Dr. Leon Speroff recently stepped down as director for the Women's Health Research Unit at Oregon Health & Science University.
How does hormone replacement therapy affect breast cancer and heart disease?
Breast cancer remains the biggest fear in women and clinicians and we have multiple, multiple studies that have found a small, and I emphasize small increased risk of breast cancer associated with hormone therapy. Here is the problem. The problem is that we do not know the answer to this very important question. Do these studies indicate a small increased risk of breast cancer or do they reflect the effect of hormones, estrogen or estrogen plus progestin on tumors that are already there. There is a good reason to believe that they are reflecting an impact on tumors already there. The studies find this increased risk of breast cancer very fast within a year or two even and everybody knows on the average it takes 10 years for a breast cancer cell to become clinically detectable. It does not happen that fast. Secondly women who have breast cancer who are taking hormone therapy have better outcomes. They have tumors that are better differentiated, less aggressive, and they have better outcomes, so it is very possible that rather than harmful exposure especially to estrogen and progestin actually is beneficial causing an effect on a cancer that is already there that leads to its earlier detection when it has a better chance of being cured. So, there remains this image in the public as well as with clinicians that there are these risks of heart disease and breast cancer associated with hormone therapy, but in fact:
1. The risks were over estimated.
2. In the younger postmenopausal women there probably is no risk. In fact I am convinced there is no risk of heart disease; it actually protects and finally rather than actually increasing the risk of breast cancer, the hormone therapy may be producing a beneficial effect.
I think that is wonderful and isn’t that the news we are kind of looking for. We are looking for good news.
Well, by the time it took five years getting response to the initial WHI it is a message that, you know, good news is no news. It is so much harder to get a good news message to the public and to have it accepted than to have a negative bad news impact that is widely spread, so that is what we are facing right now. We are facing this huge population of women who stopped taking hormones and by the way I would predict that we will now begin to document an increasing fractures and heart disease in women because of that huge group of women that stopped taking hormones in the last five years.
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Find Dr. Speroff on the web by visiting www.ohsu.edu
After graduating Case Western Reserve University School of Medicine, Dr. Speroff completed his residency at Yale-New Haven Hospital in Ohio. Following fellowship training at the Worcester Foundation for Experimental Biology in Shrewsbury, Massachusetts, he spent a number of progressive years at Yale University School of Medicine, New Haven, Connecticut until he became a member of the OHSU faculty as professor and chairman of the department of obstetrics and gynecology in 1976. In 1983 he returned to his Alma Mater, Case Western Reserve University School of Medicine as professor and chairman of the department of reproductive biology until returning to OHSU in 1989. He is the founder and recently stepped down as director for the Women's Health Research Unit at OHSU. Doctor Speroff has gained prominence in the area of women's health throughout his publications, national and international lectures and extensive work on clinical trials.