E
C
N
A
THEIR BREAST GUESS
C
›› FEATURE
by Ronnie Co he n
M
arin County could be on the brink of losing its grave distinction as the world’s breast cancer capital, thanks to droves of women abandoning a drug that pharmaceutical manufacturers and doctors once marketed as a miracle way to combat menopausal symptoms and postpone aging. In 2002, heeding public-health warnings that hormone therapy could give them breast cancer, more than 57 percent of Marin women quit taking the prescription medication. At about the same time, a study released last week shows breast cancer rates for non-Hispanic white Marin women ages 50 and older slid a whopping 33 percent—dipping below the state’s average for the first time in a decade. The initial results from the Marin Women’s Study add weight to other statewide and national investigations showing that when women stopped taking estrogen and progestin therapy, striking reductions in breast cancer incidence followed. “This is compelling evidence,” says Rochelle Ereman, a Marin County epidemiologist and principal investigator for the study published this month in BMC Public Health, a peer-reviewed online journal. “This shows that the drop in estrogen and progestin led to a dramatic drop in the breast cancer rates.” Launched in 2006 in hopes of solv-
12 PACIFIC SUN MAY 28 - JUNE 3, 2010
ing the mystery of why Marin women were at one point 38 percent more likely than other urban California women to be diagnosed with breast cancer, the Marin Women’s Study has enrolled more than 14,000 women volunteers at mammography centers. The BMC Public Health report examines survey results from 1,083 participants. It is the first in a series of reports researchers expect to write analyzing respondents’ answers to 87 wide-ranging questions—from when the women began to menstruate, when and if they bore children and breastfed, how much they drink alcohol, if they used lawn-care services, birth-control pills, fertility drugs or hormone-replacement therapy. Ereman was filing early completed questionnaires when she noticed a recurrent theme. Many of the women said they had stopped taking combination hormone therapy. An analysis of the data shows that between 2001 and 2004, half of nonHispanic white Marin women 50 years and older who had been taking so-called combination hormone therapy stopped. During the same period, breast cancer rates for the group fell 33.4 percent. The report says the drop spared some 50 Marin women a year from the disabling, disfiguring and emotionally wrenching diagnosis of breast cancer. “This type of change in a risk factor is almost unheard of,” Ereman says. “We’re not going to see dramatic changes in other breast
R
Marin Women’s Study links sky-high cancer numbers to sky-high hormone therapy
cancer risk factors—alcohol use, menarche or child-bearing. This answers a piece of the puzzle of why Marin’s rates are high.” Marin’s breast cancer rates for white women ages 50 and above dropped so significantly in 2003 and 2004 that they were lower than the state’s average. The rates climbed back up from 2005 until 2007, the most recent years available, but remained lower than they had been through much of the 1990s. Investigators are anxiously awaiting new data to see if the trend holds. For reasons it took researchers years to tease out, Marin served as a so-called canary in a coal mine for combination hormone therapy and breast cancer. Women in this mostly white, affluent county of 250,000 were more likely to take combination hormone therapy, and they were quick to abandon it in 2002, after a large national study called the Women’s Health Initiative exposed myriad health risks from the treatment. ●
●
●
●
COMING ON THE heels of other studies that reported similar though less dramatic findings, the precipitous drop in Marin women’s hormone therapy use followed by the stunning drop in breast cancer rates did not shock Janice Barlow, executive director of San Rafael-based Zero Breast Cancer. What does surprise her, she says, is that more has not been done to stop pharmaceutical companies from market-
While estrogen replacement has revealed its own ill-health effects, it was the progestin-estrogen therapy that contributed to Marin’s alarming breast cancer rates.
ing combination hormone therapy eight years after the Women’s Health Initiative concluded it harms significantly more women than it helps. “There just wasn’t enough outrage over hormone-replacement therapy when the Women’s Health Initiative came out,” Barlow says. “Neither the American Cancer Society nor the American Association for Cancer Research has taken a position. They’re avoiding it because it’s political. Nobody’s coming out strongly against taking hormone-replacement therapy. “To me, the message from a public health perspective is to get women and physicians to stop taking and prescribing hormone-replacement therapy.” Where doctors once prescribed the therapy routinely to middle-age women whether they complained of menopausal symptoms or not, most doctors now recommend the therapy only to relieve hot flashes and other problems associated with a drop in estrogen levels as a result of menopause. Furthermore, physicians nowadays are more likely to prescribe the treatment for a limited time—rather than from middle age until death, as doctors did before. In 1998, more than 21 percent of white Marin women ages 50 and above took combined hormone therapy. By the years 2006 and 2007, the number shrank to 6.7 percent. A San Anselmo woman says her doctor reassured her two years ago that she could safely take combination hormone therapy.