HRT and breast cancer: here is what you should know

A large new study has found that the most common form of hormone replacement therapy (combined HRT) nearly triples the risk of breast cancer. This is perhaps a higher risk than was previously thought. It is incredibly useful, serving to give patients more information than they had before.

However, estimates of risk are useless without context. So here is the background.

Ever since the publication of the Women’s Health Initiative and Million Women Study, attention has been rightly paid to the potential risks of HRT, particularly regarding the risk of breast cancer in women. Before these publications, many were touting HRT as the panacea of all menopausal ills, relatively free of side effects and risks.

These studies suggested that in women taking ‘oestrogen-only’ HRT, the risk of breast cancer was not increased and indeed there appeared to be a slight protective effect. This kind of HRT is given to women who do not have uteruses.

In contrast, combined or ‘estrogen-progestogen’ HRT was found to increase the risk of breast cancer by a magnitude of eight additional cases per 10,000 women a year.

Subsequent studies have affirmed this relationship, with several noting a decrease in breast cancer cases following the widespread decline in patients taking HRT. (Though other studies have found no such relation.)

The latest study suggests that the risk of breast cancer remains elevated after both five and 15 years of combined HRT use. That is, the risk is roughly tripled. However, risk is unchanged with the use of oestrogen-only HRT.

Should women be worried by this? The risks must be put into perspective. According to Cancer UK, only three per cent of breast cancer cases in the UK are related to use of HRT. Meanwhile, nine per cent of breast cancer cases are linked to obesity, six per cent to excessive alcohol consumption and three per cent to physical inactivity. Funnily enough, while all are modifiable risk factors, media attention focuses on HRT and ignores the rest.

HRT has undoubted benefits, which include improved mood, sleep, abolition of troublesome night-sweats, a decrease in colon cancer risk for combined HRT, prevention of vulvovaginal atrophy (that is, the thinning, drying and inflammation of the vaginal walls) and thus painful sexual intercourse and repeated urinary tract infection, as well as reduced osteoporosis and fractures; started in healthy women within 10 years of menopause, oestrogen-only HRT has been shown to reduce cases of ischaemic heart disease.

There are other potential side effects, however, which differ depending on the kind of HRT being administered. You can click on the tables below to view these.

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The study that established these risk margins was performed, in most cases, one could argue, on a high-risk population for whom HRT should not have been started. Thus HRT was essentially the straw that broke the camel’s back.

Ultimately, risk must be put into context. For some women, the trade-off between benefits of HRT versus breast cancer risk can be made within a framework of improved attention to overall health; risk can be mitigated considerably if you lose excess weight, reduce alcohol consumption and do more physical activity.

For others, of course, the risk will be considered too high. Ultimately, though, there are many forms of HRT. Local forms (creams or vaginal tabs) as opposed to systemic (pills and patches) have never demonstrated complications in terms of cancer. These allow clinicians considerable flexibility in addressing the health needs of women and the risks involved.

  • Jeff

    Gated Communities

    Gated communities are taking on an important role in modern politics. Donald Trump grew up in a gated community, and made his fortune building gated communities that illegally exclude African-Americans. Trump’s approach is not based on ideology, but on consumer demand, and in particular, the demand of the working class to live in a place where there are no minority groups, criminals, wierdos or politically correct (Catholic educated) people.

    A gated community has a number of characteristics. There is ideally a six metre high concrete wall to keep out intruders. When the wall surrounds a very large number of houses, the average cost of the wall becomes insignificant. Getting past the security guards is like going through customs. Hence there is no crime in a gated community, and children can roam unsupervised in complete safety. Parents can be sure their daughters will not encounter males that would be unsuitable sons-in-law.

    Allotments are typically quarter-acre or five acres (one-tenth or two hectares). Houses are fireproof and of a similar appearance. Services are provided by underground ducts, including pneumatic mail delivery. Television and internet are unobtrusively censored.

    There is a shopping centre with a supermarket and other key shops. Prices are controlled to prevent gouging. There is a club for men and older boys from which women are excluded. On the top of the shopping centre is a hospital and old people’s home overlooking a race track and playing fields.

    There is a non-denomination church, which has leather sofas instead of pews, and wallpaper with pictures of saints like in an eastern orthodox church. The priest is a family man employed by the management committee. There is a co-educational school, so that if children conceive a passionate desire for a classmate, it will be someone of the opposite gender. The school has international baccalaureate and no homework.

    Once people move into a gated community, it occurs to them that, instead of their having to move into a gated community, it would be better if the “undesirables” were forced to live in ghettos, or were kicked out of the country altogether. No doubt this is what Donald Trump has in mind. The Conservative Party should take on board this trend in modern living and become the party for people who live or would like to live in gated communities. ed

  • FashionFan

    People who are concerned about animal cruelty should also know that drugs such as Premarin and Prempro are made from the urine of pregnant horses. The mares on these urine-collection farms are repeatedly impregnated and kept confined to stalls so small that they cannot turn around or take more than a single step. The animals must wear rubber urine-collection bags at all times, which causes chafing and lesions, and they are denied sufficient drinking water so that their urine will yield more concentrated estrogen. Some of the thousands of foals born on these farms each year are used to replace their exhausted mothers. Some are offered for adoption, but the remaining foals—along with worn-out mares—are sold at auction, where most are purchased by buyers for slaughterhouses.

    • Kate Mathews

      This is absolute bald faced lying. I’ll bet you don’t have one shred of evidence to support this nonsense.