Scientists end study on hormone replacement

By Emily Leung
Daily Bruin Contributor
[email protected]

Government scientists last week ended the nation’s biggest
study of a type of hormone replacement therapy for postmenopausal
women ““ partially conducted at UCLA ““ three years
early, saying long term use of estrogen and progestin slightly but
significantly increases women’s risk of breast cancer,
strokes and heart attacks.

“We want to get the word out to women and their doctors
that long-term use could be harmful,” said Dr. Jacques
Rossouw, acting director of the National Heart, Lung and Blood
Institute, which sponsored the Women’s Health Initiative
study.

“The almost six million American women who use this
hormone combination had risks that far outweighed the
benefits,” Rossouw added.

The findings, originally scheduled for publishing this week,
were released early by the Journal of American Medical Association
due to their significance.

The hope of WHI investigators was that the drugs would not just
relieve the hot flashes, night sweats and vaginal dryness that can
plague women after menopause, but that they would also improve
women’s overall health. This, investigators report, did not
happen.

The study results showed the use of the combination of estrogen
and progestin for women who have not had a hysterectomy to increase
the risk of heart attacks in healthy women by 29 percent, stroke by
41 percent, and breast cancer by 26 percent. This, according to the
WHI press release, overshadowed the combination’s benefits of
reducing colorectal cancer by 37 percent and bone fractures by 34
percent.

“This is the biggest thing that’s ever hit in my 28
years in women’s health,” said Dr. Helen Yang,
president of the American Women’s Medical Association.

Three of the 40 study sites participating in the
government-funded nationwide trial were in the Los Angeles area,
including one headed by Dr. Howard Judd at the UCLA Medical
Center.

Approximately 38 percent of postmenopausal women in the United
States use hormone replacement therapy, according to NHLBI press
release.

After news of the cancellation, some study participants agreed
the potential risks of hormone treatments outweighed their
benefits.

“It’s not fun, but it wasn’t a question about
stopping it or not … You just stop. I didn’t read the
letter and say, “˜Oh, that’s too bad for them.’
It’s bad for me. I’m that long-term user,” said
Marcia White of Thousand Oaks, who started on the
estrogen-progestin therapy ten years ago and recently stopped.

Other study participants disagree with the study’s
conclusion that the risks of treatment outweigh their benefits, and
plan to continue taking the hormones.

“When you can’t sleep, (the therapy) is just
something you need. I can’t stop it. My everyday functioning
depends on it,” said 59-year-old Janice Keeley, a
kindergarten teacher from Arcadia.

“(The therapy) doesn’t look as promising as it once
did, but it’s fine I think,” Keeley added.

When deciding whether to continue with hormone treatments, it is
important to weigh patients’ individual needs, according to
Dr. Victoria Kusiak, vice president of Wyeth, which makes Prempro,
the estrogen-progestin combination.

“Quality of life is an important thing. These hormones
play a critical role for those women, which is the main reason
women begin taking them,” Kusiak added.

But the significance of the risks revealed by the study’s
cancellation will make any choice a difficult one.

“You can’t really say, “˜Take this combo to
prevent colorectal cancer’ if you see someone’s more
likely to develop breast cancer or have a heart attack,” Yang
said.

The trial consisted of 16,608 healthy women who had entered
menopause. It was initiated in 1993 to further examine the effect
of estrogen plus progestin on the prevention of heart disease.
Increased risk did not show up for the first four years of the
study according to the WHI update.

The risk of breast cancer increases by less than a tenth of a
percent in women who receive this combination therapy, according to
the NIH press release. Out of 10,000 women, the risk of breast
cancer increased by eight, heart attacks by seven, strokes by
eight, and blood clots in the veins or lungs by 18.

The National Institute of Health is allowing a second, smaller
study of women using just estrogen to continue for now, with
results expected in 2005, saying that so far the balance of risks
and benefits remains uncertain.