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Dec. 21--In a play called "Hot Flashes," Barb Ross spoofed the changes women go through in menopause.
Behind the scenes, Ross has been through real-life drama when treating menopause's troublesome symptoms with hormone therapy.
She stopped taking the hormones for about six months after a 2002 report tied the combination of estrogen and progestin to a slightly increased risk of breast cancer, heart disease and other ills.
When her symptoms returned, Ross gave the therapy an encore. She'd probably still be on it if her doctor hadn't ended her run about a year ago. Because she was a smoker, Ross' risk of blood clots outweighed the benefits.
A new study again has women weighing the risks and benefits. Last week, researchers linked a 2003 drop in the most common type of breast cancer to the fact that many women stopped the therapy in 2002.
While the research has prompted some calls, a handful of area doctors and cancer specialists say those who really need the treatment shouldn't make a rash decision and stop hormone therapy. More research, they say, is needed to ensure the link exists.
"They shouldn't feel bad about continuing because the risk of breast cancer is small," said Dr. J. Christopher Gallagher, professor of medicine in Creighton University's School of Medicine.
Women should, however, review the latest information on the therapy and their risks with their doctor each year, said Gallagher, who sat on a panel that wrote the North American Menopause Society's position paper on the therapy in 2004. A new statement is due this week.
Both the scientific organization and the American College of Obstetrics and Gynecology also recommend that women take the lowest possible dose for the shortest possible time. The hormone doses prescribed today typically are much lower that those used before 2002.
Dr. Thomas Martin, an obstetrician and gynecologist with the Methodist Physicians Clinic Women's Center, said he's received several calls asking for his take.
He's not advising women to rush in. Nor does he plan to change his practices based on the report.
"I say, 'Let's re-evaluate when you come in,'" he said. "I want to get more information."
As for risk, women with no family history of breast cancer typically have a 10 percent chance of getting the disease. With hormone therapy, it's 10.5 percent.
"It has helped so many women get through such a rough time," he said of the therapy. "Most of them are willing to take the small amount of risk."
In last week's report, researchers noted that breast cancer rates dropped sharply in 2003, the most recent year for which data were available.
The decline was 7 percent overall, meaning that 14,000 fewer women than expected were diagnosed with the disease. But the biggest drop -- some 12 percent -- came among older women, those most likely to have taken hormones.
The researchers, from the University of Texas M.D. Anderson Cancer Center, the National Cancer Institute and the Harbor UCLA Medical Center, concluded that the reduction in the use of hormone therapy was the best explanation.
But other efforts to reduce breast cancer could play into the drop, said Dr. Stephen Lemon, medical oncologist with Oncology Associates in Omaha.
The key is to watch the number of cases over the next several years. "That will tell us if this is just a fluke or if it's a real change," he said.
On the other hand, the results are encouraging.
"From a patient standpoint and a scientific standpoint, this is really good news," said Lemon, director of the cancer prevention program at Methodist Estabrook Cancer Center.
Ongoing debate, however, revolves around whether the therapy should be used for reasons other than menopause symptoms. Studies have shown it protects against fractures. The therapy was used for years for osteoporosis.
But Dr. Edibaldo Silva, director of the Center for Breast Care at Creighton, said women should take the therapy only to treat menopause. Better drugs are available to improve bone density.
And if they stop hormone therapy, women should continue getting annual mammograms, he said.
In fact, he said, stopping hormone therapy can make mammograms more effective. Women who take the hormones after menopause have denser breasts, making mammograms harder to read.
Anita Whalen was on hormone therapy for 12 years -- she has osteoporosis and saw improved bone density on the hormones -- when she was diagnosed with breast cancer in 1999.
After her diagnosis, she quit. The tumor tested sensitive to hormones. She completed treatment. In May, a routine mammogram found an early cancer. She had surgery again.
"I don't regret having taken it," the 69-year-old Omahan said. "I made the decision I made based on the best information I had at the time."
Ross still misses the therapy. The 59-year-old gets hot flashes that "make me nuts."
She hasn't found helpful homeopathic therapies. And she just heard about another study indicating that black cohosh, a popular herbal treatment, is practically ineffective in treating hot flashes and night sweats.
Sharing such ups and downs with other women, she said, is what made "Hot Flashes" so much fun.
"We've all been there," she said, "and if you can't laugh, you'll cry."
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Copyright (c) 2006, Omaha World-Herald, Neb.
Distributed by McClatchy-Tribune Business News.
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