Thoughts On Breast Cancer and HRT, Part Two

(Last week we began a discussion of the probable role of hormone replacement therapy (HRT) in the development of breast cancer. We conclude the discussion, with references, this week.)

As early as 1987, a study published by a group of British physicians showed that breast cancer incidence increased by 59 percent among women who took HRT, and that these women also had an increased risk of endometrial (uterine) cancer. These researchers clearly stated that ovarian hormones, such as those present in HRT, “increase the risk of breast cancer: it is likely that this is because they stimulate breast cell division” (Key 1988). So, a strong association between HRT and breast cancer should come as no surprise today.

But until a few years ago doctors in general took the opposite position, enthusiastically endorsing HRT as an effective means of preventing both breast cancer and heart disease (Bengtsson 1989). Moreover, we were told, even if it did cause an increase in breast cancer, it would at least prevent other fatal illnesses. This came home to me with force when my own wife went through menopause and had a memorable encounter with a prominent New York City gynecologist. This physician told my wife that while there was a slightly increased risk of breast cancer associated with HRT, this was “no biggie,” and that my wife was far more likely to die of heart disease, which HRT would effectively prevent. “I don’t want you to leave this office unless you agree to start HRT without delay,” she told my wife. When my wife balked, the gynecologist loaded her up with free samples of Prempro. These samples sat gathering dust on my wife’s dresser top for a few months, until we finally swept them into the garbage.

The recent revelation that HRT does nothing whatever to prevent heart disease undercut this often-heard but clearly fallacious argument.

If it is confirmed that the sudden drop in breast cancer incidence in 2002-2003 was indeed caused by the decline in HRT use, I believe the medical profession will have much soul-searching to do. The most effective measure taken in decades to reduce breast cancer incidence will have turned out not to be a new wonder drug, but the informed refusal of thousands of women like my wife, who rightly turned their backs on a medication that was pushed on them by doctors whose prescribing decisions relied more heavily on drug company promotional materials than on science.

The news concerning the possible role of HRT in breast cancer cannot fail to raise the question of whether other pharmaceutical agents might possibly also be contributing to our high rates of cancer. The drug industry is increasingly a mainstay of the economy of all developed nations. Pharmaceuticals now represent a worldwide market of $602 billion, according to IMS health, an information and consulting company. And this fabulous figure increases by about 7 percent each year. While there is no doubt that many of today’s medications are useful and have contributed appreciably to improving the lives of those who genuinely need them, the use of any drug, whether “natural” or synthetic, always involves a trade-off between putative benefits and unanticipated and possibly highly undesirable side effects.

(We saw recently, for instance, that the popular heartburn drugs, the class of drugs known as proton pump inhibitors (PPIs), had unexpected dangers. Certainly PPIs have brought much-needed relief to thousands of individuals who previously had to endure painful heartburn. But these drugs have now been shown to be associated with a 44 percent increase in the risk of hip fracture. The longer patients take PPIs, the higher their risk. Such agents include Prilosec, Prevacid and Nexium, and the global market for them tops $12 billion.)

At the same time, there has been some harsh criticism of the dietary supplement industry in recent years. To judge from some of the alarmist prose that has appeared on this subject in the popular media, one could be forgiven for concluding that herbs, dietary supplements and antioxidants represent a far greater threat to human health than any prescription drug. To redress the balance somewhat, I would suggest that in future, natural agents be studied in direct contrast to competing synthetic pharmaceutical drugs. That way we will find out how the supposed dangers of natural agents compare to the harm that is sometimes done by synthetic pharmaceuticals.

In the US, an enormous amount of money is spent each year by the pharmaceutical industry in order to promote consumer demand for drugs via the mainstream media. (For example, according to CBS News, the advertising budget for Prilosec alone in 2000 has been estimated at over $108 million.) The net effect of this consumer-directed advertising is to create a feel-good atmosphere, with lovely cartoon images and heart-warming stories. Individually, of course, each ad aims to push one particular product. But as a genre, these ads function as a kind of broad-scale propaganda campaign, especially aimed at senior citizens, promoting the desirability of drug-based medicine.

With such a huge proportion of their revenue derived from pharmaceutical advertising, the mainstream media are understandably reluctant to bite the hand that feeds them, and for this reason are perhaps less inclined to publish hard-hitting exposés on the undesirable costs and side effects of drugs. Establishing the link between HRT and breast cancer, as the media did in late 2006, may seem to be an exception to this tendency. But the latest revelations will turn out to cost the pharmaceutical industry little, since the bottom had already fallen out of the $3.5 billion market for synthetic HRT products after the 2002 Women’s Health Initiative revelations.

As we search for the causes of cancer we should not leave out the potential contribution of pharmaceutical agents themselves. No matter how good the intentions of those who prescribe them, the lesson of the recent decline in breast cancer incidence is that sometimes these drugs may do more harm than good - a piece of conventional wisdom that has often been drowned out by the relentless drumbeat of media advertising.

Ralph W. Moss, Ph.D.
www.CancerDecisions.com

References:

• Bengtsson C. Aspects of hormone replacement therapy in the post-menopause. Maturitas. 1989 Mar;11(1):35-41. Review.

• Hunt K, Vessey M, McPherson K, Coleman M. Long-term surveillance of mortality and cancer incidence in women receiving hormone replacement therapy. Br J Obstet Gynaecol. 1987 Jul;94(7):620-35.

• Key TJ, Pike MC. The role of oestrogens and progestagens in the epidemiology and prevention of breast cancer. Eur J Cancer Clin Oncol. 1988 Jan;24(1):29-43. Review.

• Collapse of HRT market: http://www.pharmafocus.com/cda/focusH/1,2109,22-0-0-NOV_2003-focus_feature_detail-0-77317,00.html

• Size of drug market: http://www.wired.com/news/technology/1,70508-0.html

• Spending on Prilosec available from: http://www.cbsnews.com/stories/2002/02/13/health/main329293.shtml