HRT & Breast Cancer | Understanding the risk
Hormone Replacement Therapy (HRT) is a common medication used to alleviate the symptoms of menopause.
HRT works by replacing the hormones oestrogen and progesterone that the body stops producing over several years as a woman begins her journey through menopause.
HRT was first introduced in the 1960s and gained popularity in the 1990s. In the 1990s when HRT began to gain a reputation for an association with breast cancer. This caused many women to be concerned about using HRT and its use was then placed under scrutiny. However, today, HRT remains the approved first-line standard of care.
· HRT is recommended to alleviate symptoms including vasomotor symptoms and genitourinary symptoms.
· HRT has been shown to prevent bone loss and fracture.
· HRT is also proven to assist with joint pain and help with mood, sexuality, sleep and quality of life.
The benefits of using hormone replacement therapy certainly outweigh the risk for most newly menopausal women, and it is the approved standard of care that should be made available to all symptomatic women at the time of the menopause. However, each woman should be assessed individually and offered an appropriate choice of treatment.
Why do patients think hormone therapy causes breast cancer?
In 2002 there was a study released called The Woman’s Health Initiative Study: 2002.
In this report, the relative risk of getting breast cancer was shown to be 28%. This was misreported as 28% of women develop breast cancer.
However, what this study actually showed was that normally 30 in 10,000 women develop breast cancer however if women take hormone replacement therapy 38 in 10,000 women develop breast cancer.
The attributable risk of breast cancer from hormone replacement therapy (the number of extra cases caused by hormone therapy) was 9 per 10,000 in excess cases.
The conclusions reported in the media were not scientifically sound, in addition, the increase in breast cancer from hormone therapy was not statistically significant when the study was properly analysed.
Due to the misreporting by journalists who did not understand the study, the use of hormone therapy reduced by 80%.
During this time 70% of women stopped treatment within a year and an entire generation of women missed out on hormone treatment.
What are the consequences of this?
Unfortunately, there were many women who died prematurely in the US between 2002 and 2012 as a result of the reduction in hormone therapy. This has been estimated to be between 18,000 and 100,000 women in the US where this was examined.
It was also reported that there was an increase of 55% of hip fractures in the group of women who stopped HRT.
Today, 20 years after the study, misconceptions around HRT remain. Many women still believe hormone therapy is dangerous and causes breast cancer.
Currently, there is an underestimation of common risks from not taking hormone replacement therapy while overestimating rare risks associated with taking hormone therapy.
The risk must be put in perspective and the risk varies by age. It is paramount that these risks are balanced against benefits.
Breast cancer is a rare risk from Hormone Replacement Therapy.
When taking hormone replacement, which hormones cause the risk?
Hormone Replacement Therapy consists of progesterone and oestrogen.
It is the progesterone element of the replacement therapy that increases the risk of breast cancer. The progesterone element is needed because it protects the womb.
The oestrogen element reduces the risk of breast cancer. However, it is not possible to take oestrogen on its own if the patient still has a womb. You need to take both oestrogen and progesterone.
Breast Cancer Risk: Other considerations
The risk of developing any cancer is related to several facts. Some of these are genetic and some are environmental.
1. Risk varies according to genetic facts such as:
· Race
· Breast density
2. Risk varies according to environmental factors, and these can be reduced by changes in lifestyle. It is thought that 34% of breast cancers can be modified or reduced by changes in lifestyle. The main risks which are proven risks are daily alcohol, lack of exercise and post-menopausal obesity.
Following the advice below will help reduce cancer risk:
Diet: limit fast foods and processed foods high in fat and starches
Eat whole grains, vegetables, fruit and beans
Exercise: be active
Weight: be a healthy weight
Alcohol: limit consumption.
Smoking: do not smoke
Sleep well
Limit caffeine
If you do decide to take hormone replacement and wish to reduce the risk the general principles are:
Staying lean
Eat smart
Keeping moving
Do not smoke
Reduce alcohol
What we now know.
The Scientific Journal of US has shown that it is the risk of breast cancer that has stopped women from taking hormone treatment. Following the publication of the study in 2002, negative and incorrect first impressions have been very hard to reverse leading to a reduction in quality of life for an entire generation of women.
Thankfully, this is now changing and it is possible to take HRT and modify other risk factors to protect against breast cancer.
The duration of the usage of hormone replacement needs to be individualised. It is no longer the lowest dose for the shortest time. It is now the appropriate dose for the appropriate patient for an appropriate period of time.
The main opportunity is before 60 years but hormone therapy can be started with medical advice at an older age.
It is no longer necessary to stop HRT after 5 years as we now know the duration of use needs to be individualised to each patient.
At Sloane Square Medical we have a special interest in menopause and offer expert clinical care and advice for women’s health care. If you are concerned about symptoms you may be experiencing, make an appointment with one of our highly experienced GPs by visiting our appointments page or calling the practice on 020 7730 8835.