by Carolyn Weichers

I was diagnosed with breast cancer in September of 1995. I had had several bouts with lumps and even a biopsy in previous years, but it was a shock to me and my family when I had a lump that was malignant. I can remember the hopeless feelings I had and the scary questions I wanted answered; but I wasn’t sure I really wanted to know the answers. My husband and I felt the need to move quickly and to get every bit of information we could and to get it right now. It was not something we wanted to be patient about.

We did get answers and we found everyone to be helpful but found that we had to work through things in our own way. I underwent chemotherapy and radiation treatments for the rest of that year. It was an experience that has ultimately changed my life. There are many events that have brought me to the peace that I have now, living with the threat of breast cancer. I have, through many different channels, met other women that are brave and strong just as I feel I am. Together we have tried to do something to educate women in our world about breast cancer.

I became one of the original members of Iowa Breast Edu-Action and we took on the huge project of writing an Iowa Breast Cancer Resource Guide. It was a tremendous amount of work but what a worthwhile project. Finally, I felt that my having experienced breast cancer would actually make a difference to others! It was very important to me to get information out to women right at the beginning of their diagnosis.

I felt strongly that that is the time they need the most support and this Resource Guide will do that! The other avenue that introduced me to breast cancer women, was my volunteering for the Reach to Recovery Program of the American Cancer Society. I know there is a close community of breast cancer survivors.

We are a strong and vital group of women. We are braver than we ever thought we could possibly be. This sisterhood and closeness begins when we first hear the diagnosis of breast cancer. From then on we need to be with others who have had similar experiences.

We need to ask and answer questions and communicate hope and strength to each other. I have found this sisterhood to be a healing touch for me and I want to share it with others. Therefore I am a strong advocate of the Reach to Recovery Program and take part in the visits very often.

Breast Cancer survivors are awesome women. They are strong and have a huge voice when they work to help each other. Get involved in some aspect of this great sisterhood and you will be the one to be rewarded!

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by Dr. Sue Joslyn

In the 1990s, Hormone Replacement Therapy (HRT) medications were among the most frequently prescribed medications in the United States. Almost 35% of postmenopausal women were taking HRT. Based on results of research available at the time, HRT was expected to lower a woman’s risk of heart disease and osteoporosis, along with easing symptoms of menopause including hot flashes, night sweats, and vaginal dryness. Imagine the shock to millions of women when, in 2002, a large multi-center randomized clinical trial known as the Women’s Health Initiative (WHI) revealed that HRT use was associated with increased risk of heart disease, breast cancer, stroke, and pulmonary embolism. The news headlines caused panic, and subsequent reports did little to calm the panic or explain the study results. However, research evidence is far from black and white, and hopefully this brief review will help explain results of the WHI clinical trials of HRT.

The WHI was the first large (16,608 women), well done experimental study on the effects of HRT on long term health benefits and risks, including risk of invasive breast cancer. In high quality clinical trial experiments funded by the federal government, researchers are required to set criteria for monitoring unexpected disease. The study is then observed by reviewers not associated with the study, and if cases of disease exceed the set number, reviewers can call for an end to the study for safety and ethical reasons. That is what happened in the WHI study, which was supposed to continue through 2005, but was stopped in 2002 based on health risks that exceeded health benefits.

Results of the study were presented in terms of “person years” which is one way to describe the risk of disease for a group based on available information. For every 1000 women taking HRT and followed for 10 years (10,000 person years), women experienced 7 more cases of coronary heart disease, 8 more strokes, 8 more pulmonary embolisms, and 8 more invasive breast cancers than the comparable group of women who were not taking HRT. The study also showed that the HRT group experienced 6 fewer colorectal cancers and 5 fewer hip fractures.

A second report from the WHI that looked specifically at breast cancer reported 199 cases of invasive breast cancer among women taking HRT compared to 150 cases among women not taking HRT. Tumors diagnosed in the HRT group were larger and were more likely to have spread compared to tumors diagnosed in women not taking HRT. These results suggested that HRT stimulates breast cancer growth and makes diagnosis more difficult.

A third WHI study looked at the effects of estrogen alone (ERT, not combined with progesterone) in postmenopausal women with hysterectomies. ERT is not given to women who still have their uterus, because it has been shown to increase risk of uterine cancer. The study found that the use of ERT increased the risk for stroke, decreased the risk of hip fracture, does not affect the risk of coronary heart disease, and possibly lowered the risk of breast cancer. 

Based on these WHI studies, as well as many other studies, the prolonged use of HRT/ERT for chronic disease prevention is not recommended. Short term use of lower dose HRT may be appropriate for management of menopause symptoms, but each woman needs to discuss her individual risk profile with her physician.

And if you are a woman who took HRT for many years, don’t panic. Researchers still do not know what causes breast cancer – most women who took HRT did not develop breast cancer, and women not taking HRT developed breast cancer. All that is known is that HRT increases risk of breast cancer in large populations of women. It may be that HRT works with some other factor in promoting the growth of breast cancer.

Because the specific cause of breast cancer is not known, the importance of early detection can not be stressed enough. The American Cancer Society, along with most other medical groups, recommends regular mammography (once each year beginning at age 40 years) for women at average risk, along with an annual clinical breast exam by a physician and monthly self breast exams. If a woman’s doctor believes the woman is at high risk for developing breast cancer based on family history, reproductive history or lifestyle factors, she may begin regular mammography at an earlier age, and/or have additional screening with ultrasound or MRI.  


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