Paul Lynn, MD
The Pacific Sun had a cover article in their June 3rd, 2010 edition discussing a research study, which has answered the questions of why women get breast cancer in such high numbers in Marin County, California.
A good article overall. We have copies at the clinic, if you call and ask. The article points out the “culprit” leading to the increased breast cancer risk is much less mysterious then was previously thought. The information in the article by Epidemiologist Rachael Erenma, MD, seems to have fully answered the question why breast cancer has a higher incidence in all areas where the more health conscious women live in the USA. Marin County is one of the most obvious examples of such areas.
The key point Dr. Erenma was able to show was that women in Marin began using post-menopausal hormonal therapy at a much higher rate and sooner than other population groups in the USA when the apparent health benefits of HRT became better known. Unfortunately, for reasons described later, this also meant they were using a compound called Provera for a longer period of time and at higher rates than other population groups. Provera was [and still is] a widely prescribed substitute for natural progesterone. Provera is a synthetic compound created from the molecule of bioidentical progesterone. Because it is derived from progesterone, it was presumed in many circles to be safe. However, even though it was created from the progesterone molecule, the Provera molecule is not bioidentical since it is not found anywhere in the human body. It is also truly synthetic since it is not found anywhere in the plant or animal kingdom. Dr Erenma was able to show that the incidence of breast cancer in Marin began to increase alarmingly with the use of HRT. The HRT being used required the use of Provera. The breast cancer increased incidence was widely reported in the press. Hormone replacement therapy was suspected. Most doctors and consumer groups felt estrogen was the culprit. Little if any suspicion was directed towards Provera.
As the article indicates, this rise in breast cancer rates suddenly reversed when the results of the Women’s Health Initiative were announced. The Women’s Health Initiative (WHI) is the name given to a large well done scientific study investigating whether or not HRT was indeed the cause of the general increase in breast cancer rates throughout the USA. The incidence of breast cancer it is important to remember was rising in all areas of the US. The study was funded and completed through the NIH [National Institutes of Health]. This is the best case available now for objectivity. In other words, to have a study which can avoid the influence of the industry producing and selling the meds being investigated. By the way, getting an objective study done and the results reported objectively is no means is this an easy task in today’s world of pharmaceutical hyper profits and lobbyists.
The WHI study found not only breast cancer, but heart disease, and vascular blood clots were increased in the women being followed in the study, all of them were taking different forms of HRT or a placebo.
The rate of increased incidence of these diseases was both alarming and unexpected. The researchers correctly stopped the entire study. They could not know without analysis which forms of HRT was causing disease. This result was reported with great media fanfare, with front page articles in newspapers across the country. All forms of HRT were labeled as dangerous. A ban on all forms of HRT therapy was discussed. As before it was assumed that estrogen was the problem. Relatively little concern was directed towards Provera.
After the study was stopped, the data continued to be analyzed for 2 years. Here is where science, culture and economics get blended together. The data, once carefully analyzed, found the increased risk of breast cancer, and heart disease could be identified with absolute certainly. The risks while large were very unevenly distributed among the participants in the study. It was only in the group using Provera that the dramatic risks were found. Estrogen did not cause significant risks. These results were also announced, but with much less fanfare. The risks to those women not on Provera were found to be inconclusive or absent. Only in the women who were taking this patented progestin [synthetic progesterone], called Provera were the statistically significant and truly alarming levels of risks found.
Where and why did Provera enter the therapeutic picture for post-menopausal HRT in the first place? Natural Progesterone was already available without even a prescription. Provera was introduced to doctors and then patients as a less expensive more scientific version of natural progesterone. Because Provera was patentable and completely synthetic, it could be produced inexpensively. The profit margin allowed this compound to then aggressively and profitably market to doctors as a better ‘progesterone’.
Starting to get the picture?
Educated women such as those living in the bay area and other similar areas wanted to participate in the health benefits being reported from the use of natural progesterone after the menopause. Pioneering physicians such as Katerina Dalton MD of the UK and John Lee MD here in Marin took great risks to their personal careers and livelihoods to write books and speak out on the benefits of natural progesterone. But through the magic of marketing, made possible by the profits form the sales of Provera, the words progesterone and Provera became interchangeable in the physicians usage. Very few physicians had worked with something like progesterone which was not available at the time in other than a non-prescription cream form. Thus they welcomed the familiar form of a pill sold through prescription pharmacies. Provera was soon substituted in place of progesterone in the minds of doctors, medical writers in newspapers and the medical consumers to the extent that the words progestin, Provera, and progesterone were used interchangeably even though the compounds have totally different histories. To this day all of these are still often referred to as progesterone in newspapers and even medical reports.
Progestin is the general word for all synthetic progesterones. No study has ever shown these compounds to be safe! Non bio-identical progesterone substitutes, of which Provera is the best known, has been shown to be the cancer producer in every serious study I know of to this date.
Yet Provera is still on the market and being prescribed. Why? Sometimes the behavior of a culture is so ingrained that it can not create reasonably expected responses to new actual dangers not known originally. Strange but true. Witness smoking 50 years ago and now… Cigarettes kill people. Cigarettes are still readily available,
Pharmaceutical reps would come to doctors offices and extol, the benefits and superiority of Provera over progesterone. It was so easy to be administered as a pill. And by the way, doctor, remember it is almost the same molecule as progesterone and comes from progesterone. It is “less messy, more patient compliance”, covered by insurance etc. Oh, also, here are lots of free samples for your patients. Doctors love to give out free samples. I can say from experience. It becomes a ‘feel good’ time between you and your patient at the end of a visit. Reps and the pharmaceutical companies know this psychological quirk well. Can you imagine a health food store owner coming in and giving doctors free samples of progesterone to pass out to their patients? Oh also, here are pens, pads, and come to a free dinner with your wife at Colibri. You can get your free continuing medical education credits required by the state, while dining for free and listening to an entertaining speaker; further extol the benefits of Provera. Note the frequency of the word free.
In summary, Dr. Rachael Erenma’s research group has unraveled the Marin Breast cancer mystery… Women living in Marin began using bio-identical hormone replacement plus Provera at a higher percentage of the population than the rest of the country. Their rates of breast cancer rose alarmingly. After the 2002 announcement from the WHI, Marin women stopped HRT and thus also Provera. Since that time, the incidence of breast cancer in women in Marin has been dropping to levels consistent with other population groups. Thus the women living in Marin initially choose at a high percentage rate to take HRT with Provera. This lead to the increase in breast cancer. When they stopped using HRT/Provera, the incidence dropped. The WHI study 6 years ago identified Provera as the problem. Case closed.
Provera, a proven cause of killer cancers is still available by prescription. It is produced and marketed worldwide by the largest pharmaceutical company in the world. Their sales of Provera has dropped from 2.0 billion dollars to 1.1 billion dollars per year since 2004, but now holding steady and stabilizing. There still are lots of profits available to pay publicists to keep confusing articles flowing which mask the difference between natural safe progesterone and a killer cheap synthetic derivative. Lobbyists are hired to keep the FDA ‘under control’. Lawyers can be paid $500/hour to neutralize lawsuits. No attempt has been made to refute the WHI study directly because it simply cannot be refuted. Provera causes breast cancer. But under the present medical safeguard systems, it can be and is still being recommended. It is a high volume selling component of HRT programs. It is still covered by insurance. Natural progesterone is still not. What are the real human costs of those free samples, pens, papers, and dinners and insurance coverage?
In spite of the above we can be thankful and grateful. The efforts of the pioneer doctors who first took risks to first inform people, the researchers at the NIH in 2004, and now Rachael Erenma’s group, have provided a way that we now have to directly reduce breast cancer and heart disease among women and still benefit from BHRT. We can all help those we know. Spread the word.
With best wishes for your abundance in health,
Paul Lynn, M.D., San Francisco Preventive Medical Group – sfpmg.com