Janet asked if HRT use might have caused some breast cancers to grow more rapidly and therefore be detected sooner than eight years. This is unlikely. A number of studies find that breast cancers in women who were using HRT were not larger and were not dividing more rapidly than breast cancers in non hormone users. Since breast cancers grow more slowly in older women and average age in this study was 63, breast cancers in this group would tend to grow more slowly and so take even longer than eight year average to be detected.

Women in WHI study used a particular type of hormone Prempro. The results of this study therefore do not apply to other, newer approaches in which more natural hormones are used and a woman's menstrual cycle is more closely approximated.

Janet was surprised to learn that many studies find that women who use HRT do not have an increase in breast cancer risk compared to women who don't use hormones, even when hormones are used for twenty years. Also, in another large study in which some women were assigned to take Prempro and others not, women who used Prempro had no significant increase in breast cancer risk.

As Janet left, she said, "I can see now that when I hear about a study I need to know how big a risk is and not just that it is increased. I'll also ask how long a study it was. This discussion has given me a whole different perspective."

Understand and manage your cancer risk. Visit http://www.ptkelly.com and sign up for our free teleforum.

Patricia T. Kelly, Ph.D. is a medical geneticist who specializes in providing information about cancer risk to individuals and health professionals. She is affiliated with Saint Francis Memorial Hospital in San Francisco. Information about her book, Assess Your True Risk of Breast Cancer, can be found on her web site: http://www.ptkelly.com.

Lat Pull-downs Behind Neck:

No story to go with this one, but think about it. Eventually you'll be doing some heavy weight. In a very unnatural position. That is a recipe for injury. It's much more natural and safe to do same movement to front. Either way your lats are getting worked. But behind neck puts pressure on shoulders which isn't muscle group you are trying work.

This same philosophy goes for pull-ups. They should be done to front as well. If you do pull-downs, try doing it to front. Don't even think about behind neck as they won't do any more for you except possibly give your an excuse not to do any more pull-downs.

Marc