Patient Alert: Update on Hormone Replacement Therapy and the Breast
Hormone replacement therapy and the breast: We should worry about the
increase in the risk of breast cancer, by J M Dixon, consultant surgeon and
senior lecturer; British Medical Journal, December 15, 2001.
This editorial in the British Medical Journal summarizes some of the recent
studies on the effect of hormone replacement therapy on the breast. Here is
what those recent studies show:
· increasing numbers of women in their 50s and 60s are using hormone
replacement therapy to alleviate menopausal symptoms,
· the studies show that HRT given to perimenopausal women increases
breast pain, increases the frequency of benign cysts and fibroadenomas in
the breast, and results in the growth of some already established benign
· breast density increases in 17 to 73% of women who use hormone
replacement therapy depending on how breast density is assessed,
· combinations of estrogen and progestin increase breast density more
than estrogen alone,
· in a recent study of 103,770 women from Australia, the sensitivity
of mammographic screening in women aged 50-69 was 64% in those given
hormone replacement therapy compared with 80% in non-users,
· recent studies have reported significantly higher levels of risk of
breast cancer in women taking combined estrogen and progestin compared with
women taking estrogen alone,
· the annual increased risk of breast cancer varied from 4% to 9% for
combined preparations compared with 1% to 3.3% for estrogen alone,
· the excess risk at five years was higher, ranging from 25% to 40%
for estrogen and progestin combined compared with a range of 1% to 17% for
· most studies have found that breast cancers that develop in women
on hormone replacement therapy are smaller, less clinically advanced, have
a lower rate of node positivity, are better differentiated and are of more
favorable histological type than cancers that develop in women who do not
use hormone replacement therapy.
The author of this update suggests that it may be time to reassess the
value of hormone replacement therapy. She notes that one option that should
be considered is to deliver progestin directly to the uterus and combining
this with systemic estrogen, which should alleviate menopausal symptoms
while limiting the risk of breast cancer.
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