"I think the time has come for women to stop making their decisions based upon what they read in the newspaper."

- Dr. Leon Speroff, founder of the Women's Health Research Unit at Oregon Health & Science University, empowher.com, Jan. 17, 2008

If you read the news, you have to wonder why any woman in her right mind is still on hormone replacement therapy.

"Study: Hormone Replacement Therapy Might Shrink Brains," ABC News, Jan. 13, 2009

"Study firmly ties hormone use to breast cancer" - Associated Press, Dec. 14, 2008

And just this week, even more bad news. The latest New England Journal of Medicine reports that postmenopausal women who take combined estrogen and progestin menopausal hormone therapy for at least five years double their risk of breast cancer every year, according to findings by Stanford University researchers.

The study is a follow-up to the landmark Women's Health Initiative Report in 2002, which turned the HRT world on its head. Five years into the massive study, researchers halted one arm of it because they thought it was too dangerous to let the participants continue. They found that the subjects taking HRT had a significantly higher incidence of heart attack, stroke, breast cancer and blood clots than the control group taking the placebos.

The findings flew in the face of assumptions that HRT protected women from heart disease and stroke.

That WHI study is still controversial. Many doctors say it was flawed and misleading. Specifically, they argued that the average age of the subjects - 63 - was too old: At that age, they would be expected to already have the beginnings of heart disease and cancer, and giving them hormones for the first time at 63 would only accelerate their diseases.

Because of the study, hormone use plummeted from 60 million prescriptions in 2001 to 20 million in 2005. And, according to Stanford researchers' latest findings, it was a good thing: "Breast cancer rates also declined significantly within the year, suggesting a strong link between hormone use and cancer risk."

But once again, many doctors question that link, arguing that breast cancer takes years to develop and that a drop in rates wouldn't have shown up that fast.

Speroff, the Oregon doctor, believes that HRT's link to increased risk of breast cancer has been overestimated and that the risk is in fact quite small. He also argues, with ample scientific evidence, that when women on HRT do get breast cancer, they have significantly better survival rates, for a number of reasons.

But at Stanford, one of the lead researchers on the original WHI study believes the new findings are unequivocal.

"There is very strong evidence that estrogen plus progestin causes breast cancer," said Marcia Stefanick, Ph.D, co-author of the new study. Specifically, women who stayed on the therapy for at least five years were found to double their risk of breast cancer every year.

The good news, she said in a statement, is that when they stop the hormones, within a year "their risk is essentially back to normal."

Here's what the American Cancer Society posts on its Web site: "It has become clear that long-term use (several years or more) of combined postmenopausal hormone therapy increases the risk of breast cancer and may increase the chances of dying of breast cancer. The breast cancer may also be found at a more advanced stage, perhaps because PHT seems to reduce the effectiveness of mammograms. Five years after stopping PHT, the breast-cancer risk seems to drop back to normal."

So why do women continue on HRT in light of so much frightening evidence? Because menopause causes such suffering for so many. Hot flashes, night sweats, insomnia, confusion, impaired concentration, depression, forgetfulness and loss of hair and muscle tone can severely affect quality of life.

A daily HRT pill can alleviate those symptoms for many women, and that's why some are willing to risk something as awful as breast cancer.

Speroff's best advice, from an online interview at empowher.com:

"Sometimes women are frightened by the idea of making a long-term decision about hormone therapy. Do not think of it that way. Find a clinician you can talk to. Every year you see that clinician, you make a new decision ... based upon what we have learned that is new that year. So you are never making a long-term decision. You are making repeated short-term decisions based upon the best available evidence."

mwinte@aol.com