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Latest HT findings: How they affect you
What’s the bottom line?

STAR search
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STAR, an acronym for the Study of Tamoxifen and Raloxifene, completed five years of trials at more than 500 medical centers in the U.S. and Puerto Rico. Some 19,000 postmenopausal women were involved.

Tamoxifen had been used for two decades to fight breast cancer. Raloxifene had been used to fight osteoporosis. They are both classified as SERMs—short for selective estrogen receptor modulators. Researchers believe the drugs compete with natural estrogen in the breast by stealing cellular “seats” that otherwise would have gone to estrogen—a known risk factor for breast cancer.

The STAR trials confirmed that raloxifene and tamoxifen are equally effective at preventing invasive breast cancer, reducing the risk by 50 percent in women at high risk.

One difference was found: Women who took raloxifene had fewer uterine cancers and blood clots than those who took tamoxifen. Neither drug helps with hot flashes during menopause, however.

More good news: Both drugs improve bone density in postmenopausal women, and there are hints they confer cardiovascular benefits, too, although this link is not well established.

A swarm of recent findings about menopausal hormone therapy (HT) has provided both new insights and contradictory information on its medical value. But has anything been resolved one way or the other?

Well…yes and no. The Women’s Health Initiative, after little more than five years, abruptly halted its study of postmenopausal women taking a combination of estrogen and progesterone, noting that the risks of taking these hormones outweighed any benefits. Among its findings:

  • The risk of developing breast cancer was higher in women taking estrogen plus progestin.
  • The risk of suffering heart attacks, strokes, or blood clots in the lungs and legs was higher in women taking estrogen plus progestin.
  • The risk of hip and other fractures or colorectal cancer was lower in women taking estrogen plus progestin.
  • There were no differences in the risk of endometrial cancer (cancer of the lining of the uterus) or in the number of deaths between the group of women taking estrogen plus progestin and those who did not take hormones.

HT may protect against colon cancer. And it is possible that HT fights Alzheimer’s disease and even halts cataracts. However, the American Heart Association no longer recommends HT for heart protection alone. That’s because studies show HT won’t prevent a second heart attack in women who already have cardiovascular disease, or CVD. And even for women who don’t have CVD, HT may pose a risk.

Moreover, HT increases the risk of blood clots in the chest and legs, which could cause stroke. Used alone, estrogen raises endometrial cancer risk, and HT may increase a woman’s risk for breast cancer. With all these concerns, it’s little wonder that many women have quit using HT, health experts say.

What’s the bottom line?

As further results come in, a better medical understanding of HT will emerge. Until researchers clear up the HT issue one way or the other, use these guidelines in collaboration with your doctor’s advice to decide if it’s right for you:

  • Don’t overreact. Some physicians still suggest that HT’s ability to help prevent osteoporosis and treat symptoms of menopause may outweigh cancer risks for some women.
  • Proceed carefully. If used for more than five years, HT may cause a small increase in risk for breast, endometrial, and ovarian cancers. Just how much of an increase—and what happens past five years—are issues that scientists want to clarify.
  • Consider alternatives. Instead of HT, many women opt for increased calcium and a nonhormonal drug that fights osteoporosis, like Fosamax, Actonel or Boniva. Tamoxifen and raloxifene can also preserve bone density. For heart health, your doctor may prescribe cholesterol-lowering medications and aspirin to provide cardiac protection without cancer worries.
  • Think. HT remains a highly personal issue that only you and your doctor can decide. Your medical history, risk factors and lifestyle choices must be weighed. HT has helped thousands of women feel better, but only you and your doctor can decide if it will help you, too.