Re: "Breast Cancer News Brings a Range of Reactions" December 18, 2006
Gina Kolata’s article on breast cancer on December 18th ignores some important facts. Although recent epidemiologic data shows a 7% decrease in new cases of breast cancer, the Women’s Health Initiative -- to date is the only randomized, controlled study of hormone therapy – predicted only 0.0008 new cases of breast cancer per year in patients on combination hormone therapy and no increase in patients on estrogen alone. This discrepancy highlights the dangers of relying on preliminary and epidemiologic data. For example, to date only 9 of 17 centers were examined, and other factors – including the difficulty in obtaining mammograms due to low reimbursement rates and high malpractice costs – may be very important. If the fall in breast cancer rates is real, it is important to find out why. In addition, the comparison of breast to endometrial cancer is inappropriate because the pathophysiology of these two diseases is entirely different with endometrial cancer showing a 20% increase over a year on estrogen and rapid disappearance with the addition of a progestin. Quality of life issues are important– telling patients to simply “open a window” does not go over well.
Michelle P Warren, M.D.
Medical Director, Center for Menopause Hormonal Disorders and Women’s Health
Columbia University Medical Center