- The Washington Times - Friday, December 15, 2006

Breast cancer rates in the United States, after rising for more than two decades, fell sharply in 2003, and Texas researchers say the drop occurred because millions of women stopped taking menopause hormone pills soon after a national study raised concerns about the safety of the drugs.

Biostatisticians at the University of Texas’ M.D. Anderson Cancer Center found a decline of more than 7 percent in breast cancer incidence from 2002 to 2003 — reportedly the largest ever in a single year — at a breast cancer conference yesterday in San Antonio.

The drop came in the aftermath of a federal study in mid-2002 that linked so-called hormone replacement therapy (HRT) to an increased risk of breast cancer, heart disease and other medical disorders.

The 2002 findings came as a shock, because many older women were taking HRT to reduce cardiovascular disease risk, Donald Berry, a professor at the Anderson cancer center, who was involved in the research presented yesterday, said in a telephone interview.

“The steepest decline [in 2003 breast cancer incidence] — 12 percent — occurred in women between the ages of 50 and 69 diagnosed with estrogen receptor positive (ER-positive) breast cancer,” the Houston-based cancer center said.

“We now realize that ER-positive breast cancer tumors are fueled by the hormone, estrogen, ” Mr. Berry said. Such tumors “slow or stop growing” without the hormone, he said.

“Given that there was a 30 percent rise in breast cancer incidence in this country between 1975 and 2000, an increase that was separate from what you’d expect from increased mammography screening, we can conclude some of the reduction [in 2003] was due to the fact that fewer women were taking HRT at that time,” he said.

In 2001, the U.S. breast-cancer rate was 137 cases per 100,000 women. It dipped in 2002 — to 134 cases per 100,000, and then came 2003’s big drop, down to 124.

Because theirs was a population study, in which it is difficult to attribute causes of results, the M.D. Anderson Cancer Center researchers said they could not be certain that the lowering of HRT use was the reason for the dramatic drop in breast cancer cases.

“But I feel it was the primary factor,” Mr. Berry said yesterday.

In a separate interview, Ahmedin Jemal, strategic director of cancer occurrence for the American Cancer Society, said research he’s submitted for publication came up with similar findings and conclusions.

“We found what they found,” he said, except for a few smaller declines in breast cancer rates before the big drop in 2003, he said yesterday.

“We support their findings and feel it is a possibility” that breast-cancer incidence decreased as a result of the sharp reduction in use of HRT, Dr. Jemal said.

“But there is no certainty that is the case, time will tell,” the ACS official said in a telephone interview.

Mr. Berry and his research associate, Peter Ravdin, also a biostatistician at the Anderson cancer center, said as many as 14,000 fewer women were diagnosed with breast cancer in 2003 than in the previous year.

“It’s the largest single drop in breast cancer incidence within a single year I am aware of,” Dr. Ravdin said.

He noted that in 2000, in 2001 and in early 2002, about a third of American women older than 50 took HRT, which provided the hormone estrogen alone or estrogen combined with progestin.

Mr. Berry said it was always recognized that HRT could pose an increased risk of breast cancer. But epidemiological studies suggested that it protected post-menopausal women from heart disease, so women and their doctors alike felt its benefits outweighed any risks.

But when a federal study of more than 16,600 women ages 50 to 79 showed that HRT increased risk of breast cancer, heart disease and stroke in the population that it was supposed to help, the research was halted prematurely.

The bad news about HRT prompted public-health officials to advise that it only be used by for a short time by women undergoing menopause who experience disturbing and stressful symptoms such as hot flashes and insomnia.

As a result of these new findings, Mr. Berry said, the official advice may change, and women could be told to “live with” menopausal symptoms rather than using HRT.

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