WEIGHING THE RISKS OF ESTROGEN

By Christine Gorman

For some women, choosing to undergo long-term hormone-replacement therapy is indeed a risky proposition. But that may not be true for all or even most women. Most evidence indicates that women can take hormones for a couple of years without increasing their breast-cancer risk. The picture is less clear, however, for women who use hormones for 10, 20 or more years. Their chance of developing breast cancer increases, but does that outweigh the benefit of avoiding heart disease?

The definitive answer won't be in for 10 years at least, but a report in last week's Journal of the American Medical Association should help women make informed decisions. Dr. Nananda Col and her colleagues at the New England Medical Center in Boston have developed a computer model that lets women plug in their own history and come up with a personal risk assessment. A questionnaire based on the model will appear this summer in Col's book, A Woman Doctor's Guide to Hormone Therapy: How to Choose What's Right for You, to be published by Tatnuck Bookseller Press.

Personal assessment is crucial because there is no average woman. "Individuals have individual risk factors," explains Col. High cholesterol, which increases the risk of heart disease, may have to be weighed against a mother who died of breast cancer. Col's model, based on data from hundreds of studies, helps rank all these factors. Among other things, it shows that women who at age 50 are already at highest risk of breast cancer and lowest risk of heart disease clearly do not benefit from HRT. Other women could extend their life expectancy from three months to three years. "We're not trying to dictate [women's choices]," Col says. "All we are trying to do is give them additional information with which to make their decisions."

--By Christine Gorman