Decrease In Breast Cancer Rates Began Before HRT Was Linked To Higher Breast Cancer Rates, Report Says

Main Category: Breast Cancer
Also Included In: Seniors / Aging;  Endocrinology;  Women's Health / Gynecology
Article Date: 07 May 2007 - 3:00 PDT

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A decline in breast cancer incidence began in 1998, before hormone replacement therapy use was linked to breast cancer, according to an American Cancer Society report published in the May 3 edition of Breast Cancer Research, the Wall Street Journal reports. According to the Journal, the recent decline in breast cancer incidence often is attributed to a drop in HRT use after the release of a 2002 Women's Health Initiative study (Parker-Pope, Wall Street Journal, 5/3).

Peter Ravdin, a research professor in the Department of Biostatistics at M.D. Anderson Cancer Center, and colleagues in December 2006 at the 29th Annual San Antonio Breast Cancer Symposium presented data showing that breast cancer incidence among U.S. women dropped by 7% from 2002 to 2003. Ravdin and colleagues in a study published last month in the New England Journal of Medicine found that the decline in breast cancer incidence observed from 2002 to 2003 continued in 2004 (Kaiser Daily Women's Health Policy Report, 4/20). For the ACS report, Ahmedin Jemal, an epidemiologist at ACS, and colleagues examined the pattern of breast cancer rates since 1975. The researchers found a 10.6% overall decline in breast cancer rates between 1999 and 2003, according to the study. In addition, the study found a 5% decrease in breast cancer rates in the years leading up to the WHI 2002 study. According to Jemal, the decrease in incidence was seen across several age groups and was greatest for small tumors and early-stage cancers that often are detected through mammography.

Reasons for Decline
The ACS report found that some of the decline in breast cancer incidence likely is the result of decreased HRT use after the release of the WHI study and another factor in the decline might be that fewer women are being screened for breast cancer (Wall Street Journal, 5/3). Ravdin and colleagues also found that 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 WHI study found that breast cancer risk increased for women who used the treatment for an extended period of time (Kaiser Daily Women's Health Policy Report, 12/18/06). According to the Journal, the ACS report's findings suggest that thousands of early stage cancers could be undetected but might show up later at a more advanced stage.

Reaction
Ravdin said whether a decrease in HRT use will have a "long-term effect" on decreasing breast cancer incidence or "whether eventually there will be an increase in incidence again, we don't know that." Marisa Weiss, a Philadelphia-based oncologist and founder of the Web site breastcancer.org, said that women saw their doctors less after HRT use declined and began receiving mammograms less regularly. "There are few reasons to see your doctor because he's no longer prescribing HRT, and the absolutely required mammogram doctors must have prior to prescribing HRT drops out." Len Lichtenfeld, ACS deputy chief medical officer, said the new repot is important because many women have been confused about breast cancer, HRT use and screening. He said the "message a woman is hearing is, 'I don't have to worry about breast cancer any more because I'm not taking hormones,'" adding that he is concerned that women will stop seeking mammograms (Wall Street Journal, 5/3).

The ACS report is available online.

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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