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Dr. Gupta on breast cancer decline: Hormone replacement therapy is key

(CNN)
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ATLANTA, Georgia -- The number of new breast cancer cases dropped by 7 percent in 2003, according to research presented at a breast cancer conference in San Antonio, Texas, on Thursday. But some cancer experts wonder whether the decline will last. CNN's Soledad O'Brien discussed the new findings with Chief Medical Correspondent Dr. Sanjay Gupta.

SOLEDAD O'BRIEN: That's a significant -- I mean, that's a huge drop by anybody's count. Why?

DR. SANJAY GUPTA : Well, it is a huge drop. We think it's mainly due to the decrease in hormone replacement therapy. And this is big news.

Between 1975 and 2000, you almost steadily had an increase in breast cancer cases. And then as you pointed out, Soledad, you had this significant drop off in 2003, a couple of years after there was a decrease in women taking hormone replacement therapy. So, 14 to 15 percent for some of the most common types of breast cancer, those are the estrogen positive breast cancers. And if you look at women who are older, 50 or older, you've got your greatest reductions overall. So some potential good news. But it looks like you can tie it all back to the decrease in hormone replacement therapy. You know, the number of prescriptions cut by almost half within a year of that study coming out, showing the risks of hormone replacement therapy.

O'BRIEN: But that still means millions of women are still taking hormone replacement therapy. What do you think happens now? Do their doctors say, for the rest of you, who are not convinced, this is the clear sign that this should be stopped?

GUPTA: This has been one of the most interesting stories to cover as a reporter. Because this is difficult and what you're asking is a difficult question. I think as a result of the reporting on your show today, there will be a further decrease in the number of women taking hormone replacement therapy.

Because doctors and patients alike will say it does work. You do decrease breast cancer cases by stopping this therapy. But there are lots of women out there for which hormone replacement therapy is still absolutely necessary to relieve some of the awful symptoms they get going through menopause. And this is the only thing that works for them.

And it's a balance, Soledad. One doctor put it to me, I thought, in a pretty good way. Eating a cheeseburger is bad for you, could potentially lead to a lifetime of heart disease. One cheeseburger is probably not going to be bad, sort of the same thing in terms of risks and benefits with hormone replacement therapy. If you have to take it, take the smallest doses for the shortest possible time.

O'BRIEN: Of course, the question, then becomes -- I mean, because it seems like this is a pretty clear indication of a link between hormones and certain types of cancer. So do women who are taking other medicines, that have hormones like birth control pills, or even other ones, saying, wow, I might also have a link because of the birth control pill/cancer -- rather the hormone/cancer link. Does that follow necessarily?

GUPTA: It can follow. There's a lot of discussion about birth control pills specifically. Most researchers will put birth control pills and hormone replacement therapy in different categories, for a couple reasons.

One is the dosing is very different. We know that smaller doses of the hormones, whether they be in birth control pills, or not, tend to be less of a risk as far as breast cancer goes. But also the women who take birth control pills tend to be younger. So, you have a different population of people altogether.

There are reformulations of birth control pills all the time trying to find the smallest does that still possibly works, because of these risks. But, Soledad, what we do know, is while I think it's still too early to say for sure, if you continue to decrease hormone replacement therapy, you're going to stop breast cancers. We do know these hormones fuel breast cancers. So, it can possibly fuel a tumor that is small or cause a tumor to grow in the first place.

O'BRIEN: Got it. Sanjay Gupta, wow, this is a big story. Thanks for talking with us, Sanjay, appreciate it.

GUPTA: It's nice to give good news every now and then, Soledad.

O'BRIEN: I know. Isn't it? And sort of clear. Because it was interesting -- I don't know if we have the time to talk about this -- but for black women, who don't take as much hormone replacement therapy, they actually don't have as many cases of breast cancer. It almost seems, again, to confirm the findings.

GUPTA: That might be a another link that, you know, we had previously unexplored.

O'BRIEN: All right, Sanjay, thanks.


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  • Hormone Therapy
  • SPECIAL REPORT