Breast Cancer Incidence & Hormone Replacement Therapy
BREAST CANCER INCIDENCE & HORMONE REPLACEMENT THERAPY
the years following the
end of World War II, the number of breast cancer cases diagnosed each
began to climb in the
Many of us in the cancer research and treatment community have been arguing, for decades, that the continuously rising incidence of breast cancer observed in the post-war United States has been due to, at least in part, the rising use of HRT medications. Even prior to the publication of the Women’s Health Initiative study’s adverse findings, there have been numerous clinical studies that have linked a woman’s lifetime exposure to female sex hormones to the risk of developing breast cancer. In fact, even decades-old epidemiological studies have, repeatedly, identified an early onset of menstrual periods and a late arrival of menopause as risk factors for breast cancer (these events mark the beginning and end of ovarian hormone production, respectively). More recently, large breast cancer prevention studies have confirmed that estrogen-blocking medications can reduce the risk of breast cancer by about 50 percent in women who are at high risk for this type of cancer.
despite decades of clinical
and scientific evidence linking HRT to breast cancer risk, it took the
results of the Women’s Health Initiative study to finally convince
numbers of women, and their physicians, that HRT increases the risk of
cancer (and, contrary to the findings of less rigorous and much older
epidemiological studies suggesting that HRT reduces the risk of
disease in women, the opposite effect actually appears to be the case). Following widespread
reporting of the
negative findings of the Women’s Health Initiative study, new HRT
clinical studies over
the past 5 years have compared HRT prescribing trends with the
breast cancer in the
update of a previous
breast cancer incidence study, from the National Cancer Institute and
When compared to the period between 2000 and 2002, significant declines in the number of new cases of breast cancer were observed between 2003 and 2005. Altogether, a 20 percent drop in the incidence of new breast cancer cases was observed during the period beginning in 2003 and ending in 2005, and this historic trend closely mirrors the results predicted by the 2002 Women’s Health Initiative study report. Moreover, nearly the entire decline in breast cancer cases was observed in postmenopausal women over the age of 50, and in breast cancers sensitive to estrogen, further linking this dramatic decrease in breast cancer incidence to decreased HRT use among women.
The other dramatic breast cancer research update was announced at the world’s largest annual breast cancer research conference, the San Antonio Breast Cancer Symposium, less than two weeks ago. At this symposium, the researchers from the Women’s Health Initiative study provided an update on the women who participated in the combination HRT group. These updated results offer striking proof that combination HRT pills are associated with a significantly increased risk of developing breast cancer. Among the study volunteers who took combination HRT pills for an average of 5 years, their risk of breast cancer is now 100 percent greater than what is being observed among the women volunteers who were secretly randomized to receive identical placebo (sugar) pills. This means that the incidence of breast cancer among the women who received combination HRT pills is now fully twice as high as is being observed in the women who did not take HRT pills.
I have, for almost two decades now, recommended against taking HRT medications. In 85 to 90 percent of women, the symptoms of menopause subside significantly within 2 to 3 years. Although they are not quite as effective as HRT drugs in relieving the symptoms of menopause, there are also a variety of prescription and non-prescription remedies available that can reduce the severity of the hot flashes, night sweats and irritability that often accompany the early phases of menopause. (I will have much more to say on the topic of breast cancer prevention in my forthcoming book, “A Cancer Prevention Guide for the Human Race.”) Today, in 2008, my recommendations against HRT drugs remain even more vigorous than ever before.
CIRCUMCISION & THE RISK OF HPV & HIV INFECTION
to be a hotly debated topic. The
practice of circumcision, most commonly performed for religious or
reasons, has been ongoing for thousands of years.
Recently, however, there has been a growing
backlash against infant circumcision in the
Three newly published studies in the Journal of Infectious Diseases add to the findings of previous studies suggesting that a potential clinical benefit may be associated with circumcision. Specifically, these new studies suggest that not only does male circumcision reduce the risk of acquiring HIV infection, but it may also significantly reduce the risk of infection with the human papilloma virus (HPV). Like HIV, HPV is a sexually transmitted virus, and several strains of the HPV virus are known to cause virtually all cases of cancer of the cervix in women, as well as many of the cases of cancers of the anal canal, oral cavity, and throat (in both men and women). Several HPV virus strains also cause genital warts in both men and women.
While chronic infection with cancer-causing HPV strains produces precancerous changes in women that can usually be detected during Pap smears, most infected males are asymptomatic. The FDA recently approved a human HPV vaccine, Gardasil, which provides protection against 4 strains of the HPV virus. Although not all cancer-causing strains of HPV are covered by Gardasil, the vaccine does provide protection against the HPV strains that, together, account for about 70 percent of all cervical cancer cases, and against more than 90 percent of all HPV-associated cases of genital warts. Because the vaccine is quite expensive, and because the vast majority of cancers caused by HPV occur in women, Gardasil is approved for use only in girls and young women between the ages of 9 and 26 years.
three new studies
presented in the Journal of Infectious
Diseases compared the incidence of HPV and HIV infections in
active men with and without a prior history of circumcision. One of these studies
the effects of adult circumcision in young African men, and after 21
follow-up, the incidence of HPV infection was observed to be 34 percent
in the men who had been randomized to undergo circumcision when
compared to the
men who did not draw the “circumcision card.”
The second clinical study was performed in the
an accompanying editorial,
both of these studies were criticized due to inherent weaknesses in
methodology and analysis, although the editor acknowledged that there
be a protective effect of circumcision against HPV infection in males. As males act as both
reservoirs and vectors
in the transmission of HPV, the possibility that circumcision may
incidence of HPV infection in men is intriguing.
As prior studies have produced conflicting
results regarding the protective effect, if any, of circumcision
infection in men, we must await the results of two large prospective
circumcision trials ongoing in
third study in the Journal of Infectious
Diseases adds to
the already substantial body of research data confirming that male
decreases the risk of HIV infection.
this third study, also performed in
Taken together, these three studies add important information regarding the potential protective effects of circumcision against infections by the HPV and HIV viruses. While the jury is still out with respect to circumcision and the risk of HPV infection, the data showing that circumcision cuts the risk of HIV infection in half is quite robust. Because of these findings, the World Health Organization now advocates on behalf of male circumcision as part of a comprehensive strategy to prevent HIV infections. However, no research study has ever suggested that male circumcision can protect men (or women) against all cases of HIV infection, and so even if you are circumcised, you still need to adhere to established safe sex practices to protect yourself and your partner from infections with HIV, HPV and other sexually transmitted diseases.
Copyright 2008. Robert A. Wascher, MD, FACS.
All rights reserved.
Dr. Wascher's Archives:
10-26-2008: Smoking & Quality of Life
10-19-2008: Agent Orange & Prostate Cancer
10-12-2008: Pomegranate Juice & Prostate Cancer
9-21-2008: Does TylenolŪ (Acetaminophen) Cause Asthma?
4-27-2008: Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function
4-6-2008: Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)
12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality