Breast Cancer and Hormone Replacement Therapy
Many women who took a combination hormone replacement therapy drug—estrogen and progestin, e.g., Prempro, et. al.—ceased their medication back in July, 2002, when a major clinical trial showed that these HRT drugs seemed to be a breast cancer risk factor. Another study, released in December, 2006, reinforced that belief. And a further study printed Wednesday in the Journal of the American Medical Association reveals that, sadly, the breast cancer risk continues long after the cessation of HRT drugs.
Women were prescribed HRT beginning over a half-century ago, as doctors believed the estrogen/progestin combination not only slowed the symptoms of aging, but protected against cardiovascular disease, colorectal cancer, and bone fractures. At the height of their popularity, an estimated 15 million women were happily taking HRT. And did it help?
Well, yes… and no. HRT did indeed help women look better and feel healthier; it lowered their risk for colorectal cancer and bone fractures. It also quelled the hot flashes and other miserable side effects of menopause. But it actually increased a woman’s risk of heart attack, stroke, blood clots—and breast cancer.
The landmark Women’s Health Initiative study, which first established the HRT/breast cancer link, has continued following women after they ceased taking HRT. And the newest results show that, while the risks for cardiovascular problems did disappear quickly, the risk for breast cancer persisted. The breast cancer risk for women who took HRT for an average of 5.6 years, compared to women who took a placebo, was 27% higher. And surprisingly, the overall risk of cancer for these women, particularly lung cancer, was 24% higher than women who never took HRT. The cancer risk remains elevated for at least 2.4 years after the women in the study stopped taking HRT, and there’s no telling when (or if) that risk will ever decrease; the study continues.
So, what’s the takeaway message here? First, if you took HRT in the past—even for as short a period as 2-3 years–be vigilant about getting your yearly mammogram. And make sure your PCP knows you took hormone replacement therapy, so that (s)he can be super-cautious about checking for cancer during your annual physical. There’s no cause for panic; just be mindful. Dr. Gerardo Heiss of the University of North Carolina School of Public Health, one of the new study’s authors, noted that “There’s a reason to be vigilant. There’s no reason for alarm.”
Second, despite all the bad news, doctors advise women with severe menopausal symptoms to seek help through HRT. “The only reason to be on hormone therapy is for short-term symptom management,” noted Dr. May Hsieh Blanchard, an OB/GYN at the University of Maryland Medical Center. Added Hugh S. Taylor of the Yale University School of Medicine, “It’s [breast cancer] a fairly small risk, and when women hear about this, it plays to their fears. I think they are suffering needlessly because of an exaggerated risk.”
Bottom line: Don’t take HRT to prevent heart disease. Don’t take it to feel young again. But do consider taking it—at a minimal dose, for a short period of time—if menopause is making your life miserable. Life is often a roll of the dice; if you want to take the HRT chance, go for it.