The PremPro Pushers in White

“I hope that doctor sitting out there reads the report and remembers all the people he pushed this on,” Ms. Balaban said.

Breast Cancer News Brings a Range of Reactions

By GINA KOLATA

Published: December 18, 2006

Diane Raymond of Columbia, S.C., was just 45 when she started taking Prempro, the most popular hormone therapy for menopause. Ms. Raymond had not yet entered menopause, but her doctor encouraged her to take the drug anyway. His words, she recalls, were, “We’ll keep the wolves from the door, so when you do go into menopause, the transition will be much smoother.”

Reversing Trend, Big Drop Is Seen in Breast Cancer (December 15, 2006)

Four and a half years later, she developed breast cancer, and her doctor told her to stop the Prempro. Immediately.

Since then, Ms. Raymond, now 60, has closely followed the developing news about Prempro and breast cancer.

In 2002 when a large study, the Women’s Health Initiative, concluded that Prempro could slightly increase the risk of breast cancer, she decided that maybe it was too soon to start thinking, “What if I’d never taken Prempro?”

But the news last Friday was different, so vivid and immediate that it hit home.

Researchers reported that breast cancer rates, which had been inching up since 1945, suddenly took a sharp turn downward in 2003, the most recent year for which national data was available. They declined 7 percent over all, and by more than twice that rate — 15 percent — in the 7 in 10 women whose tumors were fed by estrogen.

The researchers said the most likely reason for the sudden decline was that the 2002 study prompted many women to stop taking hormones or never to start them.

“If that’s all the time it takes for H.R.T. to do that kind of damage,” Ms. Raymond said, using the abbreviation for hormone replacement therapy, “someone ought to sit up and take note.”

She wishes she had never taken the drugs. It may be that they had nothing to do with her cancer. But what if they caused it?

Across the country, reactions to the new report varied from fury to disbelief to a kind of complacency, a feeling of “what else is new?” Some women say they are glad they never took the drugs; others are saying that they cannot do without them and will just have to accept the risk.

Kathy Boston, a 53-year-old dental assistant who lives in Oakland, Calif., said she was relieved that she refused to take hormones because of concerns about the side effects. Even though her doctor offered her free samples of hormones about a year ago, they have been sitting in a drawer ever since, she said.

“When I get hot flashes, I open the window,” Ms. Boston said.

Betty Young, who is 60 and lives in Oakland, said she did not take the drugs, but added that she had no confidence in studies like these.

“I get so disgusted,” Ms. Young said. “This month they say it’s bad for you; next month they say it’s good for you. If you’re going to get breast cancer, you get it.”

Some women are undaunted by the new findings, said Dr. Mary Jacobson, an obstetrician-gynecologist at Stanford.

“The patients with whom I spoke on hormonal therapy were pretty defiant about staying on it,” she said, adding that as for the breast cancer link, those patients “think it does not apply to them.”

The new study on the falling breast cancer rates was reported Thursday at a breast cancer conference in San Antonio.

The investigators, led by Donald A. Berry, a statistician at the M. D. Anderson Cancer Center in Houston, calculated that there were 14,000 fewer diagnoses of breast cancer when women stopped taking the drugs after July 2002. Prescriptions for Prempro, the most popular of the drugs, fell by half.

A similar report, by Christina Clarke and colleagues at the Northern California Cancer Center, which looked at California data, found that the trend continued into 2004.

Wyeth, the maker of Prempro, said in a statement yesterday that “the potential impact of hormone therapy on breast cancer has long been warned in product labels.” But the new data analysis, the company said, does not prove cause and effects. There were other possible reasons for the decline, Wyeth added. For now, the company said, “caution and further examination over a longer period of time is advised before these data can be fully understood.”

But researchers say the good news about breast cancer rates is a vindication of the Women’s Health Initiative, a large study that was attacked from the start as being too big, too expensive, unnecessary because everyone knew hormone therapy promoted health, and even unethical, because some women would have to take placebos for comparison.

Now, investigators say, the news that breast cancer rates are going down for the first time makes sense because hormones are among the only known factors that can affect cancer so immediately.

Something similar happened a few decades ago when researchers realized that the popular hormone therapy of the time, estrogen alone without progestins, was causing cancer of the endometrium, the lining of the uterus. When the link became known, women who had not had hysterectomies to remove their uterus began taking estrogen with progestins, which lowered the cancer risk.

Dr. Barnett Kramer, associate director of the office of disease prevention at the National Institutes of Health, said there was a sharp drop in prescriptions for estrogen alone, followed “by a very rapid decline” in endometrial cancer.

Nor did the shift in prescriptions simply delay the onset of endometrial cancers. “They never showed up at all,” Dr. Kramer said.

It is not yet certain whether estrogen alone raises the breast cancer risk. The Women’s Health Initiative did not find such a link, but other studies found a very small risk.

Barbara Balaban, 77, of Somers, N.Y., said she was furious when she read the news Friday about the fall in breast cancer rates. Not so long ago, she said, doctors were all too eager to put every woman on the drugs, starting at menopause and continuing indefinitely.

“Going through menopause was not an illness,” she said. “There was no reason to take it, but they told me I should. They said it would be so wonderful. My gynecologist, my internist, my endocrinologist, they were all pushing it.”

At one point, she said, a doctor finally wore her down and she ended up taking the drugs for a year.

“I hope that doctor sitting out there reads the report and remembers all the people he pushed this on,” Ms. Balaban said.

Yet some women, well aware of the risks of hormones, say it is not so easy for them to simply throw the drugs away.

Nancy Richardson, 60, of Wayland, Mass., said she resisted taking Prempro. When she entered menopause at age 52, she tried waiting for the drenching night sweats to go away, she tried what she called “useless homeopathic things,” and then she gave up and tried Prempro.

She has been unable go off it despite repeated efforts to taper down her dose. Every time she got down to no drug at all, her disabling menopause symptoms came roaring back.

She is trying again now, with the help of Dr. Marcie Richardson (no relation), a menopause specialist at Harvard Vanguard Medical Associates, a group practice in Boston. And if it does not work, she said, she has made her peace with the drug.

“No one in my family has ever had breast cancer,” Ms. Richardson said. “Is it quality of life or quantity of life? Truthfully, if my destiny is to feel great now and maybe shorten my future, I’d rather feel well now.”

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