Health Experts React To Report Linking 7% Drop In Breast Cancer Incidence With Decrease In HRT Use

Health experts reacted from a "fury to disbelief to a kind of complacency" to a study presented Thursday at the 29th Annual San Antonio Breast Cancer Symposium that said a 7% drop in breast cancer incidence among U.S. women from 2002 to 2003 was possibly because of a decrease in hormone replacement therapy use, the New York Times reports (Kolata, New York Times, 12/18). Peter Ravdin, a research professor in the Department of Biostatistics at M.D. Anderson Cancer Center, and colleagues examined records from nine regions across the U.S. that supply data to the National Cancer Institute's Surveillance Epidemiology and End Results. According to the study, age-adjusted breast cancer incidence decreased by 7% by the end of 2003, compared with 2002. There were about 124 breast cancer cases per 100,000 women in 2003, compared with about 134 cases per 100,000 women in 2002. Breast cancer incidence decreased by 6% in the first half of 2003 and by 9% in the second half of the year. The study found that breast cancer rates dropped by 15% among women ages 50 and older. The study -- which was funded by NCI and M.D. Anderson -- concluded that about 14,000 fewer women were diagnosed with breast cancer in 2003 than 2002. The decline in incidence was the largest since 1990, the researchers found. According to researchers, the decrease in breast cancer rates is most likely associated with a drop in both HRT use and mammography rates. HRT use decreased by about 30% in 2002 after the Women's Health Initiative found that breast cancer risk increased for women who used the treatment for an extended period of time. In addition, mammography rates between 2000 and 2003 dropped by 1% overall and by 3% among women between ages 50 and 64, which could in part explain why fewer breast cancer cases were detected. Ravdin said that it is possible that other factors -- including anti-estrogen drugs, such as raloxifene; statin drugs that reduce cholesterol; or drugs used to treat pain -- also might have contributed to the decrease (Kaiser Daily Women's Health Policy Report, 12/15).

Reaction
The study's findings are "very good news," Elsa Ford, president of Brentwood/Bay Shore Breast Cancer Coalition, said, adding, "It was so easy to embrace [HRT] without close attention to potential side effects, especially on a long-term basis." Julia Smith, director of the New York University Cancer Institute's Breast Cancer Screening and Prevention Program, said, "We believe that HRT contributes to hormone receptor positive cancers in postmenopausal women, but it's hard to believe that HRT would play the sole role in such a significant decline." She added, "Further study is necessary to see if this drop is a trend, a blip or if other factors played a role" (Ricks, Long Island Newsday, 12/18). Wyeth -- maker of combination HRT Prempro -- in a statement Sunday said that the "potential impact of hormone therapy on breast cancer has long been warned in product labels." The new research does not prove cause and effect, the company said, adding that "caution and further examination over a longer period of time is advised before these data can be fully understood" (New York Times, 12/18). The statement also said that the study included short-term and incomplete data and that the decline in breast cancer incidence might be explained by other factors (Agovino, AP/Houston Chronicle, 12/15). Ronald Strickler, chief of women's health services at the Henry Ford Health System, said, "My concern is that these statistics bounce around from year to year," adding, "We will be hearing from the same 10[%] to 20% of patients who react to every report in the news media that is negative, and they ask, 'Does this say you have put me at increased risk of cancer?'" (Anstett, Detroit Free Press, 12/15). JoAnn Manson, a women's health expert at Brigham and Women's Hospital in Boston said she worries that some women as a result of the study who "really require" HRT "will be talked out of it" (Marchione, AP/Charlotte Observer, 12/15).

Other Research Presented at Symposium
The following highlights other studies presented at the San Antonio Breast Cancer symposium.














E-75 compound: Col. George Peoples, a staff surgeon at Brooke Army Medical Center, and colleagues tested the compound E-75 -- a peptide derived from the protein HER-2/neu, which is found at elevated levels in one-fourth of breast cancers -- on 101 military and civilian women whose breast cancer had been treated and who had high levels of HER2/neu. Researchers aimed to determine if it would boost the immune system at certain times. Eighty-five additional women without HER2/neu were followed as a control group. The study found that after two years of treatment, the women who received the compound had a 50% lower risk of their cancer recurring, compared with women in the control group (Tumiel, San Antonio Express-News, 12/15).

Fat intake, Journal of the National Cancer Institute: Researchers at the National Cancer Institute at 39 sites nationwide examined 2,437 women with early-stage breast cancer who were an average age of 58 years old. All of the women had undergone surgery followed by chemotherapy, as well as five years of tamoxifen if their tumors were fueled by hormones, the AP/Yahoo! News reports. The study found that 66% of women without hormone-fueled breast cancer tumors who reduced their fat intake to about 20% of daily calories had a 66% lower risk of death, compared with women without hormone-fueled tumors who were told to continue their normal diet. Among women who had hormone-fueled tumors, there was a 24% lower risk of death five years later for women who reduced fat intake (Marchione, AP/Yahoo! News, 12/16).

Inflammatory breast cancer: Massimo Cristofanilli, associate professor in the Department of Breast Medical Oncology at M.D. Anderson, and colleagues tested 35 women with inflammatory breast cancer using the experimental drug lapatinib by itself and also in combination with chemotherapy to determine the drug's effectiveness in treating inflammatory breast cancer, the San Antonio Express-News reports. The study found that 80% of the women who took the drug alone and then in combination with chemotherapy saw a reduction in their breast tumors by 50%. There was no evidence of remaining cancer in three women who later had surgery, the study found (Tumiel [2], San Antonio Express-News, 12/15).

Post-chemotherapy menstruation: Michael Gnant of the Medical University of Vienna and colleagues reported results from a study that found women whose menstrual cycles returned after they underwent chemotherapy had higher breast cancer relapse rates than those who did not resume menstruation. Gnant said, "Additional hormone suppression may be advisable" to keep periods from returning (Marchione, AP/ABC7Chicago, 12/16).

NPR's "All Things Considered" on Friday reported on the connection between declining breast cancer incidence and the use of hormone replacement therapy. The segment includes comments from Deborah Armstrong, a medical oncologist at Johns Hopkins University's Kimmel Cancer Center; Mary Daly, a researcher at Fox Chase Cancer Center; and Manson (Palca, "All Things Considered," NPR, 12/15). Audio of the segment is available online.


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