at in its proper context.

For many years doctors have been prescribing HRT for women in their late 40s and 50s. But HRT has really escalated over the past decade as more and more women seek relief from unpleasant symptoms associated with the reduction in normal body hormonal production.

In fact, the medical journals that give doctors up-to-date information on treatment have been promoting estrogen treatment for some time.

The woman’s system soon notices the removal of these key chemicals. The nervous system is often affected first. Symptoms such as hot flushes, feelings of depression, irritability, and emotional conflict are common. The upper part of the body (face, neck, and chest) is the area most commonly affected by a sudden hot sensation that may be overpowering.

The reproductive organs are invariably affected. The breasts lose their normal tone, may shrink in size, or else enlarge as more fat accumulates.

Often the vaginal lining becomes thin and atrophied, and intercourse may become unpleasant or downright painful. The supply of natural lubricating fluid may be reduced. In turn, this may breed emotional and domestic troubles. Husbands who do not understand the natural course of events are apt to put this down to female contrariness, and tensions and anxieties frequently flare into major domestic crises.

This is often the cause of rifts in couples in their late 40s. Just the same, female libido is often heightened at this time.

However, gynecologists have long wondered how safe it is to pump hormones artificially into women when their normal supply ceases on a permanent basis. Many have believed it quite safe, reasoning that if the body can withstand hormones’ presence for 40 years from natural sources, it should be quite able to cope with artificial ones for a few years.

But the bogey of cancer has lurked in the background.

In the United States, the “New England Journal of Medicine,” probably one of the most advanced medical journals in the world, recently published the findings of three groups of doctors all carrying out research on estrogens.

In one major series, doctors Ziel and Finkle checked the estrogen history of 94 patients with cancer of the uterus. They discovered that 57 percent of the cancer patients had been treated with estrogens compared to 15 percent in a very carefully matched “control” group.

This indicated that the use of estrogens appeared to increase the risk of cancer by a factor of 7.6 times. Also, it showed that the degree of the risk was in proportion to the length of treatment.

A second study was carried out by Dr. Smith and his partners. In their series, they found that the risk of cancer was 4.5 times greater in women treated with estrogens than in similar women who were not treated with these chemicals.

The question is: how great is the risk to women? It is fairly well established that one woman in every 1000 with an intact uterus will develop cancer in any case. The use of estrogens, it seems, may increase this to four to eight women in every 1000.

However, as the “British Medical Journal” has subsequently pointed out, there has not been a massive increase in uterine cancer in the past few years.

Other workers have been quick to note that more and more women in this age group appear to be undergoing hysterectomy – removal of the uterus. This removes them from the risk category.

The BMJ has put forward a series of sensible recommendations to its readers.

In view of the positive benefits of estrogen therapy, we are justified in exposing patients to this risk when there are valid medical reasons. Treatment should be restricted to women with established symptoms. We can reduce the risks by avoiding synthetic estrogens and oestrone sulfate.

Your own doctor will know what these forms actually are. Be guided by his advice. Don’t demand estrogens merely because you think they’ll make you 20 years younger, for they won’t and can’t.

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