|To the Editor: Doctor questions cancer advice|
|Written by W.E. Feeman, Jr, MD|
|Wednesday, 16 October 2013 10:05|
I wish to clarify some comments reportedly made by Helen Mabry, MD, at Wood County Hospital. She stated that there were things that women could do to lessen their risk of breast cancer. Truth be told, the medical profession does not know what causes breast cancer. We do know that the cause is something to do with the western lifestyle, since Japanese women living in Japan have a low rate of breast cancer, Japanese women living in Hawaii have an intermediate rate of breast cancer, and Japanese women living in the continental USA have a high rate of breast cancer. It is not tobacco, since most ladies with breast cancer, at least in my practice, do not smoke cigarettes. (The most common cancer in cigarette smoking omen is, of course, lung cancer.) It is not due to eating meat - Linda McCartney died of aggressive breast cancer despite being a vegetarian. A Nobel prize awaits the discoverer of the cause.
I must take issue with Dr. Mabry's comments on Hormone Replacement Therapy (HRT). She makes the common mistake of lumping all forms of HRT into one group and making the statement that long-term HRT should be avoided. There are various forms of HRT, all of which have varying effects on breast cancer. The worst one is continuous-combined HRT, in which the woman takes a combined Premarin and Provera pill daily: the rate of breast cancer goes up on this regimen. Estrogen-only HRT does not do much to affect breast cancer rates, though I remember a study from Scandinavia dealing with higher breast cancer rates in women taking estradiol. Cyclic-sequential HRT, such as I have advocated in this newspaper at various times in the past, is associated with a 50% decrease in breast cancer, both in my own practice and in the study by R. Don Gambrel, MD, which involved 400,000 women. Moreover, whereas most of the women in my practice who developed breast cancer but who did not take cyclic-sequential HRT are dead, whereas most women in my practice who developed breast cancer despite taking it are still alive. The only woman in this last group to die under age 80 years was a woman all of whose female relatives died of breast cancer - and this lady had been off HRT for 1 1/2 years before developing breast cancer.
To the best of my knowledge and experience, cyclic-sequential HRT is not harmful and may be continued for as long as the lady is wiling tolerate menstrual cycles. The price of eternal youth is still the eternal curse.
W.E. Feeman, Jr, MD
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