By Kathy Abernethy
Peppy -Director of Menopause Services and Co –Lead of NHS Menopause Specialist Service, Harrow Immediate past Chair, British Menopause Society.
The publication in the Lancet this week of a review of other studies, indicates an increased risk of breast cancer with longer duration of use of hormone replacement therapy, especially with combined HRT and perhaps even with oestrogen only. This Is not a new study, not a prospective (forward looking) randomised controlled trial and not all the HRTs used are those used in modern types of HRT in the UK, e.g. there is little or no discussion about micronised progesterone (Utrogestan in UK) and only a small amount of data about dydrogesterone, the two types of progestogen which are thought to perhaps have a lesser adverse effect on breast and used widely by menopause specialists around the UK.
The link between long term use of HRT and breast cancer has been widely discussed for years and the 2015 NICE Guidance tells health care professionals that is should be discussed with women prior to starting HRT. If you are on combined HRT, you should have had this discussion and been given the opportunity to weigh up these small risks against the known benefits of improvement in symptoms, which for most women, is the reason they start HRT. Most women use HRT to get through a difficult time, with only a few staying on ten years or more.
What are the professionals saying?
The British Menopause Society, the lead professional group in the UK for menopause practice says that women “must be informed of the data on breast cancer risk with HRT to help them make an informed decision”, and point out that the study fails to consider other lifestyle factors such as alcohol intake and obesity, as well as the mortality of those diagnosed with breast cancer.
The International Menopause Society, a worldwide professional group, says “Much of the information regarding breast cancer risk and MHT (menopausal hormone therapy) reported in this paper is not new, although findings in relation to oestrogen-only therapy do differ from those reported in the Women’s Health Initiative randomised trial. It is important to note that, because of when the data included in this report was collected, most of the HRT regimens were different from those currently recommended.”
For women using HRT for premature ovarian insufficiency, the charity Daisy Network has provided this statement, highlighting “the study suggests that women who started HRT between the ages of 30-50 had an increased risk of breast cancer compared to postmenopausal women of the same age not using HRT. As most women age 30-50yrs are not postmenopausal – it would be more appropriate to compare the breast cancer incidence to age matched premenopausal controls.
Previous studies have suggested that women with POI or early menopause may have a 30% lower risk of breast cancer. By using HRT and replacing the hormones they are lacking, the risk of breast cancer returns to a level similar to if they hadn’t had an early or premature menopause.
If you are worried….
It is not surprising that women using HRT may be concerned. Women on HRT should continue as usual, attend regular mammograms, and be breast aware, just like any other woman There is no urgent need to stop HRT and the disadvantages of doing so might outweigh potential benefit for many women. Make a routine appointment with whoever prescribes your HRT and say you wish to discuss the new study, and in particular the personal risk to you, taking into account other risk factors such as alcohol use, obesity and family history.
Peppy menopause practitioners are also ready to discuss this with you, in a personal conversation at a time that suits you, take a look at www.peppy.health/menopause for details.
Peppy, in partnership with Henpicked