Hormone Replacement Therapy and Breast Cancer Risk

The views concerning an increased risk of breast cancer with hormone replacement therapy (HRT) have changed, over the years.  Just recently, the recommendations were that HRT, when given at as low a dose as possible, for as sort a time as possible, is safe.  A new publication in the Journal of the American Medical Association (JAMA) may change a few minds.

Professor Jean Wactawski-Wende was a co-author of the report in 2003 that reported estrogen plus progestin increased the risk of heart disease, stroke, and invasive breast cancer.  This was based on data from the Women’s Health Initiative (WHI) study, which included 40 clinical centers across the USA.  Now the same investigators have followed up the original subjects for an average of 11 years, through August 2009.  This extension is the subject of the new report in JAMA.

There were 12,788 surviving postmenopausal women in this analysis - 83% of the original participants.  The use of estrogen-plus-progestin was associated with more invasive breast cancers compared with placebo, and, more often had spread to the lymph nodes.  There were also more deaths attributed to breast cancer in the women taking HRT- 2.6 per 10,000 vs. 1.3 per 10,000 women.  Deaths from all causes were also more common in women who had used HRT – 5.3 per 10,000 vs. 3.4 per 10,000 women. 

This study should emphasize the risk associated with the use of estrogen-plus-progestin therapy, no matter how low the dose or how low the treatment duration.  Far better to seek alternative treatments for menopausal symptomatology;  there are, indeed, plenty of alternatives.