Ms X : I hear that
taking these pills may cause me to have a heart attack, a stroke, a blood
clot in my lung and after 4 years will increase my risk of breast cancer.
Is that right, doctor?
Dr. Y: Well it's possible
that this drug might increase your risk for those things, but you are not
at high risk for them in the first place so don't worry about it.
Just keep taking them.
Ms X: But doctor, from what
I can tell, there's no way of knowing ahead of time which women are at
risk for these problems. Is that true?
Dr. Y: Well, yes, but your
risk is low.
Ms X: Why do you say that?
Dr. Y: Well you haven't had
any problems like that yet, and it's been six months....
Ms X: So the danger period
for blood clots and strokes and heart attacks is past? If I haven't
already had them I probably won't?
Dr. Y: Well not exactly.
Your increased risk for stroke doesn't begin until you've been taking them
for one year, and your risk for heart attack is highest in the second year
and your risk for blood clots is 4 times as high as in someone not taking
these pills for the first two years. The good news is that after
two years your risk of blood clots is only double normal, and your increase
in risk of heart attack and stroke aren't as high after two years although
they're still higher than they would be if you didn't take the pills.
But if you take them for three years you'll still be more likely to have
a stroke or heart attack or blood clot, but you will be at lower risk for
a hip fracture or colon cancer. We think the colon cancer benefit
might be real but we aren't sure, and there weren't a lot of hip fractures
and they were all in women in their late 60's....
Ms X: And after 4 years I'll
be more likely to get breast cancer from the pills?
Dr. Y: Well, yes and the
risk gets higher every year after that.
Ms X: So let me see.
I'm putting myself at higher risk for blood clots, heart attacks, strokes
over the next year and a half, and after four I am increasing my risk for
breast cancer. I have this nuisance irregular vaginal bleeding, my
breasts hurt all the time and my ankles are so swollen I can't wear my
shoes by evening. On the plus side, I have only 2 hot flashes a day
instead of the 4 I used to have and I only wake up once a night sweating
instead of twice. I may be less likely to get colon cancer and I
may be less likely to break my hip if I'm taking it when I'm in my late
60's if I take it for three years. The pills and the doctor visits
and tests because of the pills are costing me more than $600 a year.
What will happen if I stop taking the pills now?
Dr. Y: Well, the hot flashes
and night sweats will probably come back. They may be worse than
before.
Ms X: What if I stop in 4
years? I mean I *really* don't want to increase my risk of breast
cancer.
Dr. Y: Well the hot flashes
and other problems will probably come back then too. That's what
happens for about 2/3 of women.
Ms X: You know doc, this
really looks like a no brainer to me. I get minimal benefit now and
quite a bit of discomfort, I might have a stroke or a heart attack or a
blood clot I wouldn't have had if I weren't taking the pills, and all I'm
doing is delaying the damn symptoms anyway? (voice rising dangerously)
Why the bloody hell didn't you tell me all this before I started taking
the things?
Dr. Y: (startled) but I didn't
know about some of it and I thought it wouldn't hurt you. The increased
risk is so small....
Ms X: I read that more than
25,000 women a year might have these problems if a few million all use
this drug. That doesn't look small to me. I hear that 100 more
women in the study had these problems. That's 100 out 8400?
I don't think that's small at all. I think it's pretty big.
Okay. I've decided. No more pills. Good Day Doctor.