Jewish World Review July 1, 2003 / 1 Tamuz, 5763
By Robert A. Wascher, M.D., F.A.C.S.
http://www.NewsAndOpinion.com |
More bad news this week relating to the use of estrogen/progestin
combination hormone replacement therapy (HRT).
In this week's Journal of
the American Medical Association (JAMA), another report from the large-scale
prospective Women's Health Initiative hangs the crepe on the continued use
of combination HRT. A total of 16,608 postmenopausal women without evidence
of cancer were randomly assigned to take combined HRT or placebo pills.
These women were then followed from 1993 to 1998 at 40 different
participating medical centers.
Screening mammograms and breast examinations
were performed upon entry into the study and yearly thereafter. At the end
of this very short period of follow-up, the study determined that combined
HRT, over the course of 5 years, resulted in a 24% relative increase in the
incidence of breast cancer when compared to the women taking only sugar
pills.
As if this were not bad enough news already, the women who were
taking the HRT pills tended to develop significantly larger and more
advanced breast cancers than did the women who took only placebos.
Especially worrisome was the finding that after only 1 year of combination
HRT, the percentage of women with abnormal mammograms was significantly
higher among the women receiving HRT when compared to the women not taking
HRT pills (9.4% vs. 5.4%, respectively).
This HRT-related effect on
mammographic abnormalities persisted throughout the 5-year study.
Over the past year, the scientific news regarding the potentially harmful
effects of combined HRT has been universally bad. Regular readers of this
column already know of the myriad adverse health effects now being linked to
combination HRT use, including many diseases (such as cardiovascular disease
and dementia) that the manufacturers of HRT pills have long insisted were
actually reduced in incidence with HRT.
As non-HRT treatments for the
transient emotional and thermoregulation symptoms that distress some
postmenopausal women continue to improve, there is no doubt in my mind but
that combined HRT therapy will no longer be considered safe or medically
appropriate therapy. For women who still have their uterus, HRT with
estrogen alone is not an option due to the resulting increase in the risk of
developing uterine cancer.
EFFECTS OF LONG-TERM HORMONE REPLACEMENT THERAPY
The HRT history of these 975 women
with newly diagnosed breast cancer was carefully documented. The study
found that the women who used estrogen-alone HRT (all of whom had previously
undergone hysterectomy), even for 25 years or longer, did not appear to
experience a significantly increased risk of developing breast cancer
(although a small increase in the risk of breast cancer from long-term
estrogen use could not be excluded in this study).
On the other hand, women
who had used combination HRT at any time in the past had, as a group, a 70%
increase in the relative risk of developing breast cancer. The increase in
the risk of developing a specific type of breast cancer, infiltrating
lobular breast cancer, was 170% among women with a history of prior
combination HRT use.
The risk of developing breast cancer continued to
climb with increasing durations of combination HRT. This increase in breast
cancer risk seen with combined HRT used did not vary between women who took
progestin pills every day and those who took the pills for only 7 to 10 days
per month. Ladies (and gentlemen), it is time for combined HRT to end.
THE MEDITERRANEAN DIET & HEALTH
It has long been observed
that, despite a penchant for smoking and frequent wine consumption, people
in Mediterranean Europe who adhere to a diet rich in fish, poultry, olive
oil, fruits and vegetables (and regular but moderate red wine intake) appear
to have a lower risk of dying from cardiovascular disease. This newly
reported study looked at more than 22,000 adults in Greece, examining the
dietary habits of each study participant.
This cohort of study participants
was then followed for an average of 44 months. The study found that people
who adhered the closest to the traditional Mediterranean diet had a 25%
smaller relative risk of dying than people who did not follow such a diet.
Reduction in death due specifically to coronary heart disease was 33% among
adherents to the Mediterranean diet, while death due to cancer was reduced
by 25% among the folks who adhered to the Mediterranean diet.
While no
single food item within the standard Mediterranean diet appeared to confer
any significant protection against disease or death, the cumulative health
benefits of the Mediterranean diet, as a whole, appear to be very
significant.
JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at
the John Wayne Cancer Institute in Santa Monica, CA.
Comment by clicking here.
More Nails in the HRT Coffin
Another study reported in the current issue of JAMA looks at the impact of
long-term HRT, both combined HRT and estrogen alone. A total of 975 women,
aged 65 to 79 years, and diagnosed with breast cancer between April 1997 and
May 1999, were included in this study.
As the battle between different diet camps continues to rage on, despite the
recent death of high-fat low-carbohydrate guru Robert Atkins, a new study in
this week's New England Journal of Medicine shines the investigative
spotlight on the venerable "Mediterranean Diet."
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