Breast cancer
Death by hormones
It's been more than 50 years since studies first sounded the alarm about hormone replacement therapy. Women, silenced by shame, have been guinea pigs of the pharmaceutical industry for too long.
This week’s headlines announcing the abrupt termination of part of the Women’s Health Initiative — the definitive long-term study of 16,000 postmenopausal women to investigate the benefits and risks of hormone replacement therapy (HRT) — caught many medical practitioners and their patients by surprise. The portion of the study involving women taking a combination of estrogen and progesterone was halted suddenly due to substantially increased risks for an aggressive form of breast cancer, as well as notably increased odds for heart attack, stroke and blood clots in women participating in HRT as “treatment” for menopause.
For researchers who have long maintained a healthy skepticism about hormone replacement therapy, the sudden halt of part of the study was not a surprise, but rather a relief after a recent string of bad news about the medicinal use of hormones. It started last July when the Annals of Internal Medicine reported the results of two studies contradicting the long-held belief that hormone replacement therapy protected postmenopausal women’s hearts. One review concluded that for women with heart disease, hormones actually increased the risk of heart attacks and death by 25 percent. A second study echoed those results, finding that women who started HRT after having a heart attack were 44 percent more likely to have another heart attack or die within a year when compared to those who never used hormones. (The one major study that ever showed estrogen could reduce heart attacks had been based on men.)
In February, the Journal of the American Medical Association (JAMA) printed the results of an extensive study showing that women who took hormone therapy for five years or more after menopause had a 60 to 85 percent increased risk of breast cancer, especially a type known as lobular tumors, which account for up to 10 percent of all breast cancers. The findings applied equally to women taking estrogen alone, or in combination with another hormone, progesterone, which had long been touted by HRT proponents as the safety additive to the hormone cocktail.
In that same issue, JAMA reported that HRT, long touted for improving the mental outlook for postmenopausal women, does not often help, and may in fact physically harm them. The study covered more than 2,700 women, whose average age was 67. The results, concluded Dr. Kathryn M. Rexrode, a Harvard Medical School instructor and coauthor of the study, “should challenge the widely held belief that hormone therapy helps women remain more youthful, active or vibrant.” Rexrode went on to say that “the overall data over the last few years suggest that fewer women than we thought are benefiting from hormone replacement therapy,” and concluded that “there is very much we don’t know about HRT.”
The bad news for HRT proponents continued into April. Conventional wisdom had long held that hormone therapy protected women against ovarian cancer. However, a Swedish study refuted that by showing some forms of hormone replacement might actually increase a woman’s risk of this deadly disease. The Journal of the National Cancer Institute reported that two forms of hormone replacement therapy — estrogen alone and estrogen with limited use of progestins, the synthetic form of progesterone — may increase the risk of epithelial ovarian cancer, a form of the disease involving cells covering the outer surface of the ovaries. In women who still had their uterus and used estrogen alone for 10 years, there was a 43 percent increased risk of ovarian cancer compared to women who never used estrogen therapy.
The Swedish researchers also found that women who had used estrogen combined with sequential progestin were up to 54 percent more likely to develop epithelial ovarian cancer than those women who never used this therapy. This study reinforced one published in 2001 in JAMA that found that women who used estrogen therapy for more than 10 years had double the risk of ovarian cancer.
In May, British researchers who had followed 13,000 women for three years reported that those who took HRT were three to four times more likely to develop debilitating gallstones. This confirmed similar findings in the Nurses’ Health Study, a large study underway in the United States.
These are devastating findings for my generation — baby boomers — who have been repeatedly assured that hormone replacement therapy not only offers freedom from the uncomfortable physical symptoms of menopause, but also improves heart health and bone strength, all with virtually no extra cancer risk. It turns out to be a lie — a 50-year-old lie.
Major pharmaceutical companies have been using women — duping women — since the 1950s when a few doctors started classifying menopause as “estrogen deficiency disease,” as if this natural passage was an affliction that needed medication for treatment. Doctors “treated” us with tranquilizers and antidepressants. By the 1960s, with an onslaught of advertising money from Wyeth, the manufacturer of the top-selling estrogen product, hormones became the “cure” of choice for menopause.
It wasn’t until the 1970s that doctors discovered a problem: Estrogen greatly increased the risks of uterine cancer. Hardly discouraged, the pharmaceutical companies went back to the lab and developed a mixture of estrogen and progesterone designed to block the uterine cancer risk. A relentless bid to expand the market accompanied the new menopause “cure.” After initially claiming that hormones only assisted with the symptoms of menopause such as hot flashes, the drug companies steadily added to the list of things it was supposed to help, from bone density, to heart health, to sexual vigor, to enhanced memory, to curing depression.
Every time a study has been released that has challenged the safety of hormone replacement therapy, the pharmaceutical companies have gone into high gear to minimize the results and find new reasons for women to continue swallowing the drugs. They have scared women into thinking they will fall apart when they reach menopause — even worse, cease to be attractive — if they don’t start taking hormones. If history is any guide, researchers at Wyeth are trying even now to package a new combination of hormones to replace the tainted brew.
The payback for the last 30 years of false advertising is this week’s news that millions of women have put themselves at increased risk for life-threatening illnesses because pharmaceutical companies and obliging doctors have marketed eternal youth in a dangerous hormonal cocktail disguised as a wonder drug.
Will women, embarrassed by aging and the intimacy of this discussion, continue to be silent? Are we resigned to playing the role of guinea pig for large pharmaceutical companies scrambling to develop profitable treatments? The answer is yes to both questions if we continue to approach menopause as the end of our reproductive ability and sexual attractiveness. We have become convinced that, instead of a new start, menopause signals the end of a vibrant phase of life — and drug companies have long profited from our insecurities about this natural change. They have capitalized on women’s fear, and in the process put millions of us at greater risk of serious disease. Now it is our turn to capitalize on the duplicity of drug companies to put them at risk of serious regulation.
Trisha Posner is a writer who specializes in women's health. Her first book was "This is Not Your Mother's Menopause;" her next is "No Hormones, No Fear," to be published by by Villard this November. More Trisha Posner.
Komen scandal: Goodbye, Karen Handel
One week after the foundation's blunder, its scandal-plagued V.P. steps down
Karen Handel (Credit: AP/John Bazemore) It was perhaps inevitable. But it speaks volumes nonetheless. On Tuesday morning, the Susan G. Komen Foundation announced that its vice president for public policy, Karen Handel, was resigning.
It was the latest very public – and very bitter – turn in a story that has thrown the traditionally esteemed Komen foundation for one hell of a loop. Just one week ago, Planned Parenthood announced that Komen was halting its funding for the organization’s breast cancer screenings. The move, the Komen foundation insisted, was about “the charity’s newly adopted criteria barring grants to organizations that are under investigation by local, state or federal authorities” – itself a dubious smear on a respected women’s health organization. But it didn’t take long for critics to note that Handel, who was hired just last year, had run for governor of Georgia on a platform of conspicuously anti-Planned Parenthood rhetoric. In 2010, she declared “I do not support the mission of Planned Parenthood,” and that she “strongly supports” laws prohibiting “the use of taxpayer funds for abortions or abortion-related services.” A lady like that in the driver’s seat of your organization just as you’re distancing yourself from Planned Parenthood looks like a whole more than a coincidence.
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Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
Susan G. Komen’s priceless gift
A radical decision woke the country up to an alarming rightward drift, and gave new life to women’s health advocacy
Members of Planned Parenthood, NARAL Pro-Choice America and more than 20 other organizations hold a "Stand Up for Women's Health" rally in Washington (Credit: Joshua Roberts / Reuters) The startling intensity that we saw this week in response to Susan G. Komen for the Cure’s decision to pull its grants from Planned Parenthood — an intensity that prompted the Komen foundation to reverse its decision today — may be the best thing that’s happened to the conversation about reproductive rights in this country for decades. It certainly should be.
Practically since Roe v. Wade was decided in 1973, reproductive rights activists have been left to play stilted defense against ideological opponents who grabbed the language of morality, life, love and family as their own, always deploying it with reference to the fetus. The rhetoric around reproductive rights, which has more recently begun to creep into arguments over contraception, has become suffocating in its emotional self-righteousness, but too muscular, too ubiquitous to effectively combat.
Continue Reading CloseRebecca Traister writes for Salon. She is the author of "Big Girls Don't Cry: The Election that Changed Everything for American Women" (Free Press). Follow @rtraister on Twitter. More Rebecca Traister.
Joan Walsh is Salon's editor at large. More Joan Walsh.
Komen victim of “bullying,” sad abortion foe says
Someone make an "It Gets Better" video for poor Kathryn Jean Lopez of the National Review
A very serious anti-bullying message from Kathryn Jean Lopez Poor Kathryn Jean Lopez, the National Review Online’s resident delicate flower, anti-feminist traditional Catholic, and enemy of all homosexualists and abortionists. She was so delighted when Susan G. Komen for the Cure announced that it would no longer be sending grant money to Planned Parenthood to fund breast cancer screenings and mammogram referrals, because it meant that her side had “won” a battle in the war against women’s health providers that perform abortions and provide contraception.
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Alex Pareene writes about politics for Salon and is the author of "The Rude Guide to Mitt." Email him at apareene@salon.com and follow him on Twitter @pareene More Alex Pareene.
How the Internet changed Komen’s mind
The torrent of reactions to the cancer group's Planned Parenthood defunding proves the power of social media VIDEO
Nancy Brinker, founding chair of Susan G. Komen for the Cure (Credit: AP/Salon) It started with a tweet. And in the end, that’s what won the war. On Tuesday, Planned Parenthood sent out a no-punches-pulling alert that “Susan G. Komen caves under anti-choice pressure, ends funding for breast cancer screenings at PP health centers.” By Friday, Komen for the Cure had said it was sorry, and reversed its decision.
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Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
Komen for the Cure sells out women, again
The pink-ribbon charity, with a Sarah Palin ally as senior policy director, turns its back on Planned Parenthood
Karen Handel and Sarah Palin in August, 2010. (Credit: AP/John Bazemore) First, the good: Since its founding 30 years ago, Susan G. Komen for the Cure has put over a billion dollars toward research, screening and awareness in the name of eradicating breast cancer. It’s certainly no coincidence that in that same span of time, breast cancer rates have declined sharply, and what was once a devastating diagnosis is now, for many, a treatable condition.
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Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
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