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Menopause, estrogen and breast cancer

October 15, 1999|By KATE COLEMAN

-- Facts about menopause

In 1900, a woman's life expectancy was 49.

Women didn't make it to menopause.

As this century gets ready to turn, women not only are making it to menopause, they can live more than a third of their lives after the "change of life."

[cont. from lifestyle]

What changes does that change bring?

Estrogen and progesterone, or lack thereof, affect virtually all tissues in the body, but everyone is influenced by them differently, according to National Institute on Aging.

The big issue for postmenopausal women is heart disease, says Dr. David H. Solberg, a gynecologist in practice in Hagerstown.

Taking estrogen after menopause has been shown to reduce the risk of heart disease by as much as 50 percent, according to American Heart Association.

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Is estrogen or hormone replacement therapy the answer to problems of menopause?

The answer is that there is not one answer. A treatment plan must be as individual and unique as the woman who is seeking it. There are benefits, and there are risks.

The risks specific to the subject of breast cancer will be discussed in a seminar sponsored by Y-ME of the Cumberland Valley, the Tri-State area's breast cancer support and education organization, Tuesday, Oct. 19, at 7 p.m. at Robinwood Medical Center.

A panel of four local physicians and Del. Louise V. Snodgrass, R-Frederick/Washington, a breast cancer survivor, will talk about what they believe the risks and benefits to be.

The risks

The remarkable thing about estrogen and its association with breast cancer is that although some studies show an increased risk of breast cancer for women taking estrogen, others don't, Solberg says. There probably is some risk, but it's so small that it's difficult to measure, he believes.

It is in looking at mortality that Solberg sees the benefit of estrogen replacement therapy.

If 50 percent of women will die of heart disease, and estrogen can reduce the risk of heart disease by 50 percent, the sheer numbers of lives saved make the case for considering taking estrogen, he believes.

The decision, of course, belongs to the woman herself. "I set the table," Solberg says. It's up to the woman to make the choices from the smorgasbord.

Hagerstown surgeon Dr. Charles R. Chaney, who specializes in breast surgery, says he will be the "hard nut" on the panel - the physician most conservative in recommending estrogen replacement therapy. He doesn't believe that all of the research meets scientific-method criteria and thinks the pendulum is "swinging into oblivion" in favor of estrogen. For many women, the benefits of estrogen outweigh the risks, Chaney believes. But for patients who are at increased risk for breast cancer, he views estrogen as a threat.

Dr. Dan Cornell, radiologic oncologist at John R. Marsh Cancer Center in Hagerstown, describes himself as having been very conservative about estrogen, but he says his view is gradually changing. If women are having hot flashes, for example, he first will recommend alternative therapies such as vitamin E and soy products before hormone replacement therapies.

And previously, if a woman had any risk for breast cancer, either a family history, or previous breast cancer themselves, he would have viewed hormone replacement an unacceptable risk. Now, with data from recent studies, he is willing to consider it.

It's a balancing act, according to Dr. Frederic H. Kass III, director of John R. Marsh Cancer Center.

Fifty percent of all women in the United States will die of heart disease - more than the number who will die of all types of cancer combined and doubled, according to Solberg.

"It's not so clear-cut to say that estrogen causes breast cancer, and if you have breast cancer, stay away," Kass says.

"We're all going to die from something," Kass says. We want the maximum quality of life in the time that we have, he adds.

Consider the risks. If a woman is at high risk for heart disease, if she's miserable with menopause, he will strongly consider discussing hormone replacement therapy with her. And key is asking her how she feels about it: "What do you want to do?"

The choices

After all the debate and hand-wringing, the decisions still vary widely. Some women choose hormone replacement therapy and stay on it only a week, Solberg says. Fear of breast cancer is the top reason he sees. Side effects can include uterine bleeding and breast tenderness.

Other women guard their estrogen replacement therapy like Fort Knox, Solberg says.

In the last five to 10 years, a variety of medications has become available enabling each woman and her medical professional to come up with a regimen tailored to her needs, Solberg says. There is oral estrogen and estrogen in the form of a patch. Estrogen creams, for example, can help with postmenopausal vaginal changes.

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