Jan 24, 2007

Dear OBGyn News,

Imagine my frustration when the headline on page one of OB-Gyn News read ?Lower Breast Cancer Rate Credited to Reduced HT Use?. Don?t we have enough mis-information being published in lay journals and on TV? Does our own newspaper have to join in on the misleading anti-estrogen bias bandwagon?

First of all, it would be nice if your reporter would report that less breast cancer is DETECTED, rather than to imply that the INCIDENCE is actually lower. Since breast cancers that are only a couple years old are too small to detect, many never get detected, it should be made clear that what we are measuring is ability to DETECT cancer, not the true incidence. Without careful dissection and pathologic evaluation of all womens? breasts, we will never be able to actually measure true INCIDENCE of breast cancer.

Second, most every scientist agrees that breast cancer is a slow growing cancer, and takes on average about 8 years from onset of the first cancer cell to detection. Therefore any change in the DETECTION RATE of breast cancer that is seen within a couple years of any alteration, is only reflecting a change in ability to DETECT cancer, rather than a true reduction in the actual incidence of the disease.

Third, we should remember that during the 80?s and 90?s when about 1/3 of all menopausal women were on hormone replacement, the DEATH RATE from breast cancer was steadily decreasing. That would imply that HRT possibly was helping us FIND breast cancers at an earlier stage and thus improving cure rates and thus REDUCING death. If estrogen were a carcinogen, then widespread use should have led to increased death rates from breast cancer, but the opposite was true.

Fourth, what do you think would happen to rates of (detected) breast cancer if we suddenly stopped doing mammograms? Of course rates would drop precipitously, just as we have seen with the mass exodus from HRT. Do you think we should therefore eliminate mammograms as well?

Most importantly, now that we are detecting less early breast cancer, what do you predict will happen to breast cancer death rates over the next 5 ? 10 years? This isn?t rocket science. Lack of estrogen makes breast cancer harder to detect. And if detection is delayed, death will surely increase. Unfortunately, all of those who continue to bash HRT use will each be at least partially responsible for any increase in breast cancer mortality that will occur as a result of women being too frightened by this type of journalism to replace their natural gonadal hormones when they become deficient. Shame on you.

Donna Hurlock, MD
Certified Menopause Practitioner
Alexandria, VA


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