Health News, Obstetrics & Gynecology

It is rare to find a movie sequel anywhere near as good as the original. This “part deux” continues with the elements of the original story with the same cast of characters and settings. But, I must warn you. This one is more like a Sherlock Holmes flick rather than a Harry Potter one. The mystery has not been solved yet, but we are watching it unravel before our very eyes. The mystery involves the decrease in breast cancer incidence and its possible relationship to hormone therapy. A lot has been released in the last few months. In January of this year we reported major findings regarding breast cancer incidence rates plummeting in 2003. Many researchers suggest the dive was the result of women discontinuing hormone therapy after the 2002 Women’s Health Initiative (WHI) results were released. Other experts said we were jumping the gun and wanted to wait and see the 2004 data. So here we are, “Breast Cancer and Hormone Therapy: Part Deux”. ACTION! A few weeks ago, The New England Journal of Medicine disclosed the second round of post-Women’s Health Initiative (WHI) breast cancer statistics for 2004. Apparently, the decrease we observed in mid-2002 began leveling off by mid-2003 with little additional decrease in 2004. All in all, there was about a 9% drop in the rate from ’01 to ’04. The reason for the reductions is still unclear. Even Sherlock Holmes’ intellectual prowess may not solve this mystery. We know the trend began almost immediately after the Women’s Health Initiative came to a quick halt. The study revealed an increase in coronary heart disease and breast cancer associated with the use of estrogen-progestin hormone therapy. The news was everywhere! Millions of women left the cap on their prescription bottles; they took off their HT patches; and abandoned hormone therapy all together as a result of the WHI findings. In fact, the use of hormone therapy decreased by 38% in the US with approximately 20 million fewer prescriptions written in 2003 than 2002. But, is this the primary reason for the lower incidences of breast cancer? Some experts are still not convinced. There may be other contributing factors involved in this puzzle. Are the major changes somehow linked to a decrease in the rate of screening mammography? In 2003, there was a 3.2% decrease in this rate for women between the ages of 50 and 65 years. Maybe women who formerly received hormone therapy have changed their screening patterns. If women who discontinued their hormone therapy regiment also stopped receiving mammograms, we would also see a decrease in breast cancer incidence. The point is the new statistics confirm the fact that this sequel has not resolved the mystery. Will we see a long-term reduction in breast cancer incidence? Could hormone therapy be a major player? We will inevitably need to see the production of a Part III where additional statistics are presented. COMING SOON to a theater near you! References: Kolata, G., Sharp Drop in Rates of Breast Cancer Holds: NY Times 2007 Apr 19. Ravdin, Peter M., Cronin, Kathleen A., Howlader, Nadia, Berg, Christine D., Chlebowski, Rowan T., Feuer, Eric J., Edwards, Brenda K., Berry, Donald A., The Decrease in Breast-Cancer Incidence in 2003 in the United States: N Engl J Med 2007 356: 1670-1674.