Researcher: Estrogen-only therapy may prevent breast cancer in some women

Estrogen-only hormone replacement therapy may benefit younger postmenopausal women who do not have a uterus, a Canadian researcher said Thursday at the annual meeting of the San Antonio Breast Cancer Symposium.

Dr. Joseph Ragaz, an oncologist at the University of British Columbia, presented a re-analysis of the Women’s Health Initiative — which originally concluded that both long-term estrogen-only and estrogen-plus-progestin hormone replacement were too risky for most women.

But Ragaz said his take on the data suggests that using only estrogen — for women who do not have a uterus and do not need progestin — protects against breast cancer. He found that subsets of women, such as younger postmenopausal women and those with no strong family history of breast cancer or benign breast disease, had a lower risk of breast cancer after using estrogen-only therapy and reaped other health benefits, such as a lower risk of heart disease.

Ragaz says studies are needed to determine whether estrogen produced by the body, called endogenous estrogen and which is known to fuel cancer growth, and outside sources of estrogen (called exogenous) have different effects on breast-cancer risk.

“Our conclusion, which is potentially a new paradigm, is that we see a dual effect,” Ragaz said. “On a research level, we have to identify the mechanisms or biology that would distinguish exogenous-estrogen benefits from the carcinogenic effects of the endogenous estrogen.”

The study was called “provocative” by Dr. Judy Garber, an associate professor of medicine at the Dana-Farber Cancer Institute. But she said the idea called for further study and that the current guidelines for women regarding hormone therapy shouldn’t change.

Women Fail to Get Annual Mammograms as U.S. Physicians Debate Frequency

Half of U.S. women ages 40 or older failed to get an annual mammogram for breast cancer last year, said researchers concerned that women are confused by the debate about the effectiveness of the screenings.

The study, sponsored by Medco Health Solutions Inc., reviewed records for 1.56 million patients from January 2006 through December 2009. About 207,000 new cases of invasive breast cancer in women will be diagnosed and almost 40,000 women will die from the disease this year, according to the Atlanta- based American Cancer Society.

As death rates from the disease decreased over the last 10 years, the debate over how frequently to get a mammogram has grown. The cancer society recommends that women ages 40 or older get screened every year. In November 2009, the U.S. Preventive Services Task Force advised women 50 or older to undergo a mammogram only once every two years, and patients younger than 50 to get one only if they carry risk factors for the disease.

“As controversy becomes public and there’s so much back- and-forth, it becomes confusing for women,” said Milayna Subar, lead author of the study reported today at the San Antonio Breast Cancer Symposium, in a telephone interview. “This study shows the need to put programs in place to educate women and remind them to do it.”

Medco, based in Franklin Lakes, New Jersey, is the largest U.S. pharmacy benefit manager by number of prescriptions. Subar, a physician, heads the company’s Oncology Therapeutic Resource Center, which seeks ways to suggest health improvement for members of the health plans it serves.

Hormone Therapy

The mammogram research was among studies presented today including new findings on the use of hormone therapy, and on the risk of death for obese women with a type of breast cancer.

Mammography has been shown to reduce death rates 20 percent to 30 percent among women 40 or older, according to the National Quality Measures Clearinghouse, an agency under the U.S. Department of Health and Human Services. The decrease stemmed from earlier detection through screening and from improved treatment, the cancer society has said.

Sixty-five percent of the study’s 708,290 women ages 50 to 64 — considered the “must-do group” — had a mammogram at least twice during the four-year period, Subar said.

“That still leaves 35 percent not getting mammograms even every other year,” she said. Fifty-seven percent of the 406,746 women ages 40 to 49 had a mammogram on average at least twice during the four-year period, and 47 percent had one screening on average every year.

Estrogen and Cancer

In a second study presented today at the San Antonio symposium, researchers reported that giving estrogen alone to older women who don’t have a uterus may reduce rather than increase their risk of breast cancer.

The study found a 20 percent reduction in breast cancer for older women who took estrogen alone, compared with a placebo, for postmenopausal hormone therapy. The study, from scientists who re-examined data from the Women’s Health Initiative trial, looked only at women who didn’t have a uterus.

Millions of patients had already stopped taking hormone replacement therapy after 2002 when the Women’s Health Initiative found a higher risk of breast cancer in postmenopausal women getting hormone treatment with both estrogen and progestin. The trend of avoiding estrogen-only treatment needs to be reversed, said Joseph Ragaz, the lead researcher for the new analysis.

Thousands of Lives

“We will be saving thousands of lives every year if we use hormone replacement therapy for menopause,” said Ragaz, a medical oncologist and a clinical professor at the University of British Columbia in Vancouver. “Women will not only have quality of life improvement by handling menopause more easily, they will also have substantial benefits on bone fractures, colon cancer and now breast cancer.”

Ragaz said estrogen-alone therapy should be given only to women who don’t have a uterus, because the hormone raises the risk of uterine cancer. Women who have undergone surgery to remove their uterus, called a hysterectomy, are typically candidates for estrogen-only therapy.

Ragaz and other researchers looked at 10,739 women without a uterus who were part of the estrogen-only trial of the Women’s Health Initiative. Half received a placebo and the other half, the drug Premarin, made by Pfizer Inc.’s Wyeth unit.

While women getting estrogen showed a 20 percent lower risk of breast cancer, the reduction was 30 percent to 40 percent in patients who had a low risk at the start of the study, Ragaz said. Those included women with no strong family history of breast malignancy.

Adds to Research

The analysis adds to research suggesting estrogen alone can lower breast cancer risk and that the hormone may have a place for treating menopausal symptoms, said JoAnn Manson, a principal investigator for the Women’s Health Initiative, a 15-year program organized by the U.S. National Institutes of Health.

“Estrogen still has a clinical role in the management of moderate to severe hot flashes and other menopause symptoms, especially in women who are closer to the onset of menopause,” said Manson, chief of the Division of Preventive Medicine at Brigham & Women’s Hospital in Boston and a professor at Harvard University.

Another study presented today at the San Antonio meeting found that women who are obese and have a type of breast cancer fueled by estrogen are more likely to die of the disease than their slimmer peers.

Obesity Risk

Adult women with body mass indexes of 30 or above are 42 percent more likely to die of estrogen-receptor positive/HER-2 negative disease, the study found. Two-thirds of all breast cancers are fed by estrogen, according to the National Institutes of Health.

Today’s study suggests that breast cancer patients who are already overweight or obese should make an effort to avoid further weight gain, said study author Joseph Sparano, the associate chairman of the oncology department at Montefiore Medical Center.

“We may need to pay greater attention to nutrition, and include a nutritional evaluation for someone who has breast cancer,” said Sparano, who is also a professor of medicine at the Albert Einstein College of Medicine, in a telephone interview.

Body mass index, or BMI, is a measure of weight and height, with a 5-foot 4-inch woman weighing 175 pounds having a BMI of 30. BMI of 30 or more is considered obese, while a BMI of 25 to 29.9 is considered overweight, according to the National Institutes of Health.

Third of Population

About a third of the U.S. adult population is obese, according to the Atlanta-based Centers for Disease Control and Prevention.

The study examined 3,484 people, of which 2,115 had breast cancer that was hormone-receptor positive, HER2-negative. HER2- negative cancer doesn’t produce a protein called HER2, which is a sign of a type of aggressive breast cancer generally treated with Roche Holding AG’s Herceptin.

It may be that obese women have more estrogen, since fat cells play a role in synthesizing it, Sparano said. It may also be related to insulin levels, since higher levels of the hormone have also been associated with increased breast cancer risk, he said.

The rise of binge drinking women

As a nation, when it comes to booze and women, we’ve failed. I’m not being judgey here, I mean we literally received a big fat “F” in that category on the latest women’s health report card. The culprit is binge drinking: The percentage of women who have “had five or more drinks on at least one occasion during the past month” has gone from 7.3 percent in 2007 to 10.6 percent this year, according to the National Women’s Law Center’s annual report, “Making the Grade on Women’s Health.”

No surprise here. We’ve been following the rumblings over the trend of lady bingers for some time now, and the question often seems to be, as a 2008 New York magazine article put it: “should gender equality extend to drinking?” My answer is: yes and no. I’m more likely to order a beer and a shot of whiskey than a cosmo. I like to go against stereotypes like that. It is cocky and perhaps foolish — but, then again, the same can be said for my male friends when it comes to drinking. I might be driven by some vaguely third-wave feminist desire to “keep up with the boys” — but plenty of “the boys” are driven to keep up with each other, lest they appear unmanly. This is binge culture, and it isn’t strictly male or female anymore. We’re all full of bluster and far too much booze.

That doesn’t mean the impact is equal, though. A female friend wrote to me in an e-mail, “I’m of the opinion that, yes, gender equality means you get to drink however the eff you want and you don’t have to be confined to ‘dainty’ drinks and expected to drive the boys home or whatever. But with great binge-drinking comes great responsibility, you know? I’ve had to do a serious gut check in the past year about this because excess drinking affects women differently.” It’s true: Women’s bodies are not only generally smaller than men’s but they also metabolize alcohol differently. I’ve boasted that I could drink my male friends under the table, and I have at times through sheer force of will. Not even my iron will can force my liver to process booze differently, though.

Of course, it isn’t just physiological sex differences that raise concern here, it’s also sex, as in sex. The researchers find binge drinking troubling for many reasons, but especially so because hard-boozing women experience “more sexual-assault problems,” Michelle Berlin, an associate professor at the Oregon Health and Science University School of Medicine, tells the New York Times. These are the unfun facts: Alcohol is processed differently by women’s bodies, and it’s associated with higher rates of sexual assault. We should be able to be real about this without blaming women who are raped while intoxicated. (Unfortunately, this continues to be a really tough concept for some to grasp.) We should also be able to acknowledge the simple fact that women, like men, can make dumb sexual decisions while drunk.

If we must talk about binge-drinking in terms of feminism, it seems to me that a real victory would mean recognizing the impact hardcore boozing has on both sexes, and with a little more perspective. After all, binge drinking is much higher among men than women. Men are more likely to drive drunk (although young women are increasingly driving under the influence). Boozing college-age males are more likely than women to: land in the hospital, be physically assaulted, be involved in an accident where someone is injured, and break the law, according to a U.K. study. As I wrote in response to the New York magazine piece a couple of years back, “young women’s sometimes confused struggle for equality in their day-to-day lives … can result in their acting the part of stereotypical men, in ways that don’t seem particularly halthy for either sex.”

High-Dose HRT Still Prevalent

Eight years after the Women’s Health Initiative trial found that traditional hormone replacement therapy carried serious health risks for postmenopausal women, doctors continue to write prescriptions for it by the millions, researchers said.

According to data from a large, continuous survey of physicians, about 3.1 million visits in the U.S. in 2009 resulted in prescriptions for standard-dose estrogen therapy, alone or in combination with other hormones, according to a study published online in Menopause.

About one million of those prescriptions were for women 60 and older, the population most at risk for the cardiovascular and cancer risks identified in the Women’s Health Initiative study, noted Sandra A. Tsai, MD, MPH, of Stanford University in California, and colleagues.

“Despite reduced use, standard-dose oral menopausal hormone therapy remains the dominant formulation,” they wrote.

Overall, systemic hormone therapy for menopause symptoms has fallen by nearly two-thirds since 2001, Tsai and colleagues found, from about 16.3 million prescriptions to 6.1 million in 2009.

But low-dose oral preparations and vaginal and transdermal formulations — believed to carry less risk of adverse effects — still accounted for a minority of prescriptions.

“Greater recognition of distinctions based on menopausal hormone therapy dose, route of administration, need for concomitant progestogens, and woman’s age may move clinical practice into better alignment with available evidence,” the researchers concluded.

The study used data from 2001 to 2009 in the National Disease and Therapeutic Index, an ongoing survey of about 1,800 physicians who provide quarterly reports on their management of patients evaluated on two recent, randomly assigned workdays.

The reports list diagnoses and prescriptions written (as well as OTC products recommended) for each patient seen on those days. Consequently, the data is detailed enough to identify hormonal preparations prescribed for menopause symptoms.

In 2009, according to Tsai and colleagues, the database included about 341,000 patient encounters. The researchers extrapolated the results to the entire U.S. physician population to yield estimates of national hormone therapy prescription numbers.

Between the release of the Women’s Health Initiative results and 2009, the number of oral estrogen-only hormone prescriptions at standard doses declined 71%. Estrogen combined with other hormones at standard doses fell 83%.

Use of vaginal hormone formulations rose steadily from an estimated 2 million to 2.5 million prescriptions, whereas transdermal hormone prescriptions declined slightly, from 1.7 million to 1.5 million.

Tsai and colleagues identified differences in prescribing patterns according to physician specialty. Ob/gyns showed smaller declines over time in the percentage of visits that included menopausal hormone therapy prescriptions (46% from 2001 to 2009) compared with all other specialties (69%).

Of all visits resulting in a menopausal hormone therapy prescription, 72% were written by ob/gyns.

One of the most remarkable study findings, Tsai and colleagues suggested, was that low-dose oral therapy prescriptions did not make greater inroads into overall use of oral formulations during the study period.

Low-dose formulations, which have been found to be effective for controlling unwanted menopause symptoms, did increase from 700,000 to 1.3 million in 2009.

But this was still only 29% of all oral menopausal hormone therapy prescriptions, the researchers noted.

Moreover, use of low-dose products has been declining since hitting a peak of 1.5 million prescriptions.

“Current recommendations to use the lowest dose … effective for symptom relief should receive greater consideration,” they wrote.

They also expressed surprise that transdermal formulations have not gained in popularity during the study period.

Tsai and colleagues identified several limitations to the study. The survey excludes physicians in publicly funded practices, where lower income patients are more likely to be seen. Patients seen by respondent physicians may also not be representative of the general female population and their hormone therapy use.

In addition, information on symptoms and responses to previous therapies is sparse in the database.

As a result, the researchers noted, “there are inherent limitations in commenting on the appropriateness of current practice patterns.”

Study Adds Uterine Fibroids to Meningioma Risk Factors

MONTREAL – Meningiomas in postmenopausal women are associated with an increased rate of uterine fibroids, low levels of physical activity, and greater height and body mass index, according to an analysis of the Iowa Women’s Health Study.

The link with uterine fibroids is a novel finding, “probably due to shared risk factors,” commented Dr. Derek R. Johnson of the Mayo Clinic, Rochester, Minn. “I’m certainly not suggesting it’s causal,” he said at the annual meeting of the Society for Neuro-Oncology.

The Iowa Women’s Health study is a prospective cohort of women followed since 1986. Dr. Johnson’s analysis included 27,791 of these women who had completed a follow-up self-report survey in 1993, had no history of cancer, and were enrolled in Medicare.

The mean age of the women was 70 years (in 1993), and their mean body mass index (BMI) at the time of first enrollment was 27 kg/m2.

The analysis found 125 incident meningiomas reported over 291,021 person-years of follow-up, for an overall incidence of 43/100,000 person-years.

BMI was the strongest of the self-reported risk factors for meningioma, with a relative risk (RR) of 2.14 for BMIs greater than 30 compared with BMIs in the normal range of 19.5-24.5 kg/m2. BMI at age 50 and age 40 was positively associated with the risk of meningioma, but BMI at younger ages was not.

Height was the second strongest risk factor for meningioma, with a relative risk of 2.04 for height above 66 inches compared with height of 62 inches or shorter.

Physical activity was protective against meningioma. Compared with a low rate of physical activity, medium and high levels were associated with decreased risk (RR, 0.57 and 0.61).

A history of uterine fibroids carried a relative risk of 1.78, but no other reproductive factors seemed to be correlated. “Fibrocystic breast disease, endometriosis, and some other reproductive covariates have not shown any association, so, with uterine fibroids being so strongly associated, I think it’s not simply a coincidence,” Dr. Johnson said.

The associations were significant after adjustment for “current” BMI (1993).

The data raise the hypothesis that a metabolic environment associated with greater growth in adolescence, and greater weight later in life, may play a role in the etiology of meningiomas, he said.

“Potentially the key unifying factor in the things we found in meningioma risk is the influence of circulating sex hormones and insulin resistance,” Dr. Johnson said.

Meningiomas occur at twice the rate in women as in men, and the incidence is increasing, he added.

When asked for his opinion on the findings, Dr. Fred Barker of the department of neurosurgery at Massachusetts General Hospital, Boston, said the association with uterine fibroids was intriguing. “It is biologically plausible that the same mechanism of exposure to hormones could explain the association, but it may also be some genetic predisposition, or it may be that women who seek out imaging have both of these things found with relatively minor symptoms.”

Many meningiomas in elderly people are small and asymptomatic and are discovered only incidentally or on autopsy, he said in an interview. “As with fibroids, it could just be that certain patient behaviors lead to imaging being done.”

Can depression be a menopause-associated risk?

There is little doubt that women experience a heightened psychiatric morbidity compared to men. A growing body of evidence suggests that, for some women, the menopausal transition and early postmenopausal years may represent a period of vulnerability associated with an increased risk of experiencing symptoms of depression, or for the development of an episode of major depressive disorder.

Recent research has begun to shed some light on potential mechanisms that influence this vulnerability. At the same time, a number of studies and clinical trials conducted over the past decade have provided important data regarding efficacy and safety of preventative measures and treatment strategies for midlife women; some of these studies have caused a shift in the current thinking of how menopausal symptoms should be appropriately managed.Essentially, most women will progress from premenopausal into postmenopausal years without developing significant depressive symptoms.

However, those with prior history of depression may face a re-emergence of depression during this transition while others may experience a first episode of depression in their lives. Here I provide an overview of what is known about risk factors for depression and the risk posed by the menopausal transition, its associated symptoms, and the underlying changes in the reproductive hormonal milieu, discussing the evidence for the occurrence of mood symptoms in midlife women and the challenges that face clinicians and health professionals who care for this population.

Tropical Moments and Other Joys of Menopause

Menopause is one of those strange times when the body takes over and does its own thing beyond our control. Deb knows the ups and downs of menopause from years of sleepless nights spent flinging off the bed covers, feeling bloated like a beached whale and getting bitchy for no reason.

We recently talked with Dr. Mache Seibel, director of the Complicated Menopause Program at the University of Massachusetts Medical School, who said:
Menopause is a window of time, like puberty backward. Puberty is when there are great body changes, hormonal changes, raging feelings and things that are going on that you don’t understand, and menopause is when there are raging feelings and body changes, emotions and things that you don’t understand. Women spend at least 10 years in menopause, but the benefits last for years to come: no need for contraception, no fear of pregnancy, children are leaving or have left home so there can be greater spontaneity and freedom. In other words, women can go from making babies to making love!

As a seasoned veteran, Deb has meditated her way through the changes: Meditation is the most important thing she ever did for herself, over and above all the Chinese herbs, yam creams or other remedies. One of the difficulties with having hot flashes, for instance, is the incredible longing to get away from the heat, whether by flinging open windows or running outside in the snow, but often such activity just increases the heat. Very simply, hot sweats increase with stress and decrease with deep relaxation. Being or sitting still releases all resistance and enables the body to cool down more quickly. Meditation also shows us how all things do pass, including such intense physical discomfort.

“We don’t stop enough in life; there is rarely a pause button we can push,” says Mache. He adds:
Music would not be pretty if there weren’t some rests in between the notes, and meditation gives us that spaciousness. Menopause is one phase of life while meditation transcends all phases of life. It realigns and regroups the cells, atoms are aligned, molecules re-ordered. People should try meditation for three minutes, then for five or six, until they find a space that fits their day.

Most especially, menopause is when we can drop all the labels and come into our own sense of who we are. It is a time for us to emerge! We may want to start dancing or rock climbing, become a poet, write a book or work for the homeless — whatever it may be, now is the time to just do it!

Menopause Symptoms And Diet

Menopause is a state of women health during which her periods stop and she is no more fertile. Like in puberty during this time also women go through a lot of hormonal changes which also result in health disorders. Menopause is an important part of a woman’s life and needs immense care as her body mental and physical self become weak.

Symptoms Of Menopause

1.Irregular Periods – A woman might skip periods for several months and then have in in gap of a weeks time. The number of days of periods also get restricted to one or two days.

2.Low Fertility – During menopause, the estrogen level drops and she will have very less chance of getting pregnant.

3.Hot Flashes – A women might suddenly feel heat on her upper body, which gradually spreads to the stomach. Her skin might turn red and patchy.

4.Urinary Problems – Infections in urinary tract might happen. She might also have the tendency to urinate frequently.

5.Mood Swings – Due to hormonal changes, woman might have a lot of mood swings.

6.Osteoporosis – As the estrogen level decreases in the body, bone mass is lost, thus making the bones brittle. They are so brittle that in very little amount of pressure they can break. This is called Osteoporosis. This is one of the major symptom of menopause.

These are some of the basic symptoms of menopause. These symptoms of menopause become all the more chronic as the time approaches but if proper care is taken then it also subsides with time.

Menopause Diet

1.Menopause diet of a woman should include a minimum of 1200 to 1500 mg of calcium. Thus it is important to add yogurt, green leafy vegetables, milk and cheese in her diet.

2.Woman going through this phase tend to store cholesterol, which increases the risk of heart attack. Thus one should include sources of Omega-3 fatty acids in his diet. Food rich in Omega-3 include fish and other sea food.

3.Include fruits in your diet as they are rich in Vitamins, which a woman requires at this time. Sources of Vitamin B and B-12 should be included in her diet.

4.Menopause diet should include fiber rich food. Food rich in fiber are whole wheat, fruits, cereals etc. This will help her digest food, thus, cutting down the amount of cholesterol, prevent constipation and maintain the blood glucose level.

5.Soy is a very good source to meet menopause symptoms. Soy contains Phytoestrogen. This treats menopause symptoms like hot flashes, calcium deficiency etc. This also provides energy to the body.