Women who use post-menopausal synthetic estrogen increase their risk of dying from ovarian cancer, a new study says – but New York doctors say the study is flawed and women shouldn’t panic.
“I don’t think women need to be alarmed – the benefits of estrogen still seem to outweigh the risks,” said Dr. Richard Barakat, associate chief of gynecologic oncology at Memorial Sloan-Kettering Cancer Center.
“Doctors need to take a wait-and-see approach,” added Dr. Michelle Warren, head of the Columbia Presbyterian Menopause Center. “Even if this study is correct, the overall risk of fatal ovarian cancer is low.”
In the study, published yesterday in the Journal of the American Medical Association, American Cancer Society researchers followed 211,581 post-menopausal women from 1982 to 1996.
They found that those who used estrogen for more than 10 years to ease menopause have twice as high a risk of dying from ovarian cancer as those who did not.
“Women who used estrogen for less than 10 years had no increased risk, and those who did use it for long periods and then stopped saw the risk decline with time,” said study co-author Michael Thun, head of epidemiological research at the American Cancer Society.
Some women’s health advocates say the study may prompt a reassessment of the role of hormone-replacement therapy (HRT).
“Ovarian cancer isn’t a common cancer, but it is a deadly one,” said Barbara Seaman, co-founder of the National Women’s Health Network and author of “The Doctors’ Case Against the Pill.”
“There may only be a 1 percent increase in the number of women with this disease, but if it happens to you, it feels like it’s 100 percent.”
Some doctors pointed out several flaws in the study.
“Women in the study were taking much higher doses of hormones than they do today,” Warren said.
Another doctor said the hormones used in HRT have changed since the study was conducted.
“Most of the women in the study were taking only estrogen, while HRT now uses both estrogen and progestin,” said Steven Goldstein, professor of obstetrics and gynecology at New York University Medical Center. “That may lower ovarian-cancer risk.”
Even so, doctors say they’re not keeping women on HRT indefinitely.
“I usually recommend women stay on hormone-replacement therapy for several years after menopause, then I gradually taper them off,” said Goldstein who uses Evista or Fosemax instead of HRT to offset heart disease and bone loss.
But women sometimes prefer to remain on HRT rather than switch.
Sue, 53, a Manhattan veterinarian, has been on HRT since she was 38 and started menopause. When Goldstein tried to taper her off, her symptoms – night sweats, mood swings and bone aches – returned so rapidly that she opted to continue HRT.
“Sure I worry about cancer, but unfortunately if I were off HRT, my life would be a living hell,” she said, adding that she now has an ultrasound every six months to screen for ovarian cancer.