Estrogen and Cancer

Menopause is a difficult time of life for many women. Brought on, usually between the ages of 40 and 50, primarily by a decrease in the production of estrogen, a hormone, it is accompanied by irritability, hot flashes, depression, marked physical changes, and the cessation of menstruation. Thus, since the 1950s, when doctors began to prescribe doses of estrogen that alleviated the effects of menopause, the treatment has become increasingly popular with millions of women. Between 1963 and 1973, for example, the dollar value of estrogen prescriptions increased nearly four times. But suspicion has been growing recently that estrogen treatment poses a significant risk for menopausal women; they apparently are more likely to develop cancer of the lining of the uterus.

Monthly Cycles. The probability of a causal relationship between estrogen and uterine cancer was strengthened last week by two reports in the New England Journal of Medicine. The first, a statistical study prepared by a team led by Dr. Noel Weiss of the University of Washington in Seattle, stated that between 1969 and 1973 the incidence of cancer of the uterus had generally increased from about 20% to 60%, depending on the geographical area surveyed, among middle-aged women. The magnitude of that increase, concluded the study, "has rarely been paralleled in the history of cancer reporting in this country." Added Weiss: "The important point is that it is unlikely that the disease is due to some characteristic of the women rather than the medicine they are taking."

The second study, conducted by Dr. Thomas Mack of the University of Southern California among women at a retirement community near Los Angeles, found that no drug other than estrogen was significantly associated with the disease. Mack also found that the chance of getting uterine cancer is about eight times as great among women who take estrogen during menopause, but he found that the risk was less if they used the drug in monthly cycles including four or more days without any dosage. In any event, he advised that when estrogens are prescribed, "they should be given at the lowest effective dose for the shortest possible time."

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