Women who use estrogen for more than 10 years to ease the effects of menopause have twice as high a risk of dying from ovarian cancer as those who did not, medical researchers reported on Tuesday. But still, the overall risk of fatal ovarian cancer is low -- long-term postmenopausal estrogen replacement therapy doubles it from about 1 percent to 2 percent over a lifetime -- and no single recommendation applies to all women, Dr. Carmen Rodriguez said in a telephone interview about her research.
"The key finding is that women who use postmenopausal estrogen had twice the risk of dying from ovarian cancer as women who never take them," Rodriguez said. In a study published in the Journal of the American Medical Association, Rodriguez and her colleagues at the American Cancer Society followed 211,581 postmenopausal women from 1982 to 1996 and found that those who used estrogen for more than a decade had an increased risk of ovarian cancer.
Women who used estrogen for less than 10 years had no increased risk, and those who did use it for long periods and then stopped saw the risk decline with time, the researchers found. Postmenopausal women generally have less estrogen in their bodies, and this can put them at higher risk for osteoporosis and heart disease. Estrogen replacement therapy can counter these risks.
But some studies have shown that estrogen therapy increases the risk of endometrial cancer, or cancer of the uterine lining. A combination therapy using estrogen plus the hormone progesterone or its synthetic version, called progestin, may offset the uterine cancer risk but could be associated with increased breast cancer risk if used over the long term. Rodriguez noted that most of the women in her study were taking only estrogen, rather than estrogen plus progestin. "We don't know what the addition of progestin to the estrogen will do on ovarian cancer risk," she said. "It may happen, as with endometrial cancer, that the risk goes down, or it may happen, like with breast cancer, that the risk is higher ... We need to know what combination therapy will do."
Acknowledging that millions of women born during the Baby Boom will enter menopause in the next decade, Rodriguez said these women must balance risks and benefits from the various therapies. "I think that the recommendation is as unclear as it was before; I don't think this study changes anything," she said. Women should discuss their health with their doctors, taking into account their risk for coronary heart disease, breast cancer and ovarian cancer, Rodriguez said. But she stressed, "There is not any contra-indication for a short-term use of hormone replacement therapy and (it) really is going to improve your quality of life. The problem is when you decide that you are going to take it for 10 or more years and that is when you start to get into a not-easy decision."
The study was part of a special issue of JAMA examining women's health issues, and also included articles on the heart benefits of walking for women, the relationship between homicide and pregnant and recently pregnant women, and the lack of a link between longer reproductive periods for women and diminished risk of dementia.
Journal of the American Medical Society, March 2001
Thanks to Reuters Health and cancerpage.com
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