More bad news from HRT study

By MICHAEL CONLON

CHICAGO -The most common hormone replacement drug therapy not only increases the risk of breast cancer in post-menopausal women, but also makes cancer harder to detect with mammography, says a new report.

The American finding is the latest in a continuing stream of bad news for preparations that combine oestrogen and progestogen.

The hormones have been shown to halt or reverse osteoporosis, lessen the risk of hip fractures and prevent uterine cancer.

But the United States Government stopped its study on long-term use last year after it showed the oestrogen-progestogen combination sold as Wyeth's Prempro carried an increased risk of ovarian cancer, heart attack and stroke.

Wyeth has won US Government approval to market lower-dose versions of its hormone replacement therapy (HRT) drug which it says address the risk problems.

Tuesday's report covers a closer analysis of findings in the halted study, the Women's Health Initiative.

The new research, published in the Journal of the American Medical Association, affirmed the breast cancer problem, finding a 26 per cent increase in the risk of that cancer for women taking oestrogen plus progestogen.

But the report, from Harbour-UCLA Research and Education Institute, Torrance, California, also found that the cancers tend to be diagnosed at more advanced stages and result in substantial increases in abnormal mammograms.

In an editorial in the same issue commenting on the study, Peter Gann and Monica Morrow, physicians at the Feinberg School of Medicine, at Northwestern University in Chicago, said:

"The ability of combined hormone therapy to decrease mammographic sensitivity creates an almost unique situation in which an agent increases the risk of developing a disease while simultaneously delaying its detection.

"It strongly suggests that the breast cancers related to oestrogen plus progestogen use are not 'good' (easily treatable) ones, that they occur earlier than expected based on some previous studies, that there are no easily identified subgroups at higher risk and that, to top it off, women using oestrogen plus progestogen experience a much higher rate of mammographic abnormalities leading to anxiety and further costly work-ups."

The halted study involved 16,608 post-menopausal women, some of whom received combination hormone treatment, others an inert placebo.

The new research report said there was an "absolute increase in abnormal mammograms of about 4 per cent per year in women receiving oestrogen plus progestogen". That translated into about 120,000 otherwise avoidable abnormal mammograms a year for the 3 million US post-menopausal women using that hormone regimen.

The National Heart, Lung and Blood Institute, part of the National Institutes of Health paid for the study.

In a second study published in the same journal, researchers at the Fred Hutchinson Cancer Research Centre, in Seattle, said they found there was a breast cancer risk even when progestogen is not taken every day in combination with oestrogen - so-called sequential treatment. They looked at 51 published studies.

Hormone therapy

* For: Fights osteoporosis, hip fractures, uterine cancer.

* Against: Increased risk of breast cancer, ovarian cancer, heart attack, stroke. Breast cancers harder to detect.

- REUTERS