BY KATHERINE HOBSON
usnews.com

Here's the line on hormones and cancer: Estrogen increases the risk of uterine cancer–except when it's combined with progestin. That combination, however, has other problems: It can increase the risk of breast cancer. Yet it cuts the risk of colorectal cancer. Confused? You're not alone.

Individual answers. To find that clear path, doctors say, women and their physicians need to look at individual situations. "We need to try to understand these risks and benefits as they pertain to you," says Therese Bevers, medical director of the cancer prevention and prevention outreach programs at the University of Texas M. D. Anderson Cancer Center. Bevers first takes a family history, which may involve referring a patient to a genetic counselor. She does a risk assessment using a model that estimates the chance of getting breast cancer based on age and other predictors such as age at first menstruation and first live birth, number of breast biopsies, presence of precancerous tissue, and the number of immediate family members with breast cancer. To this, Bevers adds the additional risk of hormones as predicted by the WHI study. "I try to tell them using numbers," she says. One woman may see her predicted risk rise from 20 percent to 25 percent if she takes hormones; another may see it jump from 50 percent to 65 percent. Both need to weigh the additional risk against the severity of the symptoms.

The balancing act means that even breast cancer survivors may opt to take combined hormones for a couple of years, since the WHI study showed breast cancer risk didn't begin to climb until women had been taking the drugs for three years. Mercedes Castiel, head of gynecology at Memorial Sloan-Kettering Cancer Center, says that for some patients, symptoms like hot flashes and mood swings are so severe that they are willing to bear the extra risk. "It's not my first choice for a breast cancer survivor," she says. "But quality of life is unquantifiable."

Castiel doesn't monitor those women any more closely than she does her other patients. Bevers may see high-risk patients twice a year instead of once for manual exams. Both say that more than one mammogram a year isn't necessary. And both push the lifestyle recommendations–exercise, weight control, no smoking–for cancer risk reduction.

For women taking estrogen alone, the choices won't get any easier. Castiel suspects the not-yet-completed estrogen arm of the WHI will show an increase in the risk of breast cancer, though perhaps a little less than the rise from combination therapy. The bottom line on hormones and cancer, she says: "Nothing is without side effects."

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