Good news about breast cancer rarely makes the headlines. The disease is so dreaded and prevalent that no woman finds anything about breast cancer “good”. How different would the lives of millions of women be if the headlines in 2002 reported the good news about estrogen and breast cancer? The truth is, breast cancer is diagnosed earlier in women who take estrogen and progestin than those who don’t. Women who do not take these hormones are diagnosed with breast cancer just as often as those who do, only it’s diagnosed one to two years later. Earlier diagnosis means a better prognosis for cure.
Breast cancer is the most common cancer among women who do not smoke, and the second most common cancer among those who do. One in eight women will develop breast cancer in their lifetime. Not taking estrogen will not decrease that risk. This is shown through the progressive increase in the diagnosis of breast cancer with age, in the WHI CEE (Woman’s Health Initiative, Conjugated Equine Estrogen) plus MPA (MedroxyProgesterone Acetate) study. This study shows a cumulative increase of breast cancer in the women who are not taking estrogen. Year after year those women continued to get more and more cancer. They never stopped getting more cancer. That totaled 124 cases of breast cancer in 8,102 women who never took estrogen. Very similar results were seen in a collaborative series study of 12,467 cases of breast cancer in women who never used estrogen.
The collaborative study was published in 1997 in Lancet. The authors looked at both five and ten year marks and concluded that hormones should be stopped because of a “statistically significant” increase in the number of cases of breast cancer after ten years. The study reported 38 cases of breast cancer per thousand in non hormone users, and 42 cases of breast cancer in hormone users. They failed to look at the development of the cancer over time to see that the non users also had 42 cases, just at ten years and 11 months. In a disease that takes 7 to 10 years to diagnose, this study does not show more breast cancer in ten years by hormone users but rather earlier diagnosis. In this study, as in the WHI study, the question asked is: when do women who aren’t taking hormones get less breast cancer? The answer is never.
To better understand the relationship between hormones and breast cancer throughout a woman’s life, it is important to review the natural history of breast cancer. It takes almost seven years for a single cancer cell to progress to a size that is large enough to be seen on a mammogram. It takes another three years before it can be felt on a breast exam. This is a very important fact to remember when evaluating the data in the WHI study. In that study the average size of the breast cancers found were 1.5 centimeters. The time that lapses from a formation of a first cancer cell to the time that cancer is detected is 7 to 10 years.
The average time that a woman was in the WHI study, reported in 2002, was 5.6 years. Headlines reporting on this flawed conclusion created a mass hysteria and were completely wrong. The breast cancer that had been growing for 7 to 10 years was undetectable, but already present at 5.6 years. The women already had the cancer cells growing before they were participating in the study. If they were on placebo, the cancer cells grew more slowly, but were still discovered, only approximately 11 months later than those women on the hormones.
Finding cancer early is always the best thing. As s result, the prognosis for cure is always better. If a post-menopausal woman truly wants to decrease her risk of dying from breast cancer, she should take estrogen. If she is unfortunate enough to be that one in eight women that gets breast cancer, by taking estrogen she will increase her chances to be the survivor . There are many reasons to replace hormones that women lose after menopause; improved chances to survive breast cancer is one of the most important. Read about the other reasons in the book “Estrogen Revisited – Lifelong and Fearless” by Donna Walters and Blane Crandall, MD. Get it on the Nook or online at Amazon or Barnes and Noble.
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