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Cancer linked to hormone therapy on rise
65% jump from 1987-99, study finds
Ulysses Torassa, Chronicle Health Writer
Wednesday, March 19, 2003
©2003 San Francisco Chronicle | Feedback
URL: http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2003/03/19/MN69158.DTL
A type of breast cancer associated with the use of combination hormone
replacement therapy appears to be on the rise and may account for some
or all of the increasing incidence of the disease nationwide, a new study
suggests.
Invasive lobular breast cancer, which begins in the chambers that house
milk- producing cells, increased 65 percent from 1987 to 1999, the study
says. In contrast, the incidence of invasive ductal breast cancer, the most
common type, remained largely unchanged, according to the study being
published in today's Journal of the American Medical Association.
In a sample drawn from nine U.S. cancer registries -- including the one
covering the Bay Area -- researchers found that lobular breast cancer
accounted for 16.5 percent of all breast cancer cases in 1999, up from 9.5
percent in 1987. The incidence of breast cancer in general rose 4 percent
during the same period.
"The implication of this study is that we should be paying a lot more
attention to lobular carcinoma because it may provide really important
clues," said Dr. Marion Kavanaugh-Lynch, director of the California Breast
Cancer Research Program. "Clearly, something is changing here and when
something is changing, it gives you an opportunity to look at causes and
mechanisms."
Earlier research found a twofold to fourfold increase in the risk of lobular
cancer for women taking hormone therapy formulations containing
progesterone, said Dr. Christopher Li of the Fred Hutchinson Cancer
Research Center in Seattle and lead author of the study.
The registry information used in the research did not specifically track
hormone use. However, sales of hormone skyrocketed in the 1990s.
They've reportedly fallen off sharply since last summer's release of a large
study that found women on the pills were more likely to suffer heart
attacks, strokes and breast cancer.
Li said lobular breast cancers are harder to detect because they tend to
grow in a more diffuse pattern, as sheets or strands of cells. Ductal
cancers, which grow in the milk ducts, are easier to pick up on
mammograms and in physical exams because they usually grow as a solid
mass or lump.
At the same time, lobular breast cancers are more likely to respond to
newer drugs called selective estrogen receptor modulators (SERMs), giving
doctors additional tools to combat them.
The study used data from nearly 200,000 women with breast cancer in nine
cancer registries nationwide. One of them includes data from San
Francisco, San Mateo, Alameda, Contra Costa and Marin counties. The Bay
Area -- and Marin in particular -- has higher-than-average rates of breast
cancer.
The numbers reported in the larger study matches trends that are seen in
the Bay Area, where about 20 percent of the breast cancers are lobular,
said Tina Clarke, research scientist at the Northern California Cancer
Center, who studies cancer rates in the region.
"When you see a rapid increase in one type of cancer, that always makes
you wonder, especially one that is linked to hormone replacement
therapy," she said. "This is something we're really trying to look at closely
in the Bay Area."
The only area studied that did not see a significant increase in lobular
breast cancer was Hawaii, Li said.
Some have postulated that toxic chemicals may be fueling the increasing
breast cancer rates, but Li said that hypotheses doesn't fit well with his
results.
"The fact that we observe these trends in 8 out of 9 geographic areas of
our survey suggests that environmental factors might not be as important"
as demographic and lifestyle factors, such as hormone replacement
therapy use, childbearing patterns and alcohol consumption, he said.
E-mail Ulysses Torassa at [EMAIL PROTECTED]
©2003 San Francisco Chronicle | Feedback
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