Hysterectomies ease estrogen therapy risks

TORONTO -- Postmenopausal women who've had hysterectomies can safely take estrogen-alone therapy without raising their breast cancer risk, the latest analysis of data from a big, disconcerting U.S. study suggests.

The finding comes from the estrogen-alone arm of the Women's Health Initiative (WHI) and contrasts dramatically with another part of the study, which reported three years ago that postmenopausal women given both estrogen and progestin showed a definite spike in breast cancer risk.

Lead author Marcia Stefanick, a researcher from the Stanford University School of Medicine, hopes the latest findings will help clarify the issue for women unnerved by the seemingly contradictory results of hormone replacement research.

"The good news is we confirmed the preliminary data that there was no increase in breast cancer in the study population overall, which was really different from the estrogen-plus-progestin trial," Stefanick said.

"The issue for women who have had a hysterectomy with respect to the concern about breast cancer is very different from estrogen combined with progestin."

"If you have a uterus, you have a totally different issue to consider and that is going on hormones does increase your risk of breast cancer," she said, adding that a woman with an intact womb should not take just estrogen because of the risk of uterine cancer.

The 15-year-long Women's Health Initiative has studied causes and prevention of conditions and diseases affecting women 50 and older, among them hormone replacement therapy for menopause symptoms.

The estrogen-alone trial compared the effects of estrogen versus placebo in almost 11,000 women, aged 50 to 79, over seven years. It was designed to conclude after eight years, but was halted 12 months early after increased rates of stroke and blood clots in the legs were found among those taking estrogen.

Stefanick said the risk of stroke is highest for elderly women, as is the danger of fracturing a hip.

"When we talk about the menopause-aged women, most 50-year-old women are not at very high risk for stroke or hip fracture, so where they have the biggest concern is for breast cancer."

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