Thinking About HRT?  Think Again!

by Donna Wine 

Are you presently taking hormone-replacement therapy (HRT)?  Or, are you thinking about starting it?  For many women, the decision to begin and/or continue HRT is complex and daunting at best.  Conventional medical wisdom has prescribed HRT to millions of women to prevent heart disease, osteoporosis, and Alzheimer's disease, as well as to alleviate the tormenting symptoms of menopause -- moodiness, insomnia, and hot flashes.

When faced with the decision to take HRT, many women fear that they will be at increased risk for breast cancer.  Recently, researchers for the Women's Health Initiative, a large, long-term, in-progress study of the risks and benefits of HRT, warned women that their fears may be warranted. Researchers point out that taking the standard combination of estrogen and progestin may as much as double a woman's risk of developing breast cancer.  This risk appears to be the greatest for those women who continue HRT on a long-term basis, a decade or more.  In addition, recent, smaller-scale studies have reported findings of increased breast cancer risks of 8%-12% for women taking the therapy over those who are not. Short-term use of HRT, two to three years, to relieve menopause symptoms appears, at this time, to be relatively safe.

While long-term use of HRT may increase the risk of breast cancer, estrogen and progestin taken in combination, appear to eliminate the increased risk of uterine cancer. However, taking estrogen alone has been linked to an increased risk for uterine cancer.  In terms of its protective qualities, there is strong evidence that HRT does slow bone loss in older women.  Conversely, it has not shown promise as a protective measure for preventing heart disease or Alzheimer's disease, as once hoped.  On the contrary, for participants in the Women's Health Initiative, researchers have found that the women taking HRT have a slightly higher rate of heart attacks, strokes, and blood clots.

In light of the recent warnings about increased risks for breast cancer and lack of evidence that HRT provides protection from heart disease, experts are suggesting that women and their doctors re-evaluate the long-term use of this therapy.  Alternatives to HRT are available and include eating low-fat diets, exercising, giving up smoking, lowering blood pressure and cholesterol levels, and using new drugs, such as Fosamax and Evista, to fight osteoporosis.  With healthy alternatives available, HRT may not be worth the risks.

Adapted from "For Women on Hormone Therapy, Other Options May Be Safer," Susan Brink
"Estrogen: No Heart Protection," U.S. News and World Report, Susan Brink

CA-125:  Two Views on the Test

by Donna Wine

There is a great deal of controversy about the value of the CA-125 test for early detection of ovarian cancer in women.  Only you can decide which view presented here provides the best answer for you.  YFH can see both sides of the story.  However, our view is that the total value of the test lies not in the immediate test results of a single screening, but in a series of results over time.  We believe that tracking "personal normal" trends for an individual's CA-125 results is extremely valuable.  YFH further believes that the personal historical data provided by routine CA-125 testing is equally as valuable for women as the concept of tracking PSA Prostate results is for men.  A CA-125 score that significantly increases, when an individual's trend as been toward more favorable lower scores, would signal that some abnormality may exist and warrant attention by a health care professional.  It is true that a sudden jump in a CA-125 score may indicate the presence of a benign fibroid tumor or other disease or health condition.  However, early detection of any abnormality, as well as ovarian cancer, is an important component of health care.  Assuredly, the inexpensive cost of an annual CA-125 test pales in comparison to the high cost of failing to detect ovarian cancer or other serious diseases while in their infancy and possibly treatable.

 The two views presented here are those of a woman presumably diagnosed with Primary Peritoneal Cancer and that of the American Cancer Society (ACS) and many physicians.  The testimony of the woman writing the e-mail message is summarized as follows: 

Having suffered through symptoms ranging from diarrhea and/or constipation to severe swelling of the abdomen, this woman was tested repeatedly for various illnesses and, ultimately, misdiagnosed as having Irritable Bowel Syndrome.  When the swelling of her abdomen worsened, she insisted on more tests.  X-rays of her abdomen were negative, but her symptoms grew still worse.  Because she insisted on additional tests, her physician ordered a CT-Scan, which showed a lot of fluid in her abdomen.  She had five pounds of fluid drained from that area and subsequent tests revealed cancer cells in the fluid.  Finally, the doctor ordered a CA-125 test.  Her score was 754, radically out of the "normal" statistical lab range of 0-35.  This woman believes that the CA-125 test saved her life. She further believes that annual, or more frequent, CA-125 testing might save yours.

While there is no way to determine if this story is real, it does bring attention to the controversial issues surrounding the CA-125 test.  Clearly, this woman believes that, where other diagnoses and tests failed, CA-125 succeeded and may have saved her life.  On the other hand, the American Cancer Society and many physicians do not recommend CA-125 screening for early detection of ovarian cancer because it results in too many false positives and sometimes fails to even detect a cancer that is actually present.  Any number of other conditions such as fibroid tumors, pelvic infections, liver disease, and other ailments can cause a rise of CA-125.

The ACS does acknowledge that CA-125 can be useful for monitoring the progress and treatment of ovarian cancer.  Quoting the American Cancer Society: 

Although the study finds the CA-125 blood test useful for evaluating treatment progress, the study results do not suggest the test can be used to screen for ovarian cancer. A recent e-mail making the rounds urged women to ask their doctors for this test. For the CA-125 test to be a useful screening tool, it would have to detect most ovarian cancers in their early stages and not give positive results in women who do not have the cancer. The CA-125 test does not meet these standards.

While the ACS does not endorse CA-125 as a definitive resource for early detection of ovarian cancer for women at average risk, it does point out that, combined with pelvic exams, it may have a role for women at high risk for the disease.  Today, women at high risk for ovarian or primary peritoneal cancer in Germany are tested for CA 125 every 3 months and the scores are tracked to identify early possibilities of cancer.  If a significant rise in the score occurs, further tests and examinations are ordered and evaluated.

You be the judge.  You have the potential and the resources, in partnership with YFH and your health care professional, to be a proactive, watchful guardian of your future health.  The inexpensive cost and simplicity of the CA-125 test, on a routine basis over time, may lead you to the much grander payoff of optimum health for life.

Adapted from Barbara "readings railroaded" Mikkelson, 14 April 2000.
"Primary Peritoneal Cancer" www.urbanlegend.com, Nov., 1998.

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