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Table of Contents
- Hormones and Your Health
- Birth Control Pills
- Benefits of HRT
- HRT and Uterine Cancer
- HRT and Breast Cancer
- HRT and Colon Cancer
- Weighted Risks vs. Benefits
- HRT and Long Life
- Questions & Answers About Breast Cancer - Myths and Mysteries
- Guides to a Healthy Weight
- Breast-Cancer Survival Improves
- Breast Cancer Screening -- Who? Why? How? When? Where?
- Genetic Testing--Is It for You?
- Jewish Women and Breast Cancer
- Guarding Against Gynecological Cancers
- Make No Bones About It
- 6+ Reasons to Quit Smoking
Hormones and Your Health
How does long-term use of hormones--either as contraceptives or
estrogen-replacement therapy after menopause--affect a woman's health?
The most important thing to consider is overall health history,
including family history. Though many fear cancer most of all, older
women are much more likely to develop and die of heart conditions. For
example, while one of every eight women may eventually get breast
cancer, one in two develop heart ailments. Natural ho'rmones before
menopause and hormone replacement therapy (HRT) afterward lower this
cardiovascular risk. The use of various forms of hormones is also
associated with increasing or reducing the risk of various cancers.
Birth-Control Pills
Some studies suggest that birth-control pills may increase breast-cancer risk, at least for women with a family history of this cancer and those who have never borne children. This requires more research because contraceptive pills have changed over the years. The first ones offered in the 1960s had much higher hormone doses than today. Research has clearly shown that oral contraceptives help lower the risk of ovarian cancer and endometrial cancer--cancer of the lining, or endometrium, of the uterus. This protection appears to last at least 15 years after a woman stops taking the pill.Benefits of HRT
Throughout a woman's reproductive years, the ovaries produce the female hormone estrogen during each menstrual cycle. Replacement estrogen has long been prescribed to relieve menopausal symptoms. HRT has been shown to cut the risk of heart disease in half. HRT also helps prevent osteoporosis--the bone brittleness common after menopause.HRT and Uterine Cancer
As women grow older, they have a rising risk of endometrial cancer. Several studies have shown that women on long-term HRT with estrogen alone have a higher risk of this cancer. Adding the hormone progesterone to HRT appears to eliminate this increased risk.HRT and Breast Cancer
Research on possible links between HRT and breast cancer have drawn different conclusions over the years. A 1991 analysis by the federal Centers for Disease Control and Prevention, based on 16 breast-cancer studies in the U.S. and other countries, found that women with a family history of breast cancer who took replacement estrogen more than tripled their risk of this cancer. However, this report calculated that other women taking estrogen for five years or less had no additional risk. Those taking it for 15 years or more increased their risk of breast cancer by 30 percent (or by 100 percent if they began hormone therapy during the premenopausal stage).Two 1995 studies using different methods came up with opposite results. One by Harvard Medical School surveyed participants of a previous study and found that long-term use of either estrogen alone or estrogen plus progesterone raised the risk of breast cancer. In contrast, a study of more than 1,000 women by Fred Hutchinson Cancer Research Center found no increased risk of breast cancer with either type of HRT. This research directly compared women who had breast cancer with those who did not.
HRT and Colon Cancer
Two other recent studies--one by the American Cancer Society and another by University of Wisconsin researchers suggest that HRT reduces colon-cancer risk. But a Yale University study published in 1996 found no significant effect on the risk of colon cancer.Weighing Risks vs. Benefits
Everyone's relative risk of cancer differs with personal and family history. The accumulation of several risk factors counts most in assessing the odds. Each woman should discuss the benefits and risks of HRT with her doctor. If this therapy seems appropriate, both the dosage and duration should be carefully considered. Before and after hormone treatment begins, women to should have yearly checkups for any signs of cancer. |
HRT and Long Life |
Questions & Answers About Breast Cancer
Myths and Mysteries
Q. Does being struck on the breast cause cancer?
A. No. A bruise or other physical injury to any part of the body does not lead to cancer, but the injury may draw attention to a growing lump that was already present.Q. Does pregnancy help prevent or help cause breast cancer?
A. In general, full-term pregnancies before age 30 are protective. The first pregnancy promotes risk-reducing changes in breast tissue. Pregnancy also provides a beneficial change in hormone balance, since uninterrupted estrogen during repeated menstrual cycles can promote breast cancer in some women. Women who have never borne children have a higher risk of breast cancer. The exception is a first full-term pregnancy after 30. In some women, first-time pregnancy-related breast changes in their 30s or 40s appear to help promote breast cancer.Q. How does breast-feeding affect cancer risk?
A. A study of nearly 90,000 middle-aged women showed that those who had never breast-fed were neither more nor less likely to get breast cancer than women who did breast-feed their babies, the Harvard School of Public Health reported in 1996.Q. Will drinking coffee or colas with caffeine increase my chances of developing breast cancer?
A. No evidence links breast cancer to drinking beverages with caffeine, according to the International Agency for Research on Cancer's Working Group on the Evaluation of Cancer Risks to Humans. Caffeine consumption also does not increase the risk of benign breast lumps, as was once believed.
Guides to a Healthy Weight
Adding pounds with age may increase the risk of premature death from heart disease, diabetes and certain cancers, including breast cancer. The higher weight given for each height is best for individuals with a large-boned, muscular build. Those with a low ratio of muscle and bone to fat should aim for the lower end of the weight range.In any case, this table is only an approximate guide to your ideal weight. Avoid crash-diets--they can backfire by leading to changes in metabolism that cause you to retain fat. Adding low-calorie vegetables and fruits to your diet, cutting down on fatty foods and exercising regularly is the surest, most healthful way to achieve and maintain your goal.
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Breast-Cancer Survival Improves
This year the National Cancer Institute announced that death rates from breast cancer have begun to decline--a slow but steady decrease apparent in the most recent five-year period for which complete data is available, 1989 through 1993. In the previous decade, breast-cancer deaths had increased 3% in white women and 16% in black women. Now the overall death rate has decreased 5%--a trend that holds true for women in most age groups, though the drop is much slighter among African Americans.Among white women, breast-cancer death rates fell for all but those 80 and older. Among black women, these rates declined for all but women 70 and older. For white breast-cancer patients over age 80, the death rate rose 2%. Breast-cancer death rates for African Americans 70 and older went up 5%.
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| All Ages: | 6% decrease | All Ages: | 1% increase |
| 30 - 39: | 13% decrease | 30 - 39: | 5% decrease |
| 40 - 49: | 9% decrease | 40 - 49: | 2% decrease |
| 50 - 59: | 9% decrease | 50 - 59: | <1% decrease |
| 60 - 69: | 6% decrease | 60 - 69: | <1% decrease |
| 70 - 79: | 3% decrease | 70 - 79: | 5% increase |
| 80 +: | 2% increase | 80 +: | 5% increase |
This new trend of declining deaths from breast cancer results partly from improved treatments, including follow-up therapy, and partly from earlier detection due to screening mammograms. Racial differences in mortality rates may depend on several factors, including later diagnosis among African American women due to differences in access to screening and early detection.
Breast Cancer Screening -- Who? Why? How? When? Where?
Know your risks of breast cancer. Having a family history of breast cancer among first-degree female relatives (mothers, sisters and daughters); never having borne children; beginning menstruation before age 12; reaching menopause after age 50 and being overweight all increase the risk of breast cancer. But the biggest risk is simply growing older. Two-thirds of all breast cancer occurs after age 50.
- Starting at age 20, all women should learn to do breast self-examination and have professional breast exams as part of a regular gynecological checkup.
- Low-dose X-rays called mammograms can detect breast lumps up to two years before they can be felt, but mammography is less effective in premenopausal women because of their denser breast structure. Discuss your personal and family risk factors with your doctor to develop a mammography screening schedule that's right for you.
- Starting at age 50, all women should have an annual mammogram at a facility certified for high quality by the Food & Drug Administration.
Genetic Testing--Is It for You?
The ability to test for genes involved in breast cancer--and other cancers as well--is rapidly becoming available to physicians in many settings. Remember that testing for genetic cancer risks should be part of a total risk education and assessment process. Counseling helps you learn what is involved and whether or not it is appropriate for you.
Ongoing research at Fox Chase Cancer Center and elsewhere is exploring the role of several genes in breast and other cancers. Based on work so far, about 90% of breast cancer that runs in families (from 5% to 10% of all breast cancers) appears to result from two genes, BRCA1 and BRCA2. These genes are also involved in ovarian cancer. Both genes appear to be flawed anticancer genes--which usually protect against cancer by suppressing tumor growth. Such damaged versions of tumor-suppressor genes fail to produce enough of their essential protein that blocks unwanted cell growth.
Since every cell in the body has two copies of all genes--one inherited from each parent--most people who inherit a mutation in an anticancer gene will also receive one normal copy. This can be enough to keep tumors in check. But if the normal gene in a single cell also undergoes mutation, a tumor eventually may be free to grow. As the testing education process will explain, testing for a specific cancer-related genetic flaw yields an estimate of the person's lifetime risk. Since cancer usually involves several genes, the absence of the gene tested for doesn't guarantee you won't get the cancer. If you do have the particular gene, it doesn't mean you will definitely get the disease, but you should be sure to schedule regular screening exams.
Jewish Women and Breast Cancer
Women of Ashkenazi Jewish heritage (from Eastern Europe and Russia) may be more likely to inherit the BRCA1 and BRCA2 genes associated with breast cancer, recent research has shown. According to a 1995 National Institutes of Health report, only about .2% of all women--1 in 500--might have BRCA1, but as many as 1%--1 in 100--of Ashkenazi Jewish descent might have inherited this gene. New studies published in the October 1996 issue of Nature Genetics indicate that between 1% and 1.5% of Ashkenazi Jewish women may also have the BRCA2 gene, which appears to confer a lower breast-cancer risk than BRCA1.The National Cancer Institute has awarded Fox Chase Cancer Center a grant for a study focusing on breast-cancer risk among Jewish women and how best to educate women about this risk. Women of Ashkenazi Jewish heritage who are interested in taking part in the study may call (215) 728-2792 for more information.
Guarding Against Gynecological Cancers
Women should start having regular gynecological exams by age 18, or sooner if they are sexually active.Cancer of the uterus is the most common gynecologic cancer in the United States, the fourth leading kind of cancer among women. Most uterine cancers develop in the endometrium, the lining of the uterus.
Endometrial cancer accounts for nearly 34,000 cancer cases annually. It usually occurs after age 50, most often between ages 58 and 60. Yet too many women stop seeing their gynecologist after they pass child-bearing age. An annual pelvic exam is just as important for a woman whose family is complete as it is for younger women. The only symptom of endometrial cancer is abnormal bleeding or discharge. If you have this symptom, be sure to see your doctor. The best way for doctors to diagnose this cancer is to do a biopsy--taking samples of the uterine tissue in a procedure known as an endometrial biopsy or endo pap.
Cervical cancer --cancer of the uterine cervix, or neck of the womb--is diagnosed in about 15,700 women each year. Many more women, however, especially those younger than 50, have a precancerous condition of the cervix known as carcinoma in situ. Left undetected and untreated, it can progress to an invasive, life-threatening cancer.
The Pap test is the ideal way to detect not only true cervical cancer but easily treated precancerous conditions. This exam is simple, inexpensive and safe. Done annually, or as often as your doctor recommends, regular Pap tests are your best protection against cervical cancer. In some widely publicized cases, however, a few commercial pathology laboratories have emphasized quantity over quality and missed abnormalities that later developed into cancers. To avoid mistakes, ask your doctor where he sends your Pap smear to be evaluated and make sure the laboratory meets federal standards.
Ovarian cancer is the fifth leading type of cancer in American women, with 26,600 new cases a year. Yet it is the fourth cause of female cancer deaths--about 14,800 a year, compared to 4,900 annual deaths from cervical cancer and 6,000 deaths a year from other uterine cancers. Late diagnosis is the main reason for this low survival rate. Symptoms of ovarian cancer are vague: persistent bloating, back pain, pelvic pressure or digestive disturbances. These could be signs of many other conditions, but any woman who experiences one or more of these symptoms should see a doctor and request an evaluation.
Although ovarian cancer runs in some families, the most important risk factor for ovarian cancer is getting older. Most ovarian cancers occur in women older than 60. Detected early, ovarian cancer may often be cured by surgery alone, with no need for follow-up treatment. No single test exists, however, to detect ovarian cancer effectively. A blood test showing high levels of a protein called CA125 may indicate ovarian cancer, as well as other noncancerous conditions. This test is most useful in combination with a pelvic exam and other tests, such as transvaginal ultrasound.
A routine pelvic exam cannot always distinguish possibly cancerous ovarian growths from noncancerous fibroid tumors. Ultrasound and magnetic resonance imaging (MRI) can usually resolve this. Otherwise, a diagnostic laparoscopy--inserting a miniaturized viewing apparatus into the abdomen through a tiny incision--may be necessary.
Fibroid tumors almost never lead to cancer and often do not require treatment. Beginning as irregular cells in the muscular layer of the uterus, these growths become rubbery nodules, usually between the size of a walnut and an orange. They appear to wax and wane with hormone levels--growing larger with oral contraceptive use or pregnancy, shrinking after menopause but increasing with hormone replacement therapy.
Symptoms include bloating, pressure that may cause urinary frequency or constipation and--most commonly--heavy bleeding during menstruation. If the bleeding leads to anemia or the symptoms become intolerable, various medications may be prescribed to shrink fibroids.
Fibroids can be removed by a surgical procedure called myomectomy. Another option is to have the entire uterus removed by a partial or complete hysterectomy. A partial hysterectomy leaves the ovaries in place. Either way, every woman considering surgery should discuss the risks and benefits of various procedures with her doctor.
Make No Bones About It
Despite the dietary steps women can take to avoid osteoporosis, the ones that top the list are weight-bearing exercise, such as moderate walking for a half hour at least three times a week or more vigorous activities.To add calcium to your diet, supplements may be better than dairy products. Calcium in milk, cheese and other animal products is more likely to be excreted by the kidneys. Broccoli and spinach and other leafy dark green vegetables are excellent sources of calcium and also contribute fiber and other nutrients to your diet that may help prevent colon cancer.
6+ Reasons to Quit Smoking
More women die of lung cancer every year than breast cancer.
Breaking the tobacco habit will reduce your risk of:
- heart disease
- lung and several other cancers
- stroke
- osteoporosis
- chronic bronchitis
- emphysema and other pulmonary diseases.