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  September 30, 2002

Mammography, Hormone Replacement
Require Consultation
By Maureen McGuire

Kristen Zarfos, M.D., a Health Center surgeon and medical director of women's health programs, laments that it's been a tough year for women concerned about breast cancer.

"Last winter, we heard a group of researchers cast doubt on the value of mammography. No sooner were those studies refuted, giving women some peace of mind, when a new controversy erupted over hormone replacement therapy and risks of breast cancer and heart disease," she said.

This October, during Breast Cancer Awareness Month, Zarfos reminds women to listen carefully and proceed with caution when new studies are released about breast cancer risks.

"While it's hard not to get caught up in the frenzy surrounding every new study or article, I encourage women to try to step back and look at all the facts with their physician," she said. "This we know for sure: mammography remains a critical tool in the detection of breast cancer in its earliest stages.

Decisions regarding hormone replacement therapy for post-menopausal women need to be made on a case-by-case, individual basis."

Last winter's buzz over mammography started with published findings by Danish researchers who argued there was no evidence to prove that mammograms reduce cancer deaths.

However, a re-analysis of that research by experts at McGill University in Montreal and Cornell University in Ithaca, N.Y., found major flaws in the original study. At the same time, major health associations, including the National Cancer Institute, stood by the standard recommendations of annual mammograms for all women, starting at age 40.

"Several subsequent studies in 2002 supported the value of mammography, " Zarfos said. "In August, an article in the journal Cancer, reflecting a major study on mammography, showed that mammograms can reduce cancer deaths in women by 40 to 45 percent."

But Zarfos noted that mammography is not perfect. "Many women find it uncomfortable and it has an overall false-negative rate of 7 to 11 percent - meaning that some masses may not be detected because of dense breast tissue or because of the character of the tumor," she said. "Yet, mammograms can find lumps too tiny to feel at early, treatable stages. It is one of three important tools in the detection of breast cancer, complementing monthly self exams and annual breast exams by a medical professional," she said.

In July, women and women's health providers were swamped with negative information about hormone replacement therapy, following findings by the Women's Health Initiative, published in the Journal of the American Medical Association. This report concluded that post-menopausal women taking a daily dose of Premarin and Provera, a combination of estrogen and progesterone, for more than five years, had slight increases in their risk of developing breast cancer and cardiovascular disease.

"It's important to note that this study only looked at women taking a specific combination of hormone replacement, and that the breast cancer risk identified was a 1.4 percent increase. This is not an enormous increase in risk - though it is an increase and deserves consideration," Zarfos said.

"In health care, any decision pits risks against benefits. I encourage women to look at a host of factors before making a decision on hormone replacement therapy. Think about your overall health, family history of disease, life experience, fears and quality of life. Certainly, menopausal symptoms can diminish a woman's quality of life - her sleep, her moods, her well being - and this needs to be a very serious consideration," the physician said.

Zarfos said there is no cookie-cutter formula for the hormone replacement question because physically, every woman is different and every woman's life and the demands in her life are unique. "It is always an individual question women need to decide, with guidance and support from their physicians," she added.

Mammography services are available at the UConn Health Center in Farmington and the UConn Health Partners office on 99 Ash St. in East Hartford. Financial assistance is available for women who are uninsured or underinsured through the Charlotte Johnson Hollfelder Foundation. For more information, call the Health Center at 1-866-4-FEMALE.

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