HRT and breast cancer
Last month researchers at the University of Texas M.D. Anderson Cancer Center announced that the incidence of breast cancer in the United States had dropped by just over 7% in 2003. This drop came after the WHI brought out a report showing an increase in the risks for breast cancer and stroke for women taking combined estrogen/progesterone hormone replacement therapy. This has added more fuel to the debate on HRT.
Two articles (here and here) discussed the results of the study and the impact it may have on women already on HRT and those who may be thinking of starting it. Some specialists ask if the the decline in the incidence of breast cancer is actually due to women coming off HRT.
“This is exciting news about the incidence going down, but I think it’s very confusing as to whether or not it’s related to hormone use,”
said Dr. William Rayburn, an associate professor of obstetrics and gynecology at Texas A&M Health Science Center College of Medicine. “This has simply muddied the water more.”
Similarly, the International Menopause Society (IMS) called on experts and the public “to be very cautious when interpreting the new data on trends in breast cancer incidence in the United States” and said that hormone therapy “has a very minor potential for harm, but may carry substantial benefits.”
Out of about 2 million women starting menopause every year in the United States, about 1/4 may have moderate to severe symptoms. Women should consider the following:
- Do I have a family history or do I otherwise have a higher than average risk of developing heart disease, blood clots or breast cancer?
- Are my symptoms disrupting my life substantially?
There may not be a dramatic increase in the number of women coming off HRT because so many went off it after the WHI report on HRT risks. It is likely that most of the women on HRT today have very severe symptoms and as such are willing to accept a certain level of risk to obtain relief from their symptoms. For women who are contemplating conventional hormone replacement therapy
- Take the lowest dose for the shortest time — two or three years if possible. Start with low doses and add increase if your symptoms don’t subside.
- Don’t take hormones to try to prevent heart disease.
- Never take estrogen without progestin if you still have a uterus because that raises the risk of uterine cancer.
- Try to gradually reduce your dose and eventually wean yourself off.
