By Sarah LoBisco, ND
Back in the spring, I discussed the confusion among experts and the public alike regarding the link between the use of hormones and cancer risk. At that time, new data was released from an analysis of an additional subset of 90,000 women from the original population of the Women’s Health Imitative (WHI) study. These results sparked the reemergence of the topic of the use of hormones in women.
Background On the Study That Started It All (the WHI)
In 1991, the WHI was established to address the most common causes of death, disability, and impaired quality of life in postmenopausal women. These factors included cardiovascular disease, cancer, and osteoporosis. Basically, the WHI was a 15 year multi-million dollar endeavor with three components of intervention under study:
- a randomized controlled clinical trial testing hormone replacement therapy (HT), dietary modifications, and calcium/vitamin D supplementation (with approximately 70,000 participants)
- an observational study to identify predictors of disease (with approximately 90,000 participants)
- a study of community approaches promoting healthful behaviors
The Hormone Replacement (HT) Scare
The hormone replacement scare started when HT trials were halted due to various risk associations of women on hormonal interventions:
- The first finding from the initial randomized trial correlated the use of estrogen plus progestin to higher rates of breast cancer and number of breast cancer deaths. Due to this strong link, the trial was stopped in July 2002.
- Furthermore, the link between estrogen alone therapy and heart disease risk factors halted another leg of the WHI HT trial in 2004.
However, when the results from the observational study subset were released this spring, confusion and controversy began again. The trial looked at health and hormone use over an average of 11 years and found that women who took hormones to treat menopause symptoms and who got breast cancer were less likely to die from the illness than women who got breast cancer without taking hormones.
How could there be such differing results in the same trial?
The Issue of Cofounders : Lions, Tigers, & Bears in Scientific “Statistics”
An oncologist headed out to bravely seek the answer and to our relief, Dr. Chelbowski’s team was able to explain this difference when he accounted for confounding factors between the two studies. Specifically, he did a comparison study by splitting the observational trail into women who more closely matched the women of the randomized trails:
- This meant he accounted for and eliminated the women who were not using HRT during the study, but had in the past.
- He only used the women who were on HRT. The new results fell more in line with the original study of WHI.
The results when comparing apples with apples were that survival after breast cancer was similar for both hormone users and non-users and tumors that arose in women who took hormones were no less deadly.
As with any scientific data and studies, it’s important to weed out headlines and hype that are comparing bad study outcomes.
This can lead to misinterpretation of data and unlikely associations. One recent case and point of this is the fish oil trial with prostate cancer.
More Information is Revealed
Now, a new study released in July, further complicated the picture.
This study assessed the 2011 JAMA review of a follow up on the “Health Risks and Benefits after Stopping the Women’s Health Initiative Trial of Conjugated Equine Estrogens in Postmenopausal Women with Prior Hysterectomy.” (Scientists can get very wordy with titles of studies!) 😉
In simple terms, this trial assessed another specific population characteristic of the WHI; therefore, finding differing results:
- Specifically, the researchers reported no association with an increased or decreased risk of CHD, deep vein thrombosis, stroke, hip fracture, colorectal cancer, or total mortality.
- There was also a decreased risk of breast cancer in the women with prior hysterectomy post follow up.
- Furthermore, younger women seemed to receive the most benefit.
The study was based on the findings in 2011 and 2012 when the WHI reported that women who received estrogen compared to those who received placebo had fewer deaths each year for 10 years and were less likely to develop breast cancer and heart disease.
As with headlines in spring, estrogen and hormone replacement hit headlines again-this time with pro-estrogen banners!
Now, What’s a Woman to Do?
Does she use hormones? When? How?
Who does she trust??
What about labs, nutrition, will they help determine this??!
These cliffhanger questions will get answered next week in Part II of When Should a Woman Consider Hormone Replacement? What is the REAL Risk?
Be sure to join us then and as always, feel free to share your thoughts!
Highlight Blog to hold you over:
What is Estrogen Dominance?
Hormonal replacement can lead to Estrogen Dominance which can create a variety of imbalances in the body.
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Department of Health and Human Services, The National Institutes of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI). WHI Background and Overview. http://www.nhlbi.nih.gov/whi/background.htm. Accessed August 5, 2013.
Brown, E. Study Upholds Breast Cancer Mortality For Hormone Replacement. Los Angeles Times (latimes.com). March 30, 2013.
National Cancer Institute. Oral Contraceptives and Cancer Risk. NCI. 4/22/13 accessed. http://www.cancer.gov/cancertopics/factsheet/Risk/oral-contraceptives
National Cancer Institute. Hormone Replacement Therapy and Breast Cancer Relapse. NCI.
National Cancer Institute. NCI. Menopausal Hormone Therapy and Cancer. http://www.cancer.gov/cancertopics/factsheet/Risk/menopausal-hormones
LaCrox, AZ et al. Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial. JAMA. 2011 Apr 6;305(13):1305-14. doi: 10.1001/jama.2011.382. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656722/
Sarrel PM, Njike VY, Vinante V, Katz DL. The Mortality Toll of Estrogen Avoidance: An Analysis of Excess Deaths Among Hysterectomized Women Aged 50 to 59 Years (abstract). Am J Public Health. 2013 Jul 18. doi:10.2105/AJPH.2013.301295. PMID: 23865654
Weir, W. Yale: Avoiding Estrogen Led To Thousands Of Needless Deaths: Hormone Could Have Saved Lives Of Women With Hysterectomies, Study Finds. Courant.com. July 18, 2013. http://articles.courant.com/2013-07-18/health/hc-estrogen-therapy-0719-20130717_1_estrogen-only-therapy-hormone-therapy-yale-study
Peart, K. For women with hysterectomies, estrogen may be a lifesaver after all. Yale News. (online). July 18m 2013. http://news.yale.edu/2013/07/18/women-hysterectomies-estrogen-may-be-lifesaver-after-all
Parker-Pope, T. Cancer Risk Increases With Height. New York Times. July 25, 2013. http://well.blogs.nytimes.com/2013/07/25/cancer-risk-increases-with-height/?partner=rss&emc=rss&_r=1