Back in the news: the link between hormone replacement therapy (HRT) and breast cancer. This time, the connection is seemingly more conclusive than before, when some argued that many factors influence the risk of breast cancer, that HRT could not do the job all on its own.

Now, two separate studies offer up powerful evidence that HRT is linked to tumor growth. Case in point: when use of the therapy drops, so do incidences of breast cancer.

New figures in the New England Journal of Medicine suggest there have been 16,000 fewer cases of breast cancer nationwide since mid-2002, when women stopped taking their hormone pills following the federal Women's Health Initiative announcement connecting the therapy with increased risk of breast cancer, stroke, and heart attack.

Many did not want to believe HRT was to blame for so many breast cancer diagnoses. And maybe it's not the actual cause of the disease, but the fuel for tumors trying to grow.

These new findings do not appear to be a statistical fluke, says one doctor. Numbers have been computed and re-computed, and the message is clear: HRT is strongly implicated as the guilty party. There is just no other culprit, says a statistician at the National Cancer Institute.

Wyeth, maker of Premarin and Prempro -- two forms of hormone therapy -- continues to caution women against drawing any conclusions about HRT and breast cancer. There still may be broader explanation for the decline in cases, say their spokespeople.

I never would have predicted it -- that a tooth could become a tool for dispensing medication. But the refinement of such a creation is actually in the works and before long, you may be asking not for a gold or decorative tooth but for one capable of doling out your drugs in the exact doses and at the right times.

Think about this:

Researchers from Europe and Israel are working right now on a tiny dispensing system called IntelliDrug. Their goal is to create parts small enough they can fit into a false tooth placed in the back of the mouth. The device will release a specific amount of medication at certain intervals so patients receive the proper dosage right on schedule.

This invention, crafted by an Israeli dentist, could pick up the slack for people who forget to take medicine and could save lives for those whose lives depend on scheduled drug therapy. It could also allow for better absorption of medication into the body.

The IntelliDrug device will deliver medicine directly into the bloodstream through the lining of the cheek around the mouth. Saliva, meanwhile, mixes with the drug and carries it throughout they body in a manner more efficient than just swallowing a pill every few hours.

While researchers hope to one day turn their device into a replacement tooth, the apparatus -- consisting of a stainless steel housing, a pump, custom valves, a microprocessor, batteries, and a reservoir for the drug pill -- currently comes in the form of a block the size of two teeth. It is strapped to the the side of teeth and hugs the inside of the cheek. The unit can be removed, and a technician can refill the drug reservoir, clean the unit, and change batteries when necessary.

Clinical trials on pigs are ongoing. Human testing is expected to begin by the end of the year.

Award-winning jazz musician and former basketball star Wayman Tisdale revealed this week on his website that he has been diagnosed with cancer, that he will begin a six-month course of chemotherapy this week, and that his prognosis for recovery is excellent.

The 6-foot-9 former Oklahoma Sooners basketball great -- who played 12 seasons in the NBA with the Indiana Pacers, Sacramento Kings, and Phoenix Suns and helped score gold on the 1984 U.S. Olympic team -- reports that he broke his leg in a fall at his Los Angeles home last month.

After his fall, Tisdale's doctors determined a cyst in his right knee caused the injury. The cyst, identified as cancer, was then removed. Following chemotherapy, Tisdale, 42, will undergo knee-replacement surgery.

Tisdale has been told to hold off on his touring and public appearance schedules so can fully recover. But he plans to begin performing again in January 2008. In the meantime, he will focus on his new album with the working title Rebound.

Findings from an international study suggest that women with a waist size of more than 34 inches are more likely to develop cancer of the womb than women who boast slimmer waistlines.

The study, funded in part by the British charity Cancer Research UK, sized up 223,000 women worldwide and determined that women with a waistline less than 31 inches have half the risk of developing womb cancer than their heavier counterparts.

There has been a significant rise in cases of womb cancer in Britain. And the link between the disease and weight gain is most prevalent among postmenopausal women who have never used hormone replacement therapy or the birth control pill.

According to the National Sizing Survey conducted in 2004, the average British woman now has a 34-inch waist. This is more than six inches bigger than the average size of a woman in the 1950s, says Dr. Lesley Walker of Cancer Research UK.

"Women are larger than they were when they existed on a wartime diet and were generally more active and this is having serious consequences," Walker says.

More than 6,000 women in the UK are diagnosed with womb cancer each year. The disease kills about 1,000 annually.

Wyeth officials say their hormone replacement therapy Prempro is not the cause of one Ohio woman's breast cancer. But two jury decisions prove otherwise.

The first jury, in October, awarded Jennie Nelson and her husband $1.5 million in compensatory damages, validating Nelson's claim that her breast cancer -- resulting in a double mastectomy, chemotherapy, and radiation -- was caused by the Prempro she took for six years. When this verdict was thrown out due to a mistrial, a retrial began.

The retrial concluded yesterday -- with a Philadelphia jury awarding the Nelsons this time with $3 million.

"Both times this case has been heard on terms established by Wyeth and still the juries have clearly found that Prempro causes breast cancer," says Nelson's attorney Tobias Millrood, adding that Wyeth puts sales ahead of patient safety.

Wyeth respectfully disagrees and argues that it acted responsibly in the promotion of its hormone replacement products and in disclosing with doctors and patients all therapy-associated health risks.

Millions of women have used Wyeth's hormone replacement therapies to control the effects of menopause, and the company, sanctioned in January to pay $1 million to an Arkansas breast cancer survivor, now faces more than 5,000 lawsuits of this same nature.

Despite a large-scale study revealing drugs like Prempro increase the risk of breast cancer if used for five years or more, the drug still remains on the market. And Wyeth is so sure their drug is not at fault for causing Nelson's breast cancer that they plan to appeal yesterday's verdict.

An Arkansas woman claiming the hormone replacement drug Prempro caused her breast cancer just won her legal battle against Wyeth, the maker of the drug.

Mary Daniel was awarded $1 million in compensatory damages thanks to a Philadelphia jury decision stating Wyeth acted with malice or reckless disregard for selling Prempro -- the drug Daniels took for 16 months to relieve hot flashes. The next step for Daniels, whose husband will receive $500,000, is a hearing to consider punitive damages.

Wyeth's lawyer argues that Prempro -- a combination of estrogen and progestin -- is still prescribed to women and suggests Daniel's breast cancer was caused by other risk factors, such as family history of the disease.

2006 will forever be the year linking the decline in breast cancer cases to the decline in use of hormone replacement therapy (HRT). This was big news on the cancer front, and while some argue other forces helped drive the breast cancer drop, there is still much speculation that the use of HRT somehow increases the risk of developing the disease. Even so, it is predicted that Wyeth's sales of hormone replacement drugs will have reached more than $1 billion as of yesterday, the last day of 2006.

Even more interesting is the prediction by analysts that revenue from the pills -- used to treat symptoms of menopause -- will rise five percent annually for the next several years.

It seems the sales growth, despite the overall decline in the HRT market, is primarily due to increased demand from wholesalers and price increases too.

It's hard to tell what will happen to the world of HRT in the year 2007 -- will women embrace what is considered the best therapy around for menopausal issues? Will they abandon the controversial treatment altogether? Will they find variations of HRT that meet their needs while minimizing risk for disease? Only time will tell.

Dr. Len Lichtenfeld, MD, is the deputy chief medical officer for the American Cancer Society. He is also a blogger and authors his very own blog -- called Dr. Len's Cancer Blog.

Dr. Len writes on his blog about all sorts of topics related to cancer. He shares his opinion on the recent drop in breast cancer cases (December 15, 2006), he promotes the Great American Smokeout (November 14, 2006), he sounds off on lung cancer screenings (October 25, 2006), and he urges parents to always slather sunscreen on their children (October 5, 2006). He has so much more to say -- and his blog is a great stop for those wishing for more information on hot cancer topics.

As this year comes to a close, Dr. Len offers a review of what he believes were the hottest cancer topics of 2006.

Dr. Len reflects in his blog about decreased cancer death rates that represent real progress in the fight against cancer. He calls the HPV vaccine a breakthrough and he recaps the STAR trial -- a comparison of raloxifene to tamoxifen to reduce the risk of recurrent breast cancer in post-menopausal women -- with emphasis on how raloxifene proved just as effective as tamoxifen, but with a better safety profile. He calls new targeted therapies a dream -- with a hefty price tag -- sure to garner debate and discussion in 2007.

Dr. Len reviews the Surgeon General's report on second-hand smoke -- it's harmful to non-smokers, the report says -- and he marvels at the capability of science to approach an understanding of what makes a cancer cell a cancer cell. He also remarks on how remarkable it is that chronic myelogenous leukemia is in fact chronic and no longer fatal, thanks to the drug Gleevec.

Of course, there is ample attention given to the declining incidence of breast cancer, reportedly due to less women using hormone replacement therapy, and the risks weighing on those who are overweight and obese, and survivors and supporters who gathered for Celebration on the Hill -- the site of one incredible American Cancer Society event.

Dr. Len closes his review of 2006 with recognition of three celebrities who lost their lives this year to cancer -- Dana Reeve, Ann Richards, and Ed Bradley. And while he recognizes there are other lives and other stories that deserve mention, there is simply not enough time or space for him to do justice to every noteworthy item.

"What we have seen over the past year is an incredible leap forward in cancer research, diagnosis and treatment, and I suspect there are going to be even more exciting developments in the coming year," says Dr. Len who looks forward to 2007 -- a year that is sure to deliver more hope and more progress in the fight against cancer.

Smoking is not an easy habit to break, and of the many methods tried, only a handful seem to work. Of the methods that do seem to work -- nicotine-replacement products; bupropion drugs; counseling; classes; calling a helpline or talking to a health professional -- younger smokers between the ages of 16 and 24 years who smoke and try to quit only use one of the recommended methods of help by talking to a professional. Because of this, younger smokers are less likely to be successful in quitting, according to the US Centers for Disease Control and Prevention (CDC).

During the 2003 National Youth Smoking Cessation Survey, the CDC found that younger smokers most often tried to quit smoking by cutting back on the number of cigarettes they smoked each day; not buying cigarettes; exercising; using the buddy system and trying to quit with a friend; telling others they were quitting and changing to a lighter brand of cigarette, switching to chewing tobacco, snuff, or other tobacco products. None of these methods are recommended by the US Public Health Service.

According to the National Youth Smoking Cessation Survey, 77 percent of younger smokers have tried to quit at least once without success. Over a third have tried to quit smoking numerous times without success. Researchers suggest that many younger smokers may need help with other high-risk behaviors such as binge drinking; depression or ADD/ADHD.

If you are a younger smoker who is trying to quit, the CDC encourages you to call 1-800-QUIT-NOW or talk to your physician about methods that might lead to more success. The 2-page summary of the National Youth Smoking Cessation Survey is available as a pdf document.

Before 2002, hormone replacement therapy (HRT) was believed to prevent many conditions, and doctors routinely prescribed hormone pills. But when a 2002 study found HRT raises the risk of breast cancer, heart disease, and other problems, the use of hormones plummeted.

On Thursday, researchers reported that the rate of breast cancer cases in the United States dropped more than seven percent in 2003 -- the year after the landmark study that caused a backlash against hormones. This backlash is considered the leading cause for the now-reported decline in breast cancer cases.

Now, even more women are expected to abandon the pills. And doctors worry that women with severe menopausal symptoms -- who need the treatment -- will deny themselves the benefits hormones can offer.

There are ways to take advantage of the benefits, however, and still minimize the risks. One gynecology group shares the following suggestions.

• Take the lowest dose for the shortest time -- two or three years if possible. Start out small and add more medication if symptoms do not decrease.

• Do not take hormones to try to prevent heart disease -- because they do not prevent it.
  

• Never take estrogen without progestin if you still have a uterus. This raises the risk of uterine cancer.

• Try periodically to cut your dose and wean yourself off.

For those who don't definitively need hormone therapy, it's important to discontinue use. But some women truly do need the treatment and should not abruptly stop their therapy in light of news that is not definitive in itself. As always, consultation with a physician is the best first step.

Previous posts on the topic of HRT and breast cancer are as follows.

• Different perspective on drop in breast cancer cases
• HRT use drops breast cancer rates drop
• Hooray for HRT!?
• HRT and smoking dramatically increases breast cancer risk
• HRT increases breast cancer risks

There may be another explanation for the recently announced decline in breast cancer rates. And it's not nearly as promising as the first explanation may be.

A day after researchers announced that the significant drop in breast cancer cases is primarily due to fewer women using hormone replacement therapy (HRT), some experts suggest breast cancer rates are not dropping at all. Just as many women may have breast cancer, they say. They just aren't being screened for it.

"We have been aware for several years that the number of radiologists who specialize in mammography have been decreasing, and that there are places in the United States where women have difficulty getting access to mammography," Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, wrote on the society's blog just after the public announcement.

"If mammography use has reached a peak and is now decreasing, we may actually be diagnosing fewer cancers when they can be most effectively treated, Lichtenfeld said. "If you don't get a mammogram, you don't diagnose a cancer."

The research linking the decline in HRT to the drop in breast cancer came from the M.D. Anderson Cancer Center in Houston and was discussed at a breast cancer conference in San Antonio on Thursday. The research, based on a report by the National Cancer Institute, showed a seven percent drop in new breast cancer cases between July 2002 and August 2003, corresponding with the results of a 2002 Women's Health Initiative study.

With media reports citing HRT as the direct cause of the drop, some worry the public is getting the wrong message -- specifically women still taking hormones or those who have taken them in the past. While women not taking hormones are breathing a sigh of relief, others are in a panic.

Dr. Katherine Sherif, director of the Drexel Center for Women's Health at Drexel University College of Medicine in Philadelphia, has spoken already with 15 patients worried about this news.

"What I have told them is that three years is too short of a time to measure the effects of a drug on breast cancer," she said. "Cancers take decades to develop, and conversely, withdrawing hormones could not result in a decrease in breast cancer in three years -- it's actually absurdly short." There are also concerns women will experience anxiety about other therapies using estrogen, such as in vitro fertilization (IVF).

The study on HRT and breast cancer may be raising more questions than answers -- which could be a good thing. More questions prompt more investigation, more study, more research. And this will hopefully help us figure out one facet of the mystery of breast cancer.

Previous posts on the topic of HRT and breast cancer are as follows.

• HRT use drops breast cancer rates drop
• Hooray for HRT!?
• HRT and smoking dramatically increases breast cancer risk
• HRT increases breast cancer risks

If you have ever been diagnosed with breast cancer, it is quite likely that one of the first books, if not the only book, recommended to you was Dr. Susan Love's Breast Book. The New York Times rightly refers to her book as "the bible for women with breast cancer." Her second book, Dr. Susan Love's Menopause and Hormone Book, was one of the first to question the widespread use of postmenopausal hormones. Dr. Love is a genuinely trusted presence and clear voice in the world of women's breast health.

An eminent pioneer in the field of breast cancer for 30 years, and considered one of the founding mothers of the breast cancer advocacy movement, her mission, and the mission of the Dr. Susan Love Research Foundation, is to eradicate breast cancer within our lifetime and better the lives of women by generating resources and innovation for education, research, and advocacy on women's health issues.

Part of the recently redesigned Dr. Susan Love Research Foundation website is the addition of a blog. Dr. Love is blogging the San Antonio for the San Antonio Breast Cancer Symposium where she joins more than 8000 physicians, scientists, and breast cancer advocates in what is considered one of the most important conferences held each year regarding cancer.

On the first day, Dr. Love blogs both clinical and big picture highlights, including her take on two newsworthy study findings we posted here earlier today. The first concerns the common house mouse virus link to breast cancer and the second one regarding the dramatic decrease in breast cancer cases and the corresponding decrease in women using hormone replacement therapy (HRT).

Dr. Love posted, "There was a sudden dramatic (7 percent) decrease in breast cancer in 2003 corresponding with the equally dramatic decrease in women who stopped taking HRT after the WHI study found it appeared to do more harm than good. The study found 14,000 less breast cancers in one year! In my mind this is the final proof we need that taking hormonal therapy after menopause for the prevention of the diseases of aging makes no sense."

For a trusted analysis of the conference, you can find Dr. Love blogging the San Antonio Breast Cancer Symposium here.

Breast cancer statistics for 2003 are in, and researchers have announced that the number of breast cancer cases dropped by an impressive seven percent, with the greatest drop occurring in women between ages 50-69 diagnosed with estrogen receptor positive (ER-positive) breast cancer.

The University of Texas M. D. Anderson Cancer Center researchers attribute this good news to the fact that in the same time frame, millions of women stopped taking hormone replacement therapy (HRT) over concerns that HRT led to an increased risk for breast cancer.

If the statistics hold for upcoming years, HRT will have proven a greater causative effect leading to breast cancer than originally believed.

"Incidence of breast cancer had been increasing in the 20 or so years prior to July 2002, and this increase was over and above the known role of screening mammography," stated Donald Berry, Ph.D. "HRT had been proposed as a possible factor, although the magnitude of any HRT effect was not known. Now the possibility that the effect is much greater than originally thought all along is plausible, and that is a remarkable finding."

While the researchers best guesstimate is that HRT might be the contributing factor to the drop in ER-positive breast cancer cases for 2003, they cannot be 100 percent certain at this point. We will need to wait and see what the years 2004 and 2005 tell us about any continuing declines in breast cancer cases, and learn what other, if any, contributing factors are responsible for the decline.

Previous posts we have done regarding HRT and breast cancer:

• Hooray for HRT!?
• HRT and smoking dramatically increases breast cancer risk
• HRT increases breast cancer risks

For women with estrogen-driven breast cancer suffering the symptoms of menopause, being prescribed traditional hormone replacement therapy (HRT) is out of the question. The risks are simply too great in introducing any estrogen into the body. There are few alternatives and many women decide to suffer with hot flashes, flushes, night sweats and cold flashes, a clammy feeling, sporadic rapid heart beat, irritability, mood swings, sudden tears, insomnia, fatigue, feelings of anxiety, dread, apprehension, difficulty concentrating, disorientation, depression and mental confusion -- without any significant relief. One of the alternatives is personalized natural hormone replacement therapy that is individually mixed specific to each woman's needs.

According to Sydney Menopause Centre at Randwick's Royal Hospital for Women director Dr John Eden, who has diagnosed two women patients with uterine cancer, believes the cancer is linked to natural hormone replacement therapy. Australian doctors are warning women to think twice before taking handmade hormone compounds prepared by chemists, due to the danger that these preparations can lead to elevated hormone levels that could lead to excessive bleeding, increased risk of breast and uterine cancer and blood clots.

"Many women think they are getting a herbal treatment and are shocked to learn they are getting a hormone treatment," stated Dr Eden. Dr Helena Teede, research director at the Jean Hailes Foundation, also added that many women were unaware these preparations were not approved by the Therapeutic Goods Administration.

Britain's television and radio fitness guru Diana Moran recently shared her breast cancer experience in an interview with BBC News. Back in the 80's, Moran led a national campaign for health and fitness with a program called Get Britain Fit. She gained the nickname Green Goddess for her trademark green leotards. When she was diagnosed with breast cancer, she said it came as a complete surprise to her. She had never felt better. She had no symptoms that told her anything was wrong.

Because Moran, at 47, was entering menopause, she had gone to the doctor to see if she qualified for hormone replacement therapy (HRT). It was then she had a mammogram and breast cancer diagnosis followed. From disbelief, to fear, to anger, she searched for information but back then, no one talked about breast cancer and little information was available. Moran decided, as a high-profile personality, to keep her breast cancer diagnosis and double mastectomy private, and in retrospect she feels that was wrong. Five years after the cancer diagnosis, she found herself in counseling working through all the intense emotions she had buried in putting on a strong front and concealing all that she faced as a cancer survivor. Her message is to connect with others, be open, share what is going on.

Moran, now 66, is still going strong and is the published author of numerous fitness and beauty books focusing on women's issues, ageism, health, fitness and beauty; is a sought-after public speaker; and well-known celebrity with more than four decades of work in television and radio. She devotes a considerable amount of time to charities involving cancer, cerebral palsy and older people.