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An Aetna InteliHealth/Harvard Medical School Look At The News --
Estrogen-Progestin Pills And Ovarian Cancer

CHICAGO (AP) -- Estrogen-progestin pills do not reduce the risk of
ovarian cancer and might even increase it, according to a study that
raises more red flags about a once widely accepted treatment for women
going through menopause.

Hormones May Raise Risk Of Ovarian Cancer October 1, 2003

CHICAGO (AP) -- Estrogen-progestin pills do not reduce the risk of
ovarian cancer and might even increase it, according to a study that
raises more red flags about a once widely accepted treatment for women
going through menopause.

"It's more bad news" for hormones, said American Cancer Society
epidemiologist Dr. Carmen Rodriguez.

The findings came from the federally funded Women's Health Initiative
study, part of which was abruptly halted in 2002 because of evidence
that estrogen-progestin pills raise the risk of breast cancer, heart
attacks and strokes.

Previous findings on hormone pills and ovarian cancer have been
inconsistent. Some studies, especially those involving estrogen-only
pills, showed an increased risk. But some doctors have theorized that
combination pills would reduce the risk because they contain hormones
similar to those in birth control pills, which have been shown to lower
the odds.

The new ****ysis found that 32 of the 16,608 participants developed
ovarian cancer during about 5 1/2 years of follow-up. There were 20
cases in women who took hormones and 12 in those on dummy pills.

The difference is not statistically significant because the cancer was
so rare, but the trend is worrisome, said lead author Garnet Anderson,
of the Fred Hutchinson Cancer Research Center in Seattle. The ****ysis
appears in Wednesday's Journal of the American Medical Association.

"If women have no menopausal symptoms, they should not be taking"
hormone pills, Anderson said.

The ****ysis is "probably the best we have so far," said Rodriguez,
though questions remain because so few women developed the rare cancer.

Wyeth Pharmaceuticals, which makes the Prempro pills used in the study,
downplayed the results. "It does not prove that there's any kind of
causal relationship," Wyeth's Dr. Victoria Kusiak said.

Women's Health Initiative data also have linked hormones with an
increased risk of dementia, adding to confounding evidence that the
pills might contribute to the very ailments they once were thought to
prevent.

Hormone pills are approved for relieving hot flashes, night sweats and
other temporary problems of menopause, as well as for preventing
bone-thinning osteoporosis.

Wyeth has been saying since the first Women's Health Initiative results
were published in 2002 that hormones remain an effective treatment for
menopausal symptoms, and Kusiak reiterated that women seeking relief
should take the lowest possible dose for the shortest possible
duration.

The company estimates that 1 million women were still taking Prempro
pills as of June, down from 3.4 million before the study was halted.

An arm of the government study involving estrogen-only pills is
continuing.


October 2, 2003

By Alice Chang, M.D. Harvard Medical School


What Is The Doctor's Reaction?

Is this more bad news for hormone replacement therapy (HRT)? There has
already been enough information about the risks of HRT that this does
not change current recommendations. This study did not have enough cases
of ovarian cancer to say for sure that there are more cancers due to the
combination HRT, Prempro. The disappointment with these study results is
that HRT did not reduce the risk for ovarian cancer as expected. So
while birth-control pills can lower the risk of ovarian cancer, HRT does
not. If anything, there was a trend for a slight increase in risk in
ovarian cancer cases. Birth-control pills probably work because they
block stimulating hormones of ovulation. HRT does not block existing
hormone levels but increases them during menopause.

What Changes Can I Make Now?

Even if the results of this ****ysis showed that HRT lowered the risk of
ovarian cancer, the recommendations regarding HRT and menopause would
remain the same. There are still enough risks in terms of the slightly
increased risk for heart attacks, strokes, breast cancer, and most
recently dementia to only recommend HRT for the temporary relief of
menopausal symptoms of hot flashes and ******l dryness. You should also
try to use the lowest dose of estrogen that will take away your
symptoms.

One group of women who might change what they do is those that have a
risk of ovarian cancer because of family history. If you are taking HRT
for symptoms, you should discuss with your doctor whether you should
stop and switch to non-hormonal treatments or lower your doses of
hormones.

Another result of this study is that the combination birth-control pill
did protect the uterine lining from endometrial cancer. This effect can
only be promoted for HRT that uses Provera (medroxyprogesterone) 2.5 mg
continuously each day. So if you are using another form of HRT, you
should make sure you are taking a continuous progestin hormone. The best
results are known for Provera at 2.5 mg each day.
What Can I Expect Looking To The Future?

We still need more information about the benefits and risks of estrogen
alone other forms of estrogen, such as the patch and ******l estrogen,
and lower doses. This part of the government's Women's Health Initiative
(WHI) study is continuing. Also, there may be different results for
dementia in women using HRT at a younger age than in the WHI research,
which only studied women over the age of 65. The debate over HRT is not
entirely finished, so keep listening for more information in the
future. Copyright 2003 The Associated Press. All rights reserved.

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