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http://www.nytimes.com/2002/07/17/health/17HORM.html

Study Shows Estrogen Therapy to Raise Risk of Ovarian Cancer

By REUTERS

HICAGO, July 16 — In another piece of the increasingly complex hormone-replacement health puzzle, researchers said today that one study had found that women treated only with estrogen after menopause ran a higher risk of ovarian cancer than women not taking any form of hormone replacement.

James Lacey of the National Cancer Institute, lead author of the estrogen study, published in this week's Journal of the American Medical Association, said there was not enough evidence to say whether there was also an ovarian cancer risk from estrogen taken in combination with progestin.

The Women's Health Initiative is continuing to study the use of estrogen supplements alone in women who have had hysterectomies. That trial, which is a large, randomly controlled clinical study, is expected to go on until 2005 and so far has found no evidence that estrogen alone is causing an increased risk of breast cancer.

In an editorial in the journal commenting on the ovarian cancer study, Kenneth Noller of Tufts University and the New England Medical Center in Boston said the latest research as well as two recent studies, including one from Sweden, indicated that a causal connection could exist between estrogen therapy and ovarian cancer.

"While the data from these observational studies do not establish causality, the association between estrogen use and ovarian cancer should be worrisome enough for clinicians to consider carefully whether to suggest estrogen-only" hormone replacement therapy, Dr. Noller said.

Generally, evidence from observational studies is not considered as strong as that from randomly controlled studies.

The latest report followed two recently released studies that found that estrogen in combination with progestin did not generally protect against heart disease and might increase the risk of breast cancer, stroke and blood clots.

Hormone replacement therapy of both types is used by an estimated 13.5 million women in the United States; nearly 8 million of those take just estrogen, and up to 6 million take estrogen in combination with progestin.

The therapy is prescribed to treat menopausal symptoms like hot flashes and vaginal dryness and to protect against bone loss.

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