Don’t sweat it
Submitted by Dr.Kattlove’s Cancer Blog
One of the most challenging complaints from patients in my practice came from older women who had been treated for breast cancer. Their complaint; “Dr. Kattlove, I can’t stand these hot flashes anymore”. And I would say, “Well, you know, hormone replacement therapy isn’t recommended in women who have had breast cancer”.
Not good enough. These women were miserable. And so, I, as well as some of my partners would slip these women their hormones. Sometimes I felt like a crack dealer. Still feeling a little guilty (although none of these women suffered any ill effects and were definitely grateful) even after leaving practice, I was cheered by a study published in 1997 that found no increase in cancer recurrence in over 50,000 women who had received hormones after treatment for breast cancer.
But alas, that was what we call an observational study. There was no control group of women who didn’t get hormones. The study authors just compared their results with national averages of what should be expected. But we know that isn’t the most scientific way to study an issue.
So, in 1997 two groups of researchers, one from Great Britain and the other from Sweden did the study the right way. They prescribed hormones for half of their patients with treated breast cancer and hot flashes and no hormones for the other half with the same history. And wouldn’t you know it, the British group found that the women on hormones had a higher rate of breast cancer recurrence, while the Swedes found no difference in recurrence rate between the two groups. Go figure.
But here is the good news. Just this week, the Brits published a second paper with a longer follow-up of their two groups. They still found more breast cancer recurrences in the women who got the hormones, but it turns out that most of the recurrences were local – in the breast - and could be handled easily. When it came to spread outside the breast and death, there was no difference between the two groups.
Now this doesn’t completely reassure us that hormones are entirely safe for women who have had breast cancer. An excess of local recurrences is still a problem, even though it only occurred in the British study. But, knowing this and the results of the Swedish study we can at least say to women that hormone therapy won’t kill them.
Many of my patients would have replied that they were already dying from the hot flashes. The risk from hormones was no big deal.
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