Hormone Replacement Therapy And Breast Cancer by Patricia T. Kelly, Ph. D.

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HORMONE REPLACEMENT THERAPY AND BREAST CANCER:

THE RISKS IN PERSPECTIVE

Janet M., a fifties-something woman, entered my office and

said as she sat down, "I've read that if I take hormones I'll

increase my breast cancer risk. I'm going crazy without sleep and

with these mood swings, but I don't want to increase my breast

cancer risk by taking hormones."

Like many women, Janet had heard that a recent study, the

Women's Health Initiative (WHI), definitively showed that hormone

replacement therapy (HRT) increases breast cancer risk. Janet,

like most people, didn't realize that this study found no

statistically significant increase in breast cancer risk to women

who took HRT.

When differences are not significant, an increase in risk

may well be due to other factors, not the one being studied, such

as HRT use. As often happens when a medical story is reported,

the emphasis was on the increase in risk, not whether the

increase was likely to be due to the agent being studied or to

the size of the risk.

The actual size of a risk is important in any woman's

decision making process. In this case the risk was exceedingly

small -- only 8 in 10,000 women a year -- which is 0.08% or eight

hundredths of one percent! Janet was amazed to learn the actual

size of the increase, and said, "You mean I was getting all

concerned for a risk that small!"

"And," I pointed out, "even this very small difference in

risk may not be due to hormone use." I explained that breast

cancers take an average of eight years to reach about half an

inch in size. This means that breast cancers started in the first

year of the study would not be detected for eight or more years.

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BIO:

Dr. Kelly is a medical geneticist who has been a Diplomate of the American Board of Medical Genetics since 1982. In 1993 she became a Founding Fellow of the American College of Medical Genetics. She received her Ph.D. in genetics from the University of California, Berkeley.

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