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Women's Health

03/05/02 12:00AM By Madeleine M. Kunin

What is a woman to do to protect herself against breast cancer?

Every few weeks there is another headline on mammograms or taking the hormone estrogen.

A few months ago, a Danish scientific team concluded that mammograms did not prolong the lives of women through early detection of breast cancer.

Last week, Tommy Thompson, the Secretary of Health and Human Services, issued new guidelines that strongly recommend mammograms. Not only did he urge women to stay the course, but to begin earlier, at age 40 instead of 50.

Two weeks ago, a headline in The New York Times read "New evidence of cancer risk in hormone therapy study."

Women who take hormone therapy for five years or more after menopause have a 60 to 85 percent increased risk of breast cancer. There is no benefit in preventing heart disease, as once had been thought, but estrogen is still recommended to prevent osteoporosis and hot flashes.

Whatever decision a woman makes, we know it's a critical decision; it may in fact be a life-and-death decision.

Who to believe, and who to trust?

"Ask your doctor" is the standard answer.

I discussed both treatments with my doctor. As anticipated, she continued to recommend mammograms. When in doubt, opt for the conservative approach, even if some tumors may not show up on a mammogram - and some that do show up may not be cancerous. The HHS recommendation is not based on a new study, but merely a review of existing literature. But unfortunately that is all we have to go on.

I listened to my doctor and promptly made an appointment for a mammogram.

Because there is no history of breast cancer in my family, I will continue to take estrogen, largely to strengthen my bones. My osteoporosis had improved in the last few years when I took estrogen, and I dare not risk reversing that course.

As I confront these vital decisions, I ask, Why doesn't the research give us a straight yes or no? Is it just women's health issues that prompt so many unanswered questions, or is this true for prostate cancer as well?

Why didn't the research start years ago? A rigorous nationwide study of hormone replacement is underway, but results will not be known until 2004 or 2005. Can we afford to wait?

It's only recently that women's health issues have caught the attention of federally funded research - one of the many positive side-effects of the women's movement.

We must keep the pressure on the research community to give us better answers. In the meantime, the burden is on every woman to weigh all her options and, in the end, to ask her doctor.

This is Madeleine Kunin in Burlington.

--Madeleine Kunin is a former Governor of Vermont.

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