Research-What’s a woman to think?

The recent publication of a study suggesting that mammography is over detecting breast cancer is very confusing to women. The conclusion from the study is that small, localized breast cancers probably never spread, and should not be treated. Unfortunately, we do not have the tools to reliably determine which breast cancers are well behaved and which will become aggressive. It would be inappropriate to generalize from this study and to recommend less frequent mammography. Again, we do not have the knowledge to make a clear recommendation. The Preventive Services Task Force issued a controversial recommendation that mammography should start at 50 and be every two years. That model saves money and procedures, but accepts that some women will be diagnosed later and possibly have a less favorable outcome. That works on paper, but it doesn’t work if you happen to be that one women who was missed in the two year screening cycle. Overall, we just do not have the information we need to make the best choice. This is a decision that is, again, best made between a woman and her doctor.

There is some good news! The KEEPS trial results were announced at the North American Menopause Meeting in October. This study clears much of the confusion surrounding hormone replacement in the menopause. This was a double-blind, placebo controlled study of 700 women ages 41-59, who were healthy and within three years of menopause They were given low dose Premarin orally, or a moderate dose estradiol patch, or a placebo. Women with a uterus were given additional natural progesterone. This trial differs from previous trials in using lower doses and natural, rather than synthetic, progesterone. The hormone therapy group had a reduction in hot flashes and night sweats and an increase in bone density. The group on the patch also had an increase in sexual interest and desire. Measures of cardiovascular risk showed either no change or a modest reduction in risk. There was no increase in breast or endometrial cancer, heart attack, stroke, or deep venous thrombosis. The cognitive studies showed a decrease in depression, anxiety and anger in women on Premarin. This group also has an improvement in recall. The estradiol patch did not have a significant effect on memory.

In summary, this well designed study supports the evolving understanding that hormone replacement works best of given within 3-5 years of menopause. It also adds weight to the preference for natural progesterone rather than a synthetic. Benefit on cardiovascular risk and cognitive parameters are demonstrated with no measurable classic risks, such as breast cancer, after 4 years of observation This study should reassure women who opt for HRT during the menopausal transition.

When faced with conflicting research studies, women should do as much homework as possible and then discuss their thoughts with their doctor. Since not every doctor can follow all the research, you may need to consider consultation with a specialist. This may be money well spent if it leads to a better health outcome. We live in a complex and rapidly evolving world. It is an exciting time to be alive, but for now, we will need to accept a certain degree of uncertainty.