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HRT vs Hormonal Treatment

Posted Aug 24 2008 1:49pm
DEBU TRIPATHY, MD: Many times there are medical terms that are similar and might be confusing, so one has to be very clear and say upfront exactly what they mean by hormone treatment or hormone replacement therapy.

GENEROSA GRANA, MD: The first time that a patient hears the word "hormonal treatment for breast cancer," they often raise their eyebrow, "But I've heard hormone replacement is not acceptable now that I've gotten the diagnosis." So it can be a teaching process that you need to embark on.

ANNOUNCER: While the phrases sound the same, what they do couldn't be more different.

GENEROSA GRANA, MD: Hormonal treatment for breast cancer is the utilization of a variety of hormonal agents that target the cancer. And this is applicable only to cancers that are estrogen or progesterone receptor positive, meaning their growth is dependent on the estrogen pathway.

DEBU TRIPATHY, MD: So the treatment is actually against estrogen, either removing the estrogen altogether or, in some way, counteracting the effects of estrogen on cells.

Hormone replacement therapy refers to the adding back of estrogen for women who are having side effects of the loss of estrogen that they have during menopause. Symptoms like hot flashes, irritability and things like that are sometimes helped in the short term with replacement therapy, that is, giving estrogen back.

ANNOUNCER: Hormone replacement therapy was once thought of as a popular way to counteract the effects of menopause and prevent certain diseases in older women. But one recent study in particular has changed how we now think of this therapy.

GENEROSA GRANA, MD: The Women's Health Initiative study is a large trial that has been conducted in the United States in postmenopausal women where half of the women received hormone replacement; the other half did not receive hormone replacement.

And it was sobering because it showed that not only are we seeing an increased risk of breast cancer, be it small, but we are also seeing an increased risk of heart disease, an increased risk of clotting resulting in deep vein thrombosis and pulmonary emboli. So these things that were once thought to be preventable with estrogen are now being shown to be exacerbated by estrogen.

ANNOUNCER: Currently hormone replacement therapy is used very carefully and for a limited time.

GENEROSA GRANA, MD: Now gynecologists, primary care providers, internists are really looking carefully at who they give hormone replacement to. They are very willing to use it for the short term in a woman who is having symptoms of menopause that need to be managed. But no longer are they blindly putting all women on just because of its potential preventive benefits.

DEBU TRIPATHY, MD: To use it long term in hopes of lowering the risk of heart disease at the current time is simply not supported by the findings of the recent studies.

ANNOUNCER: While usage of this therapy is decreasing, hormonal treatment of breast cancer seems to have a bright future in many areas. It has worked effectively in early-stage disease.

DEBU TRIPATHY, MD: For people with early-stage breast cancer that are cured with surgery, we know that we can lower the risk of the cancer coming back or the risk of recurrence with the use of hormonal therapy, in some cases.

ANNOUNCER: Hormonal treatment can also be effective if the disease has progressed or spread.

DEBU TRIPATHY, MD: Hormonal treatment is used in metastatic breast cancer as well. It is used in patients whose tumors make either the estrogen or progesterone receptors. These are proteins that indicate that the tumor may be responsive to hormonal therapy.

For patients with advanced breast cancer, when the cancer has already spread, that's not curable. But in some cases, hormonal therapy can keep it in check and sometimes for a very long time.

ANNOUNCER: An exciting aspect of hormonal treatment on the horizon is that its use might even prevent breast cancer in certain situations.

DEBU TRIPATHY, MD: The use of preventive tamoxifen, that is, in someone who does not have cancer and who's never had cancer, is used in women that we consider to be at high risk. And the kinds of things that we use to define it would be women who have had a biopsy that was benign, but showed some changes that we know predispose people and that entity is called hyperplasia. People that have atypical hyperplasia, which is a type of hyperplasia, we feel might benefit from tamoxifen in this setting. Other women might be those that have a family history, that started their periods earlier, those are also slight risk factors.

ANNOUNCER: So what's in a name? In this case, everything. Two similar phrases that need to be thought of in very different ways.

DEBU TRIPATHY, MD: My technique to clarify between hormone treatment and hormone replacement is to really explain the biology to the patients. That some breast cancers respond to lowering the effect of estrogen. So we want to use hormone treatments that in fact accomplish that. For women who are having menopausal symptoms, hormone replacement really is trying to replace the estrogen.

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