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Sept. 5, 2002 – "Ask the CIS," a locally produced Cancer Information Service health column, features questions and answers in this issue about the pros and cons of using Hormone Replacement Therapy, ideas for adding more fruits and vegetables to your diet, wellness plans after cancer treatment, and ovarian cancer.
Does hormone replacement therapy cause cancer?
Two landmark studies reported recently that women who use hormone replacement therapy (HRT) are at greater risk for some cancers. In one study, National Cancer Institute (NCI) researchers found that women who used estrogen-only HRT for 10 years or more after menopause were more likely to develop ovarian cancer than menopausal women who did not use estrogen. The risk increased along with the number of years the estrogen-only HRT was used.
The findings came a week after a National Heart, Lung, and Blood Institute study reported that combined estrogen-progestin HRT in menopausal women increased the risk for breast cancer, heart disease, strokes, and deadly blood clots. The researchers stopped the study early because they believed the risks of the HRT outweighed the benefits. Progestin is a laboratory-made version of progesterone.
Progesterone and estrogen are natural hormones produced by the ovaries. At menopause, these hormones decrease significantly. This drop can cause hot flashes, vaginal dryness, and other discomforts. Usually women go through menopause between ages 45 and 55 or after a hysterectomy (surgery to remove the uterus and ovaries). HRT effectively relieves many symptoms of menopause.
Previous studies of HRT have shown other benefits as well, such as reduced risks for colon cancer, heart disease, and osteoporosis (weakening of the bones). In previous studies, estrogen-alone HRT has been linked to an increased risk for endometrial cancer. The combined HRT has been shown to reduce this risk. For this reason, doctors currently prescribe estrogen-progestin HRT for most women who have not had a hysterectomy. Today, 20 to 45 percent of U.S. women between ages 50 and 75 take some form of HRT.
Whether to use HRT is a complex decision. Women should talk with their doctor about the risks and benefits before deciding if HRT is right for them.
I want to eat more fruits and vegetables. How can I fit them into my routine?
Congratulations on deciding to eat more fruits and vegetables. Much research in the last few years has shown that what people eat has a lot of do with how healthy they are. Eating a diet that is low in fat and high in fiber, with plenty of fruits and vegetables, also may help to lower your cancer risk.
The National Cancer Institute (NCI) recommends that people eat at least five servings of fruits and vegetables every day. Here are some ways to do this:
— Buy many kinds of fruits and vegetables when you shop. Eat the ones that spoil easily (peaches, asparagus) first. Save hardier fruits and vegetables (apples, squash, carrots) for later in the week.
— When you are in a hurry, buy cut-up vegetables at the salad bar in your grocery store.
— Keep a fruit bowl, small packs of applesauce, raisins, or other dried fruit handy at home and in the office.
— Pack a piece of fruit or some cut-up vegetables in your briefcase or backpack. Carry moist towelettes for easy cleanup.
— At breakfast, drink 100 percent fruit juice or have fruit on cereal.
— Add a low-fat salad to your lunch.
— Add extra vegetables, such as grated carrots or zucchini, when you prepare soups, sauces, and casseroles.
— Have fruit for dessert. Buy frozen fruit in the winter.
For free NCI brochures on healthy eating, call the Cancer Information Service at 1-800-4-CANCER.
My cancer treatment is over and was successful. What can I do to reduce the chance of my cancer returning?
The period following your cancer treatment is an ideal time to take a close look at your lifestyle choices. A healthy lifestyle will not guarantee that your cancer will not come back. However, it can help you feel better, and it may lower your chances of developing other health problems. Ask your doctor or another health professional to help you develop a wellness plan to improve your physical, emotional, social, and spiritual health. Here are some things to consider:
— If you smoke, quit. Tobacco use is a major cause of many cancers and other diseases.
— Cut down on alcohol. Drinking alcohol can increase your chances of developing certain cancers.
— Include a variety of wholesome foods in your diet. Eat five or more servings of fruits and vegetables every day. Choose whole grains instead of refined grains. Limit refined sugars and red meats (especially processed meats), as well as fat in your diet. Maintain a healthy weight throughout your life.
— Do 30 minutes of moderate exercise (walking, biking, swimming) every day to reduce anxiety, improve mood, and relieve fatigue, and muscle tension. You can begin with 10 minutes and increase your time as you get stronger. But be sure to talk with your doctor before you begin any exercise program.
For one-on-one assistance with quitting tobacco and for National Cancer Institute booklets on nutrition, call the Cancer Information Service at 1-800-4-CANCER. The CIS also can send you "Facing Forward: Life After Cancer
Treatment," a comprehensive guide to issues facing survivors. All resources are free.

What causes ovarian cancer?
The exact causes of ovarian cancer are not known. However, studies show that the following factors may increase the chance of developing this disease:
— Age. Most ovarian cancers develop in women over age 50, with the highest risk in women over age 60.
— Family history. First-degree relatives (mother, daughters, and sisters) of a woman with ovarian cancer are at increased risk of developing the disease. The risk is especially high if two or more first-degree relatives have had it. A family history of breast or colon cancer is also associated with an increased risk for ovarian cancer.
— Personal history. Women who have had breast or colon cancer may have a greater chance of developing ovarian cancer than women who have not had these diseases.
— Childbearing. Women who have never had children are more likely to develop ovarian cancer. The more children a woman has had, the less likely she is to develop the disease.
— Hormone replacement therapy (HRT). Some studies suggest that women who use HRT after menopause may have a slightly increase risk of ovarian cancer.
— Fertility drugs. Researchers are studying a possible link between fertility drugs (drugs that cause a woman to ovulate) and an increased risk for ovarian cancer.
— Talc. Some studies suggest that women who have used talc in the genital area for many years may be at a higher risk for ovarian cancer.
Scientists are studying ways to find ovarian cancer early, when the chances of recovery are best. For more information about this research, call the Cancer Information Service at 1-800-4-CANCER.
Cancer Information Service:
1-800-4-CANCER (1-800-422-6237)
Internet: http://www.cancer.gov
The hours of operation are from 9 a.m. to 4:30 p.m., Monday thru Friday. All calls are confidential and free of charge. Organizations interested in cancer awareness and promotion/ education may contact Carthy Thomas, Partnership Program Coordinator at 774-9000 ext. 4707
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