Hormone Replacement Therapy (HRT) is treatment with female hormones (either oestrogen alone, or a combination of oestrogen and progesterone) after a natural or premature menopause. An independent panel of leading cancer clinicians brought together by cancer information charity Cancerbackup has written a report about the cancer risks involved for women taking HRT. Key points are:
- Evidence about the effect of HRT on the incidence of breast cancer is difficult to interpret.
- Two large recently published studies show that women over fifty taking HRT for more than one or two years have an increased risk of developing breast cancer
- But, more recent research has shown no increased risk in the short or medium term in women taking oestrogen-only HRT. However, long term use (more than 15 years) did significantly increase breast cancer risk.
- Results from a recent clinical trial support the theory that even short term use of HRT may increase risk of a recurrence in women with a history of breast cancer.
Recommendations are:
- For short term use of HRT, the benefits for peri and post-menopausal women (reduction of hot flushes and night sweats) outweigh the risks for many women.
- But, given the risk factors involved, HRT should not be used as the first choice of treatment to prevent osteoporosis in post-menopausal women. Instead, education about the possible benefit from lifestyle factors such as: stopping smoking; having an adequate intake of calcium and vitamin D; regular exercise and also non-hormonal approaches (such as bisphosphonates) may be more appropriate.
- Until the results of further clinical studies are available, HRT should not be used as first choice to treat menopausal symptoms in women with a history of breast cancer. Women with severe menopausal symptoms should discuss treatment options with their specialist.
- Women should be informed of the potential risks to help them make an informed decision about the use of HRT.
- Women should not change their HRT treatment without consulting their doctor and making a judgment based on their individual medical history.
- Women over the age of 50 should have regular breast screening whether they receive HRT or not.
This report discusses the types of HRT, the benefits and potential risks of HRT, breast screening and HRT, and HRT and endometrial and ovarian cancer. It also discusses the use of HRT in women with a history of breast cancer or who have a family history of breast cancer.