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Premarin and Breast Cancer
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Premarin and Breast Cancer

I had a total hysterectomy 3 years ago and have been taking Premarin since then.  I also had a baseline mammogram done right before my surgery and everything was fine.  I am now 40 years old and just recently had my second mammogram done.  I was called back to have more films taken on one side and I have to return in six months to be checked again.  The radiologist is saying that this area is "probably benign".  There is no history of breast cancer in my family.  I am worried that taking Premarin has caused this "area" to appear and I am concerned about continuing with the estrogen.  My doctor doesn't seem to think I should worry about it and continue taking the Premarin. I am worried that I am increasing my "risks" if I continue the Premarin.  I would appreciate any thoughts on this.  
jms0565
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Dear jms0565:  There was a large trial done by the National Institute of Health that was stopped early.  In this trial, hormone replacement therapy (using both estrogen and progesterone) was found to increase the risk for developing breast cancer.  The second part of the study looked at women who had no uterus taking estrogen alone.  This trial did not identify an increase in the risk of breast cancer with estrogen alone.  I have attached the findings for your review below.  Of course, there are clearly risks and benefits to all therapy and these should be discussed with your physician as they specifically apply to you.
The following findings show disease risks of estrogen-alone use compared to placebo. The number of cases given represent an average for every 10,000 women each year:
* Fatal and non-fatal strokes. Increased risk--12 cases more (44 cases in those on estrogen alone and 32 in those on placebo).
* Venous thrombosis (blood clot, usually in one of the deep veins of the legs). Increased risk--6 cases more (21 cases in those on estrogen alone and 15 in those on placebo).
* Coronary heart disease. No significant difference in risk (neither increased nor decreased)--5 fewer cases (49 cases in those on estrogen alone and 54 in those on placebo).
* Colorectal or total cancer. No significant differences in risk (neither increased nor decreased)--1 more case for colorectal cancer and 7 fewer cases for total cancer (for colorectal cancer, 17 cases in those on estrogen alone and 16 in those on placebo; for total cancer, 103 cases in those on estrogen alone and 110 in those on placebo).
* All deaths or those for a specific cause. No significant difference in risk (neither increased nor decreased)--3 more deaths (for all deaths, 81 in those on estrogen alone and 78 in those on placebo).
* Breast cancer. Uncertain effect--7 fewer cases (26 cases in those on estrogen alone and 33 in those on placebo). This finding was not significant.
* Bone fractures. Increased benefit--6 fewer hip fractures (11 cases in those on estrogen alone and 17 cases in those on placebo).
The results did not differ by race or ethnicity, or body mass index (BMI).
A separate report will be published in the near future about the effect of estrogen alone on dementia and cognitive function. That report will contain information on women age 65 and older who participated in the estrogen-alone, an ancillary study of the WHI hormone trials. In 2003, WHIMS reported an increased risk of dementia in women taking estrogen plus progestin who were aged 65 and older.
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