Shifting World Of Women's Health

It seems a day doesn't go by lately without news about hormones or mammograms.

At first, The Early Show's Dr. Emily Senay says, the issues seemed black and white. Women should get mammograms, perform breast self-exams and take whatever hormones are needed as a sure way to stay healthy. Few disputed these absolutes. Then, things started to unravel.

This past July, government researchers tracking the Women's Health Initiative — the largest, long-term study on women's health ever undertaken — found the risks associated with hormone use in post-menopausal women were greater than the benefits. They abruptly halted the trial.

Meetings were held, experts clashed and voices were raised. And women were caught in the crossfire. What was black and white now looked very gray. Despite the barrage of seemingly bad news about hormones, Barabara Klein made up her own mind and she was defiant.

"I have no intention of stopping it," says Klein. "I have reviewed the information. I'm awaiting more studies to come out."

But some women were turned off to hormones when the study showed that estogen plus progestin increased the risk of cardiovascular problems and breast cancer instead of helping to prevent them, as had been hoped.

A poll taken after the study was released found that 33 percent of women were either stopping or thinking about stopping hormone therapy because of the news.

"A lot of women have stopped hormones," says Michelle Warren, a menopause expert at Columbia Presbyterian Hospital. "And then a certain number aren't starting hormones when they really need it.

According to Warren, hormone therapy doesn't fit everyone the same way. Some hormones simply make some women feel physically better.

"A certain number are going back to taking hormones," says Warren. "They're very uncomfortable off their hormones. About 10 percent are going back."

They are going back because as the dust settles, more women and their doctors are beginning to understand that the risk of taking hormones, while real, are small.

Yes, women on hormones are more likely to get breast cancer, but for the individual, the risk is very small. That's a risk Barbara Klein is OK with.

"It works for me," says Klein. "I've never felt better. It's like a fountain of youth."

"Well, I think that doctors are going to look at risk factors, perhaps more carefully," says Warren. "And, what's changed is a long term treatment of women. Do I have patients who are continuing long term? Yes."

Warren says no other treatment works well against menopausal symptoms, but the medical community has to learn to give hormonal treatment safely.

Another Shade of Gray

Just as perplexing as the hormone upheaval was the mammogram blow-up. A complicated and controversial statistical study by Danish researchers claimed mammograms did not reduce breast cancer deaths. A nationwide uproar ensued. The sacred cow of mammography was in trouble.

"We all wish the mammograms worked more efficiently, but they're the best thing we've got," says Sharon Rappaport, a breast cancer survivor. "Because they're the best thing we've got, we need to use them until there's something better."

Rappaport credits a mammogram with finding a cancer that could have killed her.

"The tools that are there may not be perfect but they're good enough to save people's lives," says Rappaport. "I mean they saved my life."

Dr. Carolyn Runowicz of St. Lukes/Roosevelt Hospital in New York is not simply a cancer expert interested in the mammogram debate.

"I became an oncologist because I was interested in cancer, and I naively believed that I would never get cancer," says Runowicz. "My family history is negative, so I was sure between my dedication to my profession and my family history that I was somehow protected. Well, obviously I was wrong."

Runowicz developed breast cancer in 1992. She says she discovered it herself, but her mammogram was negative. She wrote a book about her experience to help other women facing cancer.

"I've seen both sides," says Runowicz. "I know as a doctor what it is to tell a patient that they have cancer, and I know as a patient what it's like to be told you have cancer."

Earlier this year, Runowicz testified before the senate on the thorny issue of the value of mammograms.

"The issue about mammography was not bad news," says Runowicz. "It was overblown, and when you actually evaluated the study that caused all of the hype, that study actually was very flawed. Mammography is still a very good thing for women."

Still, in some cases, mammograms can miss cancer and very often suggest cancer where none exists, leading invasive testing and anxiety for many women.

"I think it is very hard to deal with uncertainty," says Dr. Barron Lerner, author of "The Breast Cancer Wars."

"Twenty-five, 50 years ago, before we had techniques that were sophisticated, you could say, 'Well, mammograms are great and almost not have to prove it,'" says Lerner. "These days we're at the point where you've really got to back up what you say with good science."

Even the completely low-tech breast self-exam was subjected to scientific scrutiny. And it didn't hold up. It wasn't a surprise to Lerner.

"Breast self-exam has been something that there really has never been very good evidence for. That's something that cancer activists invented, in a sense, about 50 years ago, as something that could find smaller cancers," says Dr. Lerner. "If a woman examined her breasts, she would find smaller cancers that were more curable. We now know that women are probably finding cancers that have been there for many, many years."

So, what's really going on here? How is it possible that all of these tightly held beliefs can come undone in such a short space of time? Why does it seem issues that relate to women are disproportionately affected by the research flip-flop phenomenon?

The answer is simple. It is science. It is a revolution in women's health. A revolution where science is overturning untested habit. Many experts think women should embrace the change rather than reject it.

"What we really should be doing is cheering," says Dr. Susan Love, author of books on breast cancer and hormones. "Because what we're seeing is the result of finally having some scientific studies on women's health. I mean prior to that, there was no research on women's health. Even the rats were male."

Love says women can handle the new world of uncertainty.

"I don't think it's making women crazy," says Love. "You know, I think women are perfectly capable of making decisions based on inadequate information. We do it all day, every day. You just have to tell us that's what we're doing. And indeed, that's what's happening … I think one of the problems is, when we present medical data, we often present it as 'the truth' when in fact it's only our best guess at the moment."

"Well in the old days you went in and you got the pat on the head and the estrogen prescription and you walked out, life was simple because you had no choice," says Runowicz." And there are patients today that wish we could go back to those times. The new women that are coming up, these are women that want to know everything."

"Certainly, the more information out there, the easier it is for us to ascertain what direction we wish to follow," says Barbara Klein.

"The technology is changing so quickly it's a full time job, even being a patient, you can't assume that your doctor knows everything that's out there," says Sharon Rapport.

"This is the best time for women's health we've ever had," explains Love. "There's millions of dollars before spent, there's tons of studies going on. And we're finally going to be doing things based on science. And that really is something we all should be cheering about."

Original Air Date: 12/08/02