Artificial Ovaries Could Potentially Deliver Hormone Therapy

Title: Artificial Ovaries Could Potentially Deliver Hormone Therapy
Category: Health News
Created: 3/29/2013 4:35:00 PM
Last Editorial Review: 4/1/2013 12:00:00 AM

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More Evidence Shows Hormone Therapy May Increase Breast Cancer Risk

In new analysis, researchers found risk highest when used just before menopause

By Kathleen Doheny

HealthDay Reporter

FRIDAY, March 29 (HealthDay News) -- Women who take hormone therapy that includes estrogen and progestin are at increased risk of developing breast cancer and dying from it, especially if they start taking the therapy just as menopause begins, a new analysis confirms.

Researchers followed nearly 42,000 women, all of whom were past menopause, for an average of more than 11 years. Of those, more than 25,000 did not use hormone therapy and more than 16,000 took estrogen and progestin, also called combined hormone therapy. For this analysis, the researchers did not include estrogen-only therapy, used by women who have had a hysterectomy.

At the end of the follow-up period, more than 2,200 of the women were found to have breast cancer. Compared to non-users, those who took combined therapy were more likely to have breast cancer, said Dr. Rowan Chlebowski, a medical oncologist at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center. Chlebowski led the study, which was published in the March 29 issue of the Journal of the National Cancer Institute.

The link has been found in other studies, but Chlebowski also found the risk was greatest among those who took the hormones closest to menopause. "Women starting within months of menopause had about a threefold greater risk than women starting 10 years after menopause," Chlebowski said.

For the new analysis, Chlebowksi looked at results from the Women's Health Initiative observational study. He compared the findings with those from the Women's Health Initiative randomized clinical trial, in which women were assigned to different treatments.

The Women's Health Initiative included four clinical trials and an observational study. Women were all past menopause and were aged 50 to 79.

Chlebowski said he did the new analysis to resolve what he saw as unanswered questions. In the trial, only about one-third, or 5,000, of the women were in their 50s when they started the study. As that is the typical age for menopause to start, about two-thirds of the women in the trial were in their 60s or beyond, so began to take hormones several years after menopause.

Chlebowski set out to see if the link between breast cancer risk and combined hormone therapy use was influenced by earlier use of hormones.

"We had a substantial number closer to menopause than the clinical trial of [the Women's Health Initiative]," he said.

He found, however, that not only was the risk of breast cancer still increased, but it also increased even more if the women were closer to menopause when they began to take the hormones.

He speculated that women who start the hormone therapy close to menopause still have circulating levels of estrogen high enough to make them exceed some threshold, beyond which it may become hazardous.

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Should Short Boys Take Growth Hormone?

If they're healthy, probably not, experts say

By Amy Norton

HealthDay Reporter

WEDNESDAY, March 27 (HealthDay News) -- Parents often worry when their child, especially a son, is much shorter than average. But as long as there is no medical cause, parents can rest easy, experts say.

Writing in the March 28 New England Journal of Medicine, two pediatric endocrinologists describe a scenario pediatricians see all the time: Parents bring in their 11-year-old son because he's substantially shorter than his classmates, and his growth seems to have slowed in recent years.

Their concern is reasonable, said Dr. David Allen, co-author of the article and a professor of pediatrics at the University of Wisconsin School of Medicine and Public Health in Madison.

In the vignette, Allen and Dr. Leona Cuttler describe a boy whose height was in the third percentile at age 9 years. (That means he was shorter than 97 percent of boys his age.) But his growth rate slowed further, so that he is now in the first percentile for height.

"When a child falls off the growth curve like that, it's appropriate for parents to be concerned and have him evaluated," Allen said.

The potential medical causes include growth hormone deficiency, certain genetic disorders or an underactive thyroid gland. Fortunately, though, most short kids are healthy.

The "conundrum," Allen said, is that parents are often still worried, especially when that child is a boy. And, in the United States, human growth hormone is approved to treat so-called idiopathic short stature -- that is, short stature with no known medical cause -- when a child is below the first percentile for height.

So parents may want costly treatment even if their child has a clean bill of health.

Dr. Patricia Vuguin, a pediatric endocrinologist at Cohen Children's Medical Center in New Hyde Park, N.Y., said some doctors will recommend doing nothing. And, "some will say, let's try growth hormone," she said.

But both Vuguin and Allen said it's important for parents to have realistic expectations of growth hormone. For short, healthy children, studies predict that growth hormone will deliver an extra 1 to 3 inches as an adult. And that's the average; other factors come into play.

If both parents are short, that limits what growth hormone therapy can do. "We can't modify your genetic potential," Vuguin said.

The fictional family in Allen's report fit that scenario. The mother was 5 feet tall, while the dad stood at 5 feet 6 inches. Their son's predicted height, with no intervention, was 5 feet 5 inches -- the lower end of "normal."

"You have to think, how important is an inch or two of extra height in the big picture?" Vuguin said. "Is the difference between 5 feet 5 inches and 5 feet 6 inches that important?"

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