December 14, 2006
The hot news of the day reports that 14% less breast cancer has been detected in the past four years compared to prior years (since the Women's Health Initiative scared so many women into quitting their HRT.) What does this mean? It most likely means that out ability to DETECT breast cancer is less. Specifically, there is probably still just as much breast cancer out there as before, but we are just not finding it as well now. Taking estrogen somehow helps breast cancers be detected easier, so decreasing estrogen use has taken that detection advantage away. The same thing would happen if we suddenly stopped doing mammograms. BIG NEWS! 50% LESS BREAST CANCER (detected) SINCE WE OUTLAWED MAMMORGRAPHY! But is decreased DETECTION of breast cancer a good thing? I don't think so. In recent years, during the time before the Women's Health Initiative, when HRT use was widespread, death rates from breast cancer were steadily dropping. That was primarily due to the fact that many of the cancers were caught at such an early stage that they were easily cured. In fact, most studies show that cancers that are detected in women who take estrogen replacement are smaller and less aggressive than the cancers that are found in women who do not take estrogen. I have found that to be true in my practice. As you know, most of my menopausal patients do replace their estrogen, and I can count on one hand the number of them who have died from breast cancer in the past decade. So essentially, it seems that if you take estrogen it helps us detect any breast cancer that may occur at an earlier (and more curable) stage. It is also true that women who are on estrogen who do get breast cancer tend to have a much higher chance of survival than women who are not on estrogen when they are found to have a breast cancer. Further, almost all studies that measure death from breast cancer show that women who take HRT die less from breast cancer than women who do not take HRT. If estrogen were a true carcinogen that would not be possible. Therefore, it is likely that the reason that we are finding fewer cancers of the breast since so many mis-led women have stopped their HRT is that their cancers are still hiding. Time will certainly tell. If what I'm saying is correct, I will predict that in another 10 to 15 years we will start to find many more advanced cancers that lead to a much higher death rate (since they were not found early as they usually are in women on HRT.) Of course, by the time we realize that, many women's breasts and lives will be lost.
Bottom line: Never make decisions based only on studies that simply report DETECTION of breast cancer. Instead, it's better to focus on studies that measure DEATH from breast cancer. Many breast cancers are never detected, particularly if you die at an early age from someting else.
Always remember that breast cancers usually grow for about 8 years before they are detected, so any study that reports a change over less than a 10 year period, is probably only reflecting changes in our ability to DETECT those cancers. Gee, I hope they don't also tell us to stop doing mammagrams so that we can lower the rate of DETECTED breast cancer even further!!!


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