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HRT increases risk of breast cancer
Title:Effect of hormone replacement therapy on breast cancer risk: estrogen versus estrogen plus progestin
Author: R. Ross, et al.
Address: Los Angeles, California
Source: Journal of the National Cancer Institute 92: 328-332 (February) 2000
Summary: Researchers studied 1,897 postmenopausal women with breast cancer and 1,637 postmenopausal control subjects in this population-based, case-control study to determine whether combination hormone replacement therapy (HRT) influences the risk of developing breast cancer. HRT was used by just over half of the breast cancer patients and control subjects. Among those who used combination therapy, 50% more used sequential therapy (estrogen and progestin given sequentially during the month) than continuous therapy (estrogen-progestin in combination each day). Estrogen replacement alone, no progesterone, increased the risk of breast cancer only in women who took estrogen for 15 years or more. Five years of combination therapy increased the risk of breast cancer by 24%, four times as much as ERT. The excess risk of ERT was limited to in situ disease, while the risk associated with combination HRT was comparable for all pathologic stages of breast cancer. However, researchers pointed out that estrogen substantially reduces the risk of cardiovascular disease, lowers the risk of osteoporosis, and provides other benefits in the form of better cognition and an improved sense of well-being. Giving progestins to women who no longer have a uterus is not recommended because of the added breast cancer risk. But for those who still have a uterus, progestin reduces their risk of endometrial cancer, which serves to complicate the issue.
Comment: A lot of hype about 2 recent studies reporting an increase in breast cancer risk with HRT. The American College of Obstetrics and Gynecology has issued a press release starting that the studies should not change our present prescribing methods. It is still believed that the benefit significantly exceeds the risk for most women.