Yogi Berra was said to have used the phrase ‘its deja vu, all over again’. Well, I feel the same. 15 or so years ago, two very large meta analyses were published that caused consternation in women and doctors. They suggested that the risks of HRT were greater than previously thought.
Over the years, sub analyses of these trials were performed, and these showed that for oestrogen only HRT, the risks were really very small prior to the age of sixty.
Well, another large meta-analysis has been performed and this tends to revert back to the original findings of earlier analyses.
First some background facts, hormone replacement therapy (HRT) is used to relieve symptoms of the menopause such as hot flushes and night sweats. It is not controversial to say, HRT should be used at the lowest dose for the shortest period of time needed to relieve symptoms. This is because it is accepted that HRT increases the chance of some cancers, blood clots and stroke.
The new study has indicated that women who use HRT for longer than 1 year have a higher risk of breast cancer than women who never use HRT. This risk falls after HRT is stopped but some increased risk remains for more than 10 years compared to women who have never used HRT. The increased risk of breast cancer is seen with all types of HRT, except for topical HRT applied directly into the vagina.
Your exact increase in risk will depend on what type of HRT you use and how long for.
In the UK about 1 in 16 women who NEVER use HRT are diagnosed with breast cancer between the ages of 50 and 69 years. This is equal to 63 cases of breast cancer per 1000 women.
Over the same period (ages 50–69 years), with 5 years of HRT use, the study estimated: about 5 extra cases of breast cancer per 1000 women using oestrogen-only HRT
about 14 extra cases of breast cancer per 1000 women using oestrogen combined with progestogen for part of each month (sequential HRT)
about 20 extra cases of breast cancer per 1000 women using oestrogen combined with daily progestogen HRT (continuous HRT).These risks are for 5 years of HRT use.
The numbers of extra cases of breast cancer above would approximately double if HRT was used for 10 years instead of 5.
It is OK to stop HRT at any time but stopping gradually can reduce the chance of menopause symptoms coming back.
All women should check their breast monthly for the signs of breast cancer, such as dimpling of the skin, changes in the nipple, or any lumps you can see or feel. This is best done after a period for those still menstruating. Breasts are less lumpy after the menopause and easier to examine. Always see a doctor if you notice any changes to your breasts. It is important for all women to go to breast cancer screening when invited. Invitations begin at the age of 50 in the UK, but you may not be called for three years if screening has been done recently in your area. You can call your local breast screening unit to arrange a mammogram if this is the case.
Topical HRT may not be an option for all women since it does not help with other menopause symptoms such as hot flushes or night sweats. The study found no evidence that this type of HRT increased the risk of breast cancer.
Other factors that increase risk of breast cancer include smoking, family history, alcohol use, and obesity. It needs to be borne in mind that the risk of breast cancer associated with obesity in much higher than the risk associated with HRT.
- 2% of breast cancer cases in the UK are caused by post-menopausal hormones.
- 8% of breast cancer cases in the UK are caused by overweight and obesity.
- 8% of breast cancer cases in the UK are caused by alcohol drinking.
- 5% of breast cancer cases in the UK are caused by not breastfeeding.
So before throwing away the HRT and suffering menopausal symptoms, ask yourself how you might otherwise reduce your risk.
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